Why You Need A Dental Plan For Seniors
As you age, you may be at increased risk for certain dental conditions, according to the American Dental Association. Dental conditions associated with aging include dry mouth, dental caries and periodontitis, a serious gum infection. Physical and cognitive impairments may also make home oral health care difficult for seniors, exacerbating dental problems. You may wish to have a Medicare dental plan to avoid paying out-of-pocket for dental treatment.
Compare Medicare Advantage Dental Plans
Using Medicares Find a Medicare Plan tool, you can log in without an account, choose a Medicare Advantage Plan, type in your ZIP code, and follow the simple instructions to get a list of the available plans. The Plan Details button helps you learn more about the coverage offered, such as preventative dental or comprehensive dental .
Does Medicare Advantage Cover Dental Care
You may be able to get dental coverage under some Medicare Advantage plans.
Medicare Advantage plans can include extra benefits like routine dental, routine vision, and Medicare prescription drug coverage.
You can check out Medicare Advantage plans in your area by visiting ehealthmedicareplans.com.
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Dental Crisis In United States
Nearly half of Medicare beneficiaries have no dental insurance at all, and nearly half of all Medicare beneficiaries have not seen a dentist in the last year. Thats worrisome not just for oral health, but also for overall health. Theres a significant link between untreated dental disease and various other systemic ailments, including heart disease and diabetes.
Oral cancer is seven times more likely to be diagnosed in people over age 65, and routine dental check-ups are an excellent means of detecting oral cancer.
About one out of six Americans age 65 or older indicated that they hadnt seen a dentist in the past year due to cost barriers. And more than one in five Medicare beneficiaries have not seen a dentist in the last five years.
About 20% of Americans age 65+ have untreated dental cavities. And about 20% of Americans age 65 and older are missing all of their natural teeth, although there is significant variation in tooth retention based on geographic area, income, and education level seniors in rural areas are especially hard hit by a lack of access to oral health care.
There is no doubt that we have a dental crisis in the U.S. And although the ACA deemed dental coverage for children to be an essential health benefit, theres no requirement that adults have dental coverage, or that insurance carriers provide it .
Emergency Or Urgent Dental Care
Emergency or urgent care administered at a Kaiser-approved facility requires a small copay and all other applicable copayments, coinsurance or other plan charges apply. Such care delivered at a non-Kaiser facility requires a larger copayment, and plan members are responsible for all charges exceeding a certain limit.
The annual dental benefit maximum does not apply to emergency or urgent care, which includes care for pain relief, acute infection, hemorrhage or injury.
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Other Dental Insurance Options For Seniors
As mentioned, unless you enroll in a Medicare Advantage plan that includes routine dental coverage, youâll typically have to pay the full cost for routine dental care.
However, there are other ways to cover dental costs outside of whatâs covered by Medicare, including dental insurance and dental discount cards.
Please note that these types of dental coverage are not part of Medicare.
Dental Coverage With Medicare Advantage Plans
Medicare Advantage Plans , sometimes called Part C, combine Original Medicare Part A and Part B into one complete plan. These plans are offered through private insurance companies approved by the government Medicare program. These plans may also offer extra programs and services not covered by Original Medicare, such as dental coverage. Some plans may also include Part D prescription drug coverage and vision.
Medicare Advantage Plans work similarly to traditional health plans in cost and coverage. For example, there are HMOs, PPOs, POS plans, and more. They can include deductibles, copays, and coinsurance .
But not all Medicare Advantage Plans cover dental care. So before you sign up, make sure to read the details of what the plan covers. If you want Medicare dental coverage, then make sure the Medicare Advantage Plan you choose covers the dental care services that you need.
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Medicare Advantage Dental Coverage
Some Medicare Advantage plans include dental insurance, and others dont. Dental benefits vary from plan to plan. Some plans cover only standard services, while others cover a wider range of dental procedures.
The easiest way to know what your plan covers is to do research beforehand. Every Medicare Advantage plan offers an outline of coverage available on Medicare.gov. Here, you can see what benefits your plan offers and where those benefits are accepted. You should never go into Medicare Advantage blind. Knowledge is key when enrolling in a Medicare Advantage plan.
Does Medicare Cover Dental
The world of Medicare can be confusing in general. When it comes to Medicare dental coverage, it can be difficult to know what options are available to you.
If youre focused on oral care, then its important to know if Medicare covers dental. Take a look at the types of Medicare and how they may or may cover dental costs.
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Best Medicare Alternatives For Dental
Does Medicare cover dental? Unfortunately, Original Medicare does not offer dental benefits. This lack of coverage can be frustrating, as your oral health is an essential part of your overall well being. While Original Medicare does not cover dental services and you are able to get dental coverage with a Part C plan, you do have additional options to find dental care.
Dental And Vision Coverage
The only way to get dental and vision coverage through Medicare is enrolling in Medicare Advantage. These areas of coverage are not included within Original Medicare. If youre enrolled in Original Medicare and use dental or vision services, then youll most likely need to pay out-of-pocket. This can get extremely expensive.
Dental and vision coverage is important for many people to have. If you think that you will be using these services, then its recommended that you enroll in the corresponding coverage. This is the best way to make sure that youre saving as much money as possible.
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Medicare Advantage Plans With Dental Care Benefits
Another option for Medicare beneficiaries is to enroll in a Medicare Advantage plan that offers routine dental care coverage.
A Medicare Advantage plan provides all the same coverage as Original Medicare .
In addition to covering the same benefits as Original Medicare, some Medicare Advantage plans may offer additional benefits such as:
- Prescription drug coverage
The dental coverage afforded by some Medicare Advantage plans can provide patients with benefits such as access to networks of qualified dentists while offering price protection in the form of deductibles, cost-sharing measures and out-of-pocket spending limits.
Plus, many Medicare Advantage plans also offer coverage for prescription drugs, so some of the medications needed for oral care may be covered under the plan as well.
When you consider the annual costs of receiving dental care without insurance, you may find that a Medicare Advantage plan with dental benefits could fit your situation and health care needs.
How To Compare Medicare Plans
Youll need to consider a number of factors when you select a Medicare Advantage plan, including the following.
- Cost: Be aware pf what youll pay, meaning deductibles, copayments, annual maximums, drug costs and other out-of-pocket costs. Youll want to make sure that the plan youre considering fits what you can handle financially.
- Provider choice: Each plan has its own network of healthcare providers. If you already have a certain doctor or dentist that you go to, you can try and find a plan that allows you to go to that particular provider. If you dont, youll still want to make sure that the network has providers available that are convenient for you in your area.
- Benefits offered: Certain plans offer different benefits such as dental, vision or prescriptions. When comparing plans, youll want to choose a plan that offers the benefits you need or want. If dental benefits are very important to you, be sure that your Medicare plan covers these treatments.
- Star rating: The Medicare Plan Finder offers star rating resources. This resource gives an overall star rating that takes into consideration the plans quality as well as performance regarding the services offered. This resource is similar to reading reviews on Google and allows you to see peoples opinions of that particular plan before choosing it.
- Plans not available in every area
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Determining What Is Covered: Primary And Secondary Services
If you are unsure about what dental services you can receive through Medicare, the best place to start is determining what kind of dental care you need. Most kinds of dental work fall into two categories: primary services and secondary services.
Primary services focus on the care and treatment of your teeth, gums and overall oral health. If you need teeth removed, replaced or repaired for any reason, this is considered a primary service regardless of what caused tooth deterioration or how bad tooth decay may be. Some example primary services are:
- Having teeth pulled so that dentures can be fitted
- Removing decayed teeth
- Filings, bridges and crowns
- Annual or biannual oral exams and cleanings
Primary services are not covered by Medicare. If you need to have any of these procedures, looking into a dental plan through Medicare Advantage or a private insurer is your most reliable option for lowering what you will pay out-of-pocket. The Medicare Specialists at PolicyZip are available to help you compare your coverage options and find the optimal level of benefits at the most cost effective price.
Secondary services can be described as the dental implements you need to support your teeth and oral health. In simpler terms, these are often needs like full or partial dentures or implants. Medicare will not cover the cost of these medical devices, no matter how much you need them.
What Dental Care Does Medicare Part A Cover
Medicare Part A won’t cover dental services such as cleaning, fillings, root canals, crowns, extractions or dentures.
However, if you have an emergency or complicated dental procedure where you need to go to the hospital, Medicare Part A can cover your hospital care. This could include jaw surgery, tooth extractions before cancer radiation treatments, splints for facial fractures, an oral exam before a kidney transplant or other major treatments.
In these situations where you need hospital treatment for your jaw, mouth or teeth, we recommend that you check the billing codes for each service to confirm your coverage.
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Services Excluded Under Part B
The following two categories of services are excluded from coverage:
A primary service provided for the care, treatment, removal, or replacement of teeth or structures directly supporting teeth, e.g., preparation of the mouth for dentures, removal of diseased teeth in an infected jaw.
A secondary service that is related to the teeth or structures directly supporting the teeth unless it is incident to and an integral part of a covered primary service that is necessary to treat a non-dental condition and it is performed at the same time as the covered primary service and by the same physician/dentist. In those cases in which these requirements are met and the secondary services are covered, Medicare does not make payment for the cost of dental appliances, such as dentures, even though the covered service resulted in the need for the teeth to be replaced, the cost of preparing the mouth for dentures, or the cost of directly repairing teeth or structures directly supporting teeth .
Option : Standalone Dental Plan For Seniors
Some health insurers offer dental coverage for seniors as standalone dental plans. These add-on plans are a great choice for dental coverage if you only have Original Medicare or if you have a Medicare Supplement plan.
When selecting a plan, compare coverage details and plan specifics because there is a broad range of policies on access and restrictions. Each plan will specify how much it covers for preventative dental care, basic services or major services. Most plans have a network of providers, and checking this list can make sure you have access to your preferred dentist.
The best dental insurance plans for seniors are from DentaQuest, Aetna and Humana.
DentaQuest: best customer satisfaction
Remember to compare plans based on the waiting period, and some policies may not cover major services until you’ve had the policy for several months. Humana is a great option if you need dental care immediately because most plans have no waiting period for major services like root canals, crowns and dentures.
Many providers may also offer an alternative to dental insurance called a dental discount program. These dental network programs aren’t the best fit for everyone, but we recommend them as one of the five ways to get a cheap dental cleaning without insurance.
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How Else Can You Get Coverage For Dental Services Medicare Doesnt Cover
For an added layer of protection, some Medicare Advantage plans may be paired with a . You’ll have to pay a monthly premium and satisfy deductibles and copays, but the cost may be offset by lower out-of-pocket fees. Most of these dental plans require that you see an in-network dentist. Some plans let you go to any dentist , but you may have to pay more for their services.
A may be worth considering if you dont have dental insurance. These discount plans arent dental insurance. They are a type of membership, similar to a warehouse club, but rather than getting bargains on food or clothing, you get discounted prices on dental services.
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In 1974, the Whitlam Government decided to exclude dental care from Medicare for two reasons. The first was cost. The second was political. Whitlam felt that combatting the doctors would be hard enough without having to combat dentists as well. Forty-six years later, with Australia much richer and the proven success of Medicare, it is now time for dental care to be progressively included in Medicare.
Gough Whitlam was well aware that any serious reform in healthcare would be greeted by the usual conservative response where is the money coming from? The British National Health Service was wrongly criticised at the time for its alleged cost and waste. With the years, however, we can now see that the NHS is probably the best value for money of any healthcare service in the world despite Conservative governments underfunding and privatising key parts of it.
Yet Aneurin Bevans national health service was bitterly opposed by doctors and dentists. It was supported by a minority of doctors and overwhelmingly by nurses, and most importantly by the community.
But with the hatred of the NHS by Australian doctors, Whitlam did not want to add to his political problems by upsetting dentists as well.
So for financial and political reasons dental care was excluded from Medicare in 1974.
In addition to high costs the parasitic PHI system has other damaging consequences and risks:
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Medicare Advantage Plans & Dental Coverage
At Clover Health, we know how important dental care is to our members overall health. So we want to let you know which types of Medicare plans include preventive and comprehensive dental coverage. This page gives you an overview of the dental coverage offered with different types of Medicare plans and how Clover Health can expand your coverage to provide this essential benefit.
Medicare Advantage Plans Dont Have Standardized Dental Coverage
In 2021, 94 percent of Medicare Advantage enrollees in individual plans had access to some dental coverage, according to the Kaiser Family Foundation. Only 10 percent of the Medicare Advantage enrollees are required to pay a separate premium to get dental benefits.
Most plans cover preventive services, such as cleanings and X-rays, but the coverage of more extensive services definitely varies, Freed says. The Kaiser study found that nearly two-thirds of enrollees in plans with access to oral exams, cleanings and X-rays do not get billed for these services.
Beyond preventive services, members usually have to pay a larger portion of the cost for crowns, dentures, extractions, implants, root canals and treatments for gum disease. The most common coinsurance amount Kaiser found was 50 percent for more extensive services. Cost sharing ranged from 20 percent to 70 percent in the plans studied.
Coverage caps averaged $1,300 in 2021 but varied a lot. You may find higher limits if you shop around, but expect to pay higher premiums than for plans with lower limits, Freed says.
Fewer than a quarter of the people who had dental insurance were enrolled in a plan with an annual coverage cap of $2,000, the study found. About 1 in 12 were in a plan with an annual cap of $2,000 to $5,000.
A link to the Plan website is at the top of the Plan Details page. Some sites have phone numbers and chat features so you can talk to a customer service representative.
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Best For Potential New Offerings: Wellcare
WellCare is our top choice for a newcomer to the field of Medicare Advantage plans. Founded in 1985, it’s an up-and-coming provider.
Access to a personal emergency response system
Easy to navigate website
Only available in 36 states
Not as established as some other providers
Founded in 1985, WellCare is a relative newcomer compared to other insurers. We picked them as one to watch for potential new offerings in their Medicare Advantage Plans for two reasons: In 2018, WellCare acquired Aetnas Part D prescription drug plan , and in 2020, they were acquired by Centene, one of the largest providers of Medicaid. This deal-making activity could result in new Medicare Advantage Plan offerings that address specific pricing or feature needs.
Benefits offered with some WellCare Medicare Advantage Plans include over-the-counter coverage and access to a personal emergency response system. The OTC benefit is a fixed dollar amount for non-prescription medications and wellness-oriented items that can be shipped directly to you. The personal emergency response system, for people who live alone or are left alone for long periods, is connected to your phone and allows you to get emergency help with the push of a button.
WellCare has greatly expanded its Medicare Advantage offerings since merging with Centene plans are available in 36 states for 2022. The companies offer a full range of plans .