Does Medicare Advantage Provide Dental Benefits
Original Medicare does not provide dental benefits except under extremely limited circumstances. Fortunately, some Medicare Advantage plans come with options for covering basic and major dental services. About 42% of Medicare Advantage beneficiaries had access to preventive and extensive dental benefits such as dental implants in 2016.
What Do Medicare Advantage Dental Benefits Cover
Medicare Advantage plans with dental coverage generally have preventive coverage and comprehensive coverage. Preventive coverage refers to general dental checkups every six months and includes dental exams, X-rays, and cleanings. Comprehensive coverage includes restorative crowns, fillings, root canals, tooth extractions, prosthodontics , and some oral surgeries.
Bonus: Learn more about affordable dental care for seniors for other dental options outside of Medicare.
Some Medicare Advantage plans with dental benefits combine preventive and comprehensive services in their plans max coverage amount. Other plans have no maximum amount for preventive coverage and a plan limit for comprehensive coverage. Medicare Advantage plans with dental coverage tend to be comparable to dental coverage under the employer plans you may be used to.
How Do You Determine Which Dental Insurance Is Primary And Which Is Secondary
There are a few ways to figure out which of your two dental plans will be the primary and which one will be the secondary.For example, if you have a plan from your job and another that you bought on your own, the one from your employer might be deemed the primary policy. Or, if you and your spouse have dental insurance from your jobs, your primary policy may be the one on which youre the account holder, while your secondary policy may be your spouses insurance.
Also Check: Does Medicare Cover You When Out Of The Country
How Do You Get Dental Coverage If Medicare Doesnt Include It
If youre on a Medicare plan thats working for you and doesnt offer dental coverage, there are other options you may consider:
- Buy a separate or standalone dental plan from a private insurance company. There are many types of dental plans to choose from, usually with affordable monthly premiums. Basic dental plans may offer you coverage for preventive dental care with lower monthly premiums. Other plans may provide more dental coverage for a little higher premium. Standalone dental plans usually include deductibles, copays, and coinsurance.
- Look for an affordable walk-in dental clinic in your area. Depending on where you live and what kind of dental services you need, you may be able to find affordable dental care even if it means paying out-of-pocket.
- Check with your state department of health. They may have information on where you can get low-cost dental services.
- Have a local dental school or university program nearby? You can contact them to see if they offer any free or low-cost dental clinics.
- Before age 65, you can consider opening a Health Savings Account if you have a high deductible health plan. Once you enroll in Medicare you can no longer contribute to the fund, but you can certainly use what youve saved to help pay for covered expenses, including eligible dental care.
Impact On Beneficiary Decision
Choosing whether to enroll in traditional Medicare, with or without a Medigap plan, or to enroll in a Medicare Advantage plan is complicated. This analysis highlights another way that traditional Medicare with Medigap diverges from MA, as access to additional benefits such as dental, vision, and hearing in MA is growing.
Beneficiaries are asked to make trade-offs about cost and access, with imperfect information about their future health needs. Moreover, given the differences between how Medicare Advantage and Medigap plans are designed, funded, and managed, with the former variable by county and the latter largely standardized, the decision is not a simple one for beneficiaries.
As the number of people enrolling in Medicare increases, policymakers must focus on the implications that Medigap benefit design has on quality, affordability, and access and whether efforts to provide additional benefits within Medigap plans is necessary to better meet beneficiaries needs.
Don’t Miss: How Do You Qualify For Medicare In Texas
Using Kaiser Medicare Dental Coverage
Kaiser Medicare Advantage plans may only be used at Kaiser Permanente hospitals and medical facilities. The company operates hundreds of facilities, including dentist offices, in the states in which its plans are sold.
Kaiser Medicare plans are often structured as HMO plans, which is a type of coordinated care. That means plan members utilize a primary care physician who coordinates care and issues referrals within the Kaiser network.
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.
Recommended Reading: Must I Take Medicare At 65
Which Medicare Plans Will Be Most Helpful If You Need Dental Implants
Medicare Advantage plans with supplemental dental coverage that includes dental implants will be most helpful. You may have to pay an additional monthly premium, and there will always be a maximum dental benefit amount allowed, along with either a copay or coinsurance. If you need dental implants, you will incur some amount of out-of-pocket expense.
Not all MA plans cover dental implants. Some MA plans specifically exclude dental implants, even if they offer other comprehensive dental benefits.
MA plans list dental implants as either a covered item or an exclusion in the Evidence of Coverage document associated with each plan. If dental implants are covered, you will be responsible for a copay or coinsurance until the max annual benefit is reached. You will then be responsible for the remaining costs of the services you receive that year.
Dental coverage is detailed in the EOC, but the terminology, codes, and lists of dental procedures can be overwhelming. It is best to talk with a dental provider who routinely works with insurance companies and understands all the terms and codes associated with prosthodontic procedures.
Supplemental Insurance Vision & Dental
Medicare Part C, or Medicare Advantage, is private insurance. Its a for-purchase type of Medicare plan that you need to pay for, but you can purchase it to cover some vision and dental care as well as some other types of services that arent typically covered under Medicare Parts A and B. Medicare Part C may have some dental and vision coverage as well as some coverage for hearing services and limited prescription drug savings plans.
Because Medicare Part C typically offers limited dental coverage many seniors might benefit from purchasing supplemental dental insurance from a company like Guardian Direct which allows them to choose a plan that with the coverage they may need. Premium costs may be slightly higher when choosing a private insurance plan, but any out-of-pocket expenses will be lower which is important for seniors with limited or fixed incomes. For more information on Medicare, please visit www.medicare.gov.
You May Like: How To Apply For Medicare By Phone
Medicare Supplement Plans In Virginia For People Under Age 65
Because premiums are significantly higher for Medicare recipients under the age of 65, Virginia requires Medigap insurers to offer them at least one Medigap plan. Who qualifies for Medicare under age 65? Social Security disability recipients , plus individuals diagnosed with End-stage Renal Disease and permanent kidney failure.
If youre disabled and receiving Social Security benefits, you automatically qualify for SSDI after 2 years. In Virginia, 13% of all Medicare recipients are under the age of 65. Virginia has recently enacted laws to make sure these individuals can take advantage of Medigap plans as well. Still, people under age 65 do pay more.
Medicare recipients in Virginia age 65 or older average monthly premiums anywhere from $100 to $160. Compare that to beneficiaries under the age of 65 who pay from $400 to $650 per month. Diasabled recipients do have access to lower rates when they turn 65.
Insurance companies in Virginia are not required to sell Medigap policies to recipients who are under age 65.
Dental Coverage With Stand
Although Original Medicare does not provide comprehensive coverage, that does not mean seniors will be left without dental plan options. There are senior dental plans that can be purchased as stand-alone plans, meaning they are not connected to your other forms of medical insurance. These standalone senior dental plans can cost around $20 – $60 per month and can cover preventive, diagnostic, and restorative services and procedures.
At HealthMarkets, we can help you save on your dental bills by finding you dental insurance that covers regular dental care for Medicare beneficiaries. Shop online now to get quotes, compare plans, and even apply.
HealthMarkets FitScore can even take the guesswork out of choosing a plan by ranking each one based on how well it fits your needs.Our services are free, so visit us now to find the right dental coverage for you.
Recommended Reading: Does Aspen Dental Accept Medicare
Do Kaiser Medicare Plans Include Dental Coverage
Depending on the type of Kaiser Medicare plan you choose, you may receive coverage for preventive dental services such as exams, cleanings and X-rays every six months. Dental services may require a small copayment.
More advanced dental services may also be covered at a reduced rate and may include diagnostic and restorative services, endodontics, periodontics, extractions and prosthodontics.
Supplemental Insurance Dental Coverage
Medicare coverage is divided into four parts: Part A, Part B, Part C, and Part D. Medicare parts A and B usually combine to make up what most people think of as Traditional Medicare coverage. Medicare Part A typically covers hospital expenses if you need to be admitted to a hospital for medical treatment because of an illness or accident. It also typically covers some services related to hospital care, like having a nurse at home during recovery after a surgery. Medicare Part B covers doctor visits, preventive services, and some home health visits. Some people assume that Medicare Part B covers dental care because it covers certain preventative services but Medicare Part B doesnt typically cover any type of dental care. You can find out more about what Medicare Parts A and B cover here.
Medicare Part A and Part B is the type of Medicare coverage that seniors typically have. Dental coverage is not a part of Medicare, although if a senior needs dental care because of an accident or an emergency Medicare will usually pay for that treatment.
Also Check: What Are The Four Different Parts Of Medicare
Types Of Dental Work Covered Under Medicare Advantage Plans
Seniors should contact their Medicare provider to determine which types of dental work are covered in a plan. Most dental plans cover basic services, such as:
- General procedures
Some Medicare Advantage plans cover more comprehensive dental services. If not, providers will often offer supplemental plans that can be added to a Part C plan at an additional cost.
Can You Get Medicare Supplemental Dental Insurance
Seniors need to take great care of their teeth and gums because their risk of oral health problems may be higher. But if you only have Medicare Part A and Part B, trips to the dentist likely wont be covered because there are limitations on the types of dental treatments that Medicare will pay for.The good news is Medicare supplemental dental plans are available to provide support when you need anything from preventive cleanings to restorative bridges. You might be able to get dental coverage with a Medicare Advantage plan, or you can enroll in a stand-alone policy, such as one from the providers discussed above.
Recommended Reading: Is Keystone 65 A Medicare Advantage Plan
What To Do If A Plan Doesnt Cover Dental Services
If a Medicare Advantage plan doesnt cover dental work, the beneficiary will have to pay all of the costs for their dental visit, unless they have subscribed to an additional plan that their provider offers to fill the gaps of Medicare Advantage. Those whose dental work isnt covered may want to search for another Medicare provider or call their current provider to inquire about alternate plans.
Not all Medicare Advantage plans cover dental services, but many do. Before scheduling a trip to the dentists office, its a good idea to review dental plan coverage.
What You Need To Know About Full
Choosing the Medicare health plan that’s right for you can be a chore, and you may be tempted to quit after selecting your medical plan. But don’t forget your dental health!
Maintaining oral health can be more challenging for seniors and people with certain disabilities. This may be due to an inability to brush their teeth properly, as well as an increased use of medications. Plus, as we grow older, our teeth become less sensitive, so we may not notice a problem until it is too late. All of these factors make it even more important to protect your dental health as you age.
Recommended Reading: Does Medicare Cover Oxygen At Home
Covering Some Of The Costs
Medicare Supplement Insurance plans help cover some of Original Medicare’s out-of-pocket costs. And although Medigap policies do not offer dental insurance, they could help cover some of the out-of-pocket costs that might come with dental care.
If you are admitted as an inpatient hospital patient for certain emergency dental services or complicated dental procedures, a Medicare Supplement Insurance plan will help cover your Medicare Part A hospital coinsurance. Some plans will cover your deductible as well.
There are 10 standardized Medigap plans available in most states labeled A, B, C, D, F, G, K, L, M and N.
Connect with a licensed insurance agent at to find Medigap plans in your area, or read through our guide, What Does Original Medicare Cover? to learn more.
How To Sign Up For Supplemental Medicare
Supplemental Medicare plans dont have open enrollment periods like traditional Medicare does. Those eligible can sign up for plans at any time.
Use Medicares Plan Finder to locate supplemental plans in the desired area. Some applicants may be able to sign up online through the plans website. If that is not possible, they can contact the plan provider for a paper enrollment form, fill it out and return it to the plan provider. All plans offer a paper enrollment option. The plans provider will ask for a Medicare number and the date the Part A or Part B coverage started, which is found on the Medicaid card.
Once an individual finds a suitable plan, they can call the provider for more information. Those with more general questions can call Medicare at 1-800-MEDICARE .
Also Check: What Does Medicare Part B Include
Medicare Advantage Dental Benefits
Medicare Advantage plans may provide extra benefits that are not covered under traditional Medicare, such as dental, vision, hearing, and fitness benefits. The cost of these benefits may be covered using rebate dollars. Plans can also charge additional premiums for such benefits. In 2021, 94% of Medicare Advantage enrollees in individual plans, have access to some dental coverage. The majority of these Medicare Advantage enrollees have access to a plan with more extensive coverage, while 14% had access to preventive coverage only. Preventive dental coverage under Medicare Advantage plans generally includes oral exams, cleanings, dental x-rays, and sometimes fluoride treatments. More extensive benefits cover a range of services, including restorative services , endodontics , periodontics , prosthodontics , and oral surgery.
The Scope of Covered Dental Benefits Varies Across Medicare Advantage Plans
Virtually all Medicare Advantage enrollees in plans that offer access to dental benefits , have access to preventive services, including oral exams , cleanings , and x-rays , although fewer enrollees have access to fluoride treatment .
like other dental benefits, coverage for dentures varies across plans
Medicare Advantage Plans That Offer Dental Benefits Typically Have an Annual Dollar Cap on Dental Coverage
Preventive Services Are Often Covered Without Cost Sharing For More Extensive Dental Services, 50% Coinsurance and Caps Are the Norm
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.
Also Check: Is Oral Surgery Covered By Medicare
Additional Kaiser Medicare Advantage Coverage
Kaiser Medicare Advantage plans include all of the same basic benefits found in Original Medicare . That includes inpatient care administered at hospitals, skilled nursing facilities and other inpatient centers as well as doctors appointments, rehabilitation and outpatient procedures and appointments.
In addition to these basic benefits, Kaiser Medicare Advantage plans may also include prescription drug coverage and coverage for certain over-the-counter health items purchased from pharmacies or other retailers.
What Dental Services Are Covered By Medicare Part B
While there’s no coverage for the regular care, treatment, removal, or replacement of teeth, Medicare Part B dental coverage does cover dental services performed by a physician that are an integral part of another covered procedure. Examples include:
- Oral exams in anticipation of a kidney transplant.
- Extractions done in preparation for radiation treatments involving the jaw.
- Reconstruction of the jaw following an accident.
- Outpatient exams required before an oral surgery.
Because none of these cases are preventative or common dental treatments, it would be beneficial for Medicare beneficiaries to invest in a stand-alone dental plan to help subsidize the cost of receiving the regular dental services that are essential to maintaining oral health. Services such as cleanings, fillings, tooth extractions, dentures, dental plates, and regular dentist visits are not covered by Medicare Part B or Part A.
You May Like: Is Stem Cell Treatment Covered By Medicare