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What Do You Need To Know
Does Medicare Cover Dental?
Original Medicare does not typically cover dental services. However, it is possible to buy a dental plan along with Medicare to cover routine dental services.
There are a few exceptions in which Original Medicare may cover dental services. For example, if you need dental work due to an accident or medical condition, Original Medicare may cover the costs. However, these situations are limited, and it is best to consider your options available for covering dental.
What Does Medicare Cover?
The Medicare program was designed to help seniors cover healthcare costs. What this includes varies depending on the part.
Original Medicare (Part A) covers hospital insurance. This includes things like inpatient hospital care and skilled nursing facility care. Part B Medicare covers medical things like doctor’s visits or treatment.
Neither of these parts includes dental care. Parts A and B of Medicare will only cover dental services if it’s necessary to complete another procedure. For example, part A covers hospitalization, so if you need dental work while in the hospital, it may cover it. However, this is usually only in preparation for another procedure, like an organ transplant or facial reconstruction.
If you are hospitalized due to a dental condition, then Part A may cover the hospitalization costs. However, they will not likely cover the cost of dental services, even though you are in the hospital. For example, if you require hospitalized monitoring during a necessary dental procedure, Medicare would cover the cost of the hospital monitoring, but not the dental care.
Medicare Part C may sometimes cover some dental costs. Part C refers to a Medicare Advantage Plan. This is similarly to an HMO or PPO policy in that you can choose which policy type works for you. This means that you may be able to add dental care to a Medicare part C policy. However, each policy will differ, depending on the insurance provider.
Part D covers prescriptions. This may assist with any medications that you need following a dental procedure . However, it will not cover the actual cost of dental care.
Medicare was not designed to include dental care and cover routine or necessary dental procedures, like cleanings or fillings, wisdom teeth removal, or dentures. This means that if you receive any dental services without an add-on dental policy, you will likely be responsible for the full cost.
How to Get Dental Coverage on Medicare
The lack of dental coverage can be problematic as senior’s dental needs increase with age. With many seniors on a limited income, they may find it difficult to receive routine dental work. Avoiding routine dental work can lead to many health problems. If the senior eventually needs a root canal or tooth extraction, it can easily cost them hundreds or thousands of dollars out-of-pocket.
Still, some might avoid dental procedures due to costs, even when in pain. Even when seniors add on a dental plan through a Medicare Advantage Plan or an employer, the dental plan rarely covers the full cost of dental care.
Here are a few plans to consider if you need dental coverage in addition to Medicare:
A stand-alone dental plan is a separate insurance policy that you buy to cover all your dental needs. These plans are usually available through insurance companies like Humana or AARP.
Some stand-alone plans also have specific dental plans designed for seniors. They often come at a lower price but may be more limited as to what they cover. For example, AARP recently partnered with Delta Dental to offer affordable dental coverage to seniors. However, their coverage may limit dental costs to as little as $1,000 or $1,500 per year.
Stand-alone dental plans work similar to any other private insurance. You have to pay a monthly payment for benefits. If you need to use the benefits, you most likely will be responsible for a deductible. Some plans have in-network and out-of-network, which means you have to visit a dentist they approve to keep costs low.
This usually means that seniors are still left paying a portion of their dental costs themselves. Therefore, it is always important to consider your unique dental needs and budget when choosing the right plan.
Some Medicare Advantage plans come with dental coverage. Medicare Advantage plans may also include vision and hearing, depending on the plan. Medicare Advantage is available through private insurance companies. This is also known as Medicare Part C. It includes private insurance companies that the Medicare program has approved.
A Medicare Advantage plan may cover both routine and necessary dental services. They may include routine care like teeth cleanings and routine x-rays. Some will also assist with costs for teeth extractions.
Dental Discount Plan
A dental discount plan may also be an option. However, this is not insurance but may provide you with dental discounts. This is also known as a discount savings plan. Most plans offer between 10-60 percent discounts off dental needs, but the actual amount will vary between the different plans.
If you, or your spouse, is still employed, you may have access to dental benefits through your employer. While it is not usually included in traditional health insurance, it is usually available as an affordable add-on to your policy.
Even if you are currently covered through a spouse, or your own, work-sponsored insurance, it is always a good idea to consider your future needs. For example, if you believe that you might need oral surgery or dentures in the future, it is never too early to plan for coverage.
Waiting too long to enroll in Medicare Part B can lead to penalties. While staying on your employer’s insurance policy may be the best decision right now, you must decline coverage after age 65. Once your employer’s policy no longer covers you, you will need to enroll in Part B during your Special Enrollment Period to avoid paying penalties.
What Procedures are Considered Dental?
Some dental plans may only cover preventative care, whereas others cover procedures like oral surgery. When choosing the right plan for your dental needs, always consider what dental procedures are a part of the policy.
Each company includes different coverage types. This is why it is essential to consider your needs when choosing the right plan. While the types of procedures that are included in a Medicare Advantage plan, or a private dental insurance policy, will vary from plan to plan, they typically include the following:
- Oral exams
- Dental cleanings
- Routine x rays
- Diagnostic needs
- Restorative needs, like tooth fillings
- Endodontics, or root canals
- Teeth aligners
- Periodontics, or the treatment of gum diseases or inflammation
- Tooth extractions
- Abscess tooth
- Prosthodontics, like crowns or bridges
- Dentures care
Depending on the type of service, you may be responsible for a copayment. This is an amount that you have to pay, along with the insurance company. The specific amount of how much you have to pay will depend on your policy.
When to Enroll in a Medicare Advantage Plan
Similar to Original Medicare, it is important to enroll in a Medicare Advantage Plan with dental benefits at the right time. If you want to add-on dental coverage in the form of a Medicare Advantage Plan, you can do so in one of the following ways:
- During the initial enrollment period: The initial enrollment period is the seven-month period that begins three months before your 65th birthday, and concludes three months after.
- During the open enrollment period: You can change your Original Medicare plan, including adding on a Medicare Advantage Plan, during your enrollment period. This occurs each year from Oct. 15- Dec. 7.
- During special enrollment period: You may be able to enroll during the special enrollment period if you qualify. This is only available to those previously covered under a work policy.
Make sure you know your eligibility requirements and when to enroll. Otherwise, you may be subject to penalties, and your Part C coverage may be limited.
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What Costs to Expect With Dental Coverage
Even with a dental plan, you may be subject to out-of-pocket costs for dental procedures. Most dental plans limit how much, and how many procedures, they will cover each year. If you need dentures and have dental insurance, you may also have to pay for a portion of the costs. Most insurance companies do not pay 100 percent. If you have dentures, it may be worth it to choose a plan with denture coverage.
Even if you have a policy that includes adult orthodontic coverage, especially for cosmetic purposes, you can expect to pay a portion of costs.
Some dental plans may cover the full cost of preventative exams. But depending on the plan, you may need to choose a primary dentist in the network. The typical cost of a comprehensive dental exam, out of pocket, according to MarketWatch, is between $90-$137. If you need additional dental services, you may end up paying thousands of dollars. For example, the full cost of dentures is between $1795-2490.
With the average monthly cost of an add-on dental plan being only $21 per month, it is usually worth the cost.
It is also important to note that with most add-on policies, whether you opt for a stand-alone plan or a Medicare Advantage Plan, you will likely be responsible for costs like a monthly premium, copayment, and in some cases, a deductible.
When evaluating potential dental policies, always consider how much you will have to pay for services. This includes your copayment for routine dental care, or necessary procedures. Preparation is important in ensuring that your dental needs are taken care of without having to spend a fortune.
The Importance of Dental Care As You Get Older
Dental care is a necessity as you get older. Unfortunately, seniors are at an increased risk of dental problems, including gum disease and tooth decay. Some of these dental conditions can also increase your risk of other health conditions like heart disease and stroke.
Almost two-thirds of seniors with Medicare don’t currently have dental coverage. Approximately 69 percent of people between the ages of 50-64 years avoid or delay dental care due to cost, according to NerdWallet. Dental insurance is an option so seniors don’t have to avoid necessary dental services.
Poor dental care as a senior can also affect quality of life. It can affect nutritional intake if bad teeth make it difficult to eat. Damaged teeth can also make it harder for seniors to chew, limiting the foods they consume. Oral pain can also affect sleep habits, which can lead to a long list of health problems.
Dry mouth is one of the most common symptoms of poor oral health. It is also a common side effect of many senior medications. Dry mouth can affect a person’s ability to speak, taste, chew, or swallow. It also increases chances of tooth decay or oral infections.
The Importance of Diverse Healthcare as a Senior
Oral problems aren’t the only senior need that Medicare misses. Fortunately, as Medicare Advantage Plans sometimes cover dental services, they may also cover these other needs.
This might include routine vision exams and glass lenses and frames. It may also include routine hearing screenings and hearing aids. Medicare Advantage, in some cases, also covers prescription drugs. While some prescription drugs may be included in Medicare Part D, a Medicare Advantage Plan may be a good add-on to cover medications that it doesn’t. It may also help seniors cover coinsurance payments of Part D for costlier prescriptions.
Although Original Medicare does not cover dental services, routine or necessary, there are options available. Seniors can consider a stand-alone policy, opt for a Medicare Advantage Plan, or join a dental discount program. Each of these options can help seniors maintain their dental health.
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