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What Do You Need To Know
Medicare Dental Benefits
Medicare and Medicare Advantage plans are two of the most common forms of health insurance for seniors. While Medicare can help cover the costs that come with aging, it doesn’t always cover all necessary costs, including dental care. Original Medicare doesn’t typically cover any costs related to dental care, meaning you may have to research other options.
Does Medicare Cover Dental Care?
Medicare doesn’t typically cover dental care unless there is an emergency. A few examples of emergencies might include:
- You need an oral exam before a transplant.
- You need an oral exam before a valve replacement.
- You need surgery to treat a jaw fracture due to an accident.
- You need dental splints or wiring after surgery.
Even if Original Medicare does cover these emergency dental services, they typically won’t cover any follow-up services. Original Medicare will only cover the cost of medical services or hospitalization including dental care if it’s absolutely necessary for another medical life-saving treatment. However, other Medicare plans, like a Medicare Advantage plan, may cover dental benefit.
What Medicare Parts Pay Dental Care
It can be helpful to evaluate the different parts of the Medicare program. Each part covers different types of medical needs, including:
- Part A: Part A is hospital insurance and typically only covers emergency medical and hospitalization costs. Unless you need dental services for an emergency, Part A won’t cover it.
- Part B: Part B is medical insurance and may cover dental care but only if you have an emergency and dental care is required for another type of surgery.
- Part C: Part C, Medicare Advantage, may cover dental care, depending on the details of your policy.
- Part D: Part D is prescription coverage. It does not cover dental care.
Make sure you know all the details of a plan before enrolling. If you’re enrolled and it doesn’t cover dental care, you may be subject to high out-of-pocket costs.
What is Medicare Advantage and Does it Cover Dental Care?
Medicare Advantage is often referred to as a Medicare add-on plan, or in some cases, Medicare Part C. Medicare Advantage plans are available through private insurers who are still federally regulated by the Original Medicare program. They offer individual plans that include all the benefits available with Parts A and B of Original Medicare. However, they may also include other types of coverage in the plan, including prescription coverage, or even routine dental care. Medicare Advantage plans may also be used to cover services like hearing, vision, or chiropractic care.
Medicare Advantage plans work similarly to traditional health insurance plans that you may already be familiar with. They often come in the following types:
- HMO: A Health Maintenance Organization (HMO) plan requires you to receive medical services from a network of healthcare providers. Some services, like emergency care or urgent care, are not subject to this same requirement. Most HMO plans also offer some type of prescription coverage.
- PPO: Preferred Provider Organization (PPO) plans offer more affordable medical services in-network. You can go out of the network, but it will usually cost more.
- POS: A Point-of-Service (POS) plan offers partial coverage to medical providers who are out of the network’s managed care plan.
Each of these plans may be subject to deductibles, copayments, or coinsurance. Some Medicare Advantage plans may cover your dental care needs but this may also come with an added cost.
Dental Services Covered By a Medicare Advantage Plan
If you have access to dental care under a Medicare Advantage plan, it will usually cover preventative services, including dental procedure, cleanings, or x-rays. Fluoride treatment is not always covered. Most Medicare Advantage plans will determine how many visits you can schedule each year. The most common duration is two times per year. Other dental services, like x-rays, may be limited to once per year.
Of course, specific coverage will vary from plan to plan. It’s always a good idea to find out what your plan covers before receiving dental services. Medicare Advantage plans may also limit you to the providers you can visit. A lot of Medicare Advantage plans require you to receive medical services from in-network providers. This means that you must receive dental care from a dentist in your network. If you do receive dental services from a provider who is out of network, you could be subject to higher costs. Many of these costs will be your responsibility to pay out of pocket.
Many plans that do include any kind of dental benefit may only cover preventative care. Preventative care may include services like:
- Dental exams
- Dental cleanings
- Fluoride treatments
Some plans may also cover the treatment of some dental conditions. Treatment dental care may include services like:
- Dental fillings
- Endodontics, or root canals
- Periodontics, scaling, or root planning
- Prosthodontics, which includes dentures or dental implants
- Oral surgery
Medicare doesn’t cover cosmetic dental work. This also includes any elective dental care needs.
Medicare Advantage Plan Eligibility
Before signing up for a Medicare Advantage plan, it’s a good idea to find out if you meet the different eligibility requirements.
Eligibility Age for Enrollment
As long as you are 65 years or older, and have paid into the Medicare program long enough, you should be eligible for Medicare or a Medicare Advantage program.
Necessary Documents for Smooth Enrollment
Having certain documents ahead of time can help you have a smooth enrollment, getting you your coverage faster. You need the following documents to apply for Medicare:
- Social Security number
- Date and place of birth
- Citizenship status
- Name and Social Security number of your spouse
- Date and place of any marriages or divorces
Depending on your application, you may also need documents that prove your income history or military service. While having the information alone may be enough, you may also be asked to provide proof with the original documents, so it can be helpful to have them. You may also need other documents, depending on your situation. Other documents might include names and ages of children on disability, your employer’s information for the past two years, information on previous applications, or information of children still in high school. When applying for a Medicare Advantage plan, you will need a copy of your Original Medicare card.
How to Enroll in Medicare
Enrolling in Medicare is easy but requires that you do so during your open enrollment period. If you’re already receiving Social Security benefits, you don’t need to do anything. You will be automatically enrolled in Original Medicare Parts A and B. However, if you want a Medigap policy, or you want to enroll in a Medicare Advantage plan, you will need to enroll within your open enrollment period.
Medicare Part A is free, as long as you have paid into the program long enough, and part B comes with a monthly premium. Your income can affect this cost.
Once you are ready to enroll, you can do so online. You can also enroll in person or by mail if you prefer. You can enroll in Original Medicare as long as you are within three months of turning 65 years.
Once you apply, the Centers for Medicare & Medicaid Services (CMS) will review your application. If your application is approved, they will mail you a Medicare Welcome Packet and Medicare card. You will use this Medicare card to receive medical care services within the Medicare program. You will need a copy of this card to enroll in a Medicare Advantage plan.
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What is Medigap?
Medigap is a type of supplemental insurance that helps you cover other medical costs, like copayments or coinsurance. It doesn’t typically help with covering dental treatment. It’s also important to note that if you enroll in a Medicare Advantage plan, you cannot also enroll in a Medigap policy.
Finding the Best Plan for You
You have a few options available when choosing the best Medicare plan for you. If you want coverage that includes things like dental or hearing care, then you’ll need to consider Advantage plans.
Original Medicare includes Parts A and B. Part A is hospitalization insurance and Part B is medical care. You may also enroll in a Medigap policy which can help you cover other medical costs, like copayments and coinsurance.
You also have the option to buy a Medicare Advantage plan instead of enrolling in the Original Medicare program. Medicare Advantage plans still provide you with access to Parts A and B, but with the addition of other care you may need, like dental or hearing care.
Alternative Ways to Cover Your Dental Needs
Because dental care is important as a senior, it may be necessary to find other ways to get dental coverage. The most important thing to do is to consider Medicare Advantage plans. However, before choosing one, make sure you find out how much it offers in coverage for alternative plans, including dental care.
If you need dental care, a Medicare Advantage plan is available. Here are a few other ways to get dental coverage:
- Purchase a dental insurance plan: You may be able to purchase a separate standalone dental plan from a private insurance company. Some programs offer discounted dental plans to seniors. You can shop around and choose the best for you.
- Ask about discount programs: Some local dentists may offer discounts or discount programs to seniors.
- Open a Health Savings Account: If you have a high deductible health plan, you may be able to open a health savings account before age 65 years.
- Consider nearby dental schools: Dental schools often have low-cost community programs that are available to the public.
If you have access to a flexible spending account (FSA), you may also be able to use this to cover dental costs. Always consider if a Medicare Advantage plan is right for you first.
The Importance of Routine Dental Care for Seniors
Dentists treat medical conditions that affect the teeth and mouth. They may assist patients with pain due to things like broken teeth or exposed nerves. Many seniors deal with dental pain or conditions as the teeth can wear and break down over time. A lot of seniors may also deal with tooth loss, which may lead to a need for dental dentures. Dentures are considered cosmetic.
Whereas some Medicare Advantage plans cover preventative or treatment of dental care, most don’t cover cosmetic care. Dentures are a common need for seniors. In fact, many seniors choose to buy a separate dental policy to cover the costs associated with them.
Because Original Medicare doesn’t typically cover dental care, a large percentage of seniors don’t have any dental coverage. In fact, according to data from the Kaiser Family Foundation (KFF), as many as 24 million people who are enrolled in Medicare don’t have dental insurance.
Another half of Medicare recipients have not had a dental visit within the last year. Medicare Advantage plans can make more seniors eligible for dental care, with an estimated 94 percent of Medicare Advantage policyholders having some access to dental care.
Dental care is an important consideration for seniors. While it may not be the immediate healthcare need on your mind, it is an important one to consider. Dental health has an immediate correlation with overall health and poor dental hygiene can also affect common medical conditions. Additionally, a balanced diet is important as a senior. Broken teeth or painful symptoms can make it difficult for a senior to eat and receive the nutrients they need.
How Much Do Dental Services Cost?
It can be helpful to consider the average cost of dental services, as well as how much a Medicare policy may cover. If dental care is available with your Medicare Advantage plan, it’s important to note that there is likely a maximum spend. This is a maximum amount that the plan will cover for dental services each year.
It is a good idea to monitor these limits, or you could end up owing out of pocket if you exceed the costs. According to KFF, the average maximum or limit on dental care for Medicare Advantage plans is $1,300 in 2021. Some plans may be even more limited, with maximum amounts set at $1,000.
You may also be subject to other out-of-pocket costs, like deductibles or copayments.
The biggest problem with this is that most dental services exceed this cost. A single visit to the dentist can cost thousands of dollars and with most Medicare plans limiting annual benefits to just $1,000 or less, it can lead to many seniors having to pay out of pocket for their care. For more extensive dental needs, like oral surgery, you may be subject to copayments. Again, according to KFF, the copayment for more in-depth dental services can be as much as 50 percent out of pocket.
You may also be subject to an extra monthly cost for dental services added to a Medicare Advantage plan.
Average Cost of Dental Services
Dental services can be expensive, depending on the type of service. According to information from Humana, even preventative dental care can be expensive. Here are the average costs of dental care for 2021:
- Dental cleanings: Between $75 – $200.
- X-rays: Between $100 – $200.
- Dental fillings: Between $50 – $4,500 per tooth.
- Dental crowns: Between $500 – $2,000 per tooth.
- Tooth extraction: Between $75 – $800 per tooth.
- Root canal: Between $500 – $1,500.
These costs are based on averages. The actual costs may vary, depending on your dentist or dental needs.
Frequently Asked Questions About Medicare Dental Care
Here are a few frequently asked questions that we get about dental care and benefits available with Medicare:
Do I Need a Referral for Dental Care?
Because Medicare doesn’t usually cover dental care, a referral won’t help. The only way that traditional Medicare will cover your dental care services is if it’s an emergency. If you have a Medicare Advantage plan that covers some portion of your dental care, you don’t usually need a referral. However, your spending will be limited.
Will Dental Care Ever Be Fully Funded Under Medicare?
Recently, lawmakers have begun to realize the gap in certain medical services, including dental care, with Medicare. In fact, the FY 2022 budget request proposes that seniors should have more access to other coverage, including dental, hearing, and vision.
Each of these services is important to a senior’s overall health. These proposals have not yet been voted on, meaning we don’t know how they will affect the Medicare program. Throughout history, numerous bills have been proposed to give seniors access to these necessary health care services, including dental care.
How Can I Get Denture Coverage?
Dentures are one of the most common dental needs for seniors. Depending on the need for dentures, it may or may not be covered with a Medicare Advantage plan. If you need assistance with dentures, you may find help with a dental insurance plan that is specifically designed for seniors.
What If I Have a Dental Emergency?
Dental emergencies can be expensive and painful. It’s best to find out ahead of time if your Medicare Advantage plan covers dental emergencies to avoid any unexpected costs.
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