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A trip to the dentist usually isn’t covered under Original Medicare. But there are other ways to get dental coverage. Anyone who’s ever gone to the dentist knows that the care doesn’t come cheap. You might be able to manage a routine cleaning or even a cavity filling. But if you need more extensive work — such as a root canal or an implant — you could be staring down a bill that stretches into thousands of dollars. Making matters even more complicated, dental care usually isn’t covered by Original Medicare. In fact, according to the Kaiser Family Foundation (KFF), the average person who had Medicare spent $874 out of pocket for dental care in 2018. That said, you have ways to get the coverage you need. Here’s what you need to know. Find an affordable Medicare plan with extra benefits. We can help you find an all-in-one Medicare plan that may include, at no additional charge, free dental benefits, hearing aids, eyeglasses, and more. Start now. What kind of dental care does Original Medicare cover?Medicare will pay for certain dental services that you might receive when you’re hospitalized. If you were injured and needed jaw reconstruction surgery, that care would be eligible too. And if you experienced dental issues related to another treatment, such as radiation, that would qualify as well. If, however, a doctor didn’t treat you directly and instead referred you to a dentist or an oral surgeon, that’s a sign that the dental work probably wouldn’t be covered under Medicare, says Shain. Here’s a case where Medicare might not pay: Say you knocked out two teeth after a fall and go to the ER. The hospital may tell you that they’re not going to treat the tooth loss since it’s not an emergency. In that case, you’d have to see a dentist and would need to use separate dental insurance, if you have it, to pay for the care. Sometimes dental appointments are required before you can have certain procedures. Medicare will pay for those pre-op dental exams. If a dentist at the hospital provided the dental exam, it would be covered under Part A. If it was performed by a doctor outside of a hospital setting, it would be covered under Part B. What type of dental care is not covered by Original Medicare?Original Medicare doesn’t cover most types of routine dental care, including:
That’s because when Medicare was established in 1965, the goal was to cover higher-cost, rarer types of health services such as surgeries, says Shain. Low-cost, more routine care wasn’t part of what Original Medicare was designed to do, he says. And even though you can supplement your Medicare coverage with a Medigap policy, that policy doesn’t usually cover dental services either. How can you get dental care covered?Original Medicare may have limited dental benefits, but you still have plenty of ways to get help paying for your care. And it’s worth staying on top of dental visits. Untreated gum disease can increase your risk for a range of serious conditions, including heart disease. Plus, certain conditions, such as diabetes and osteoporosis, can impact your oral health. Medicare Advantage (Part C): If you want an insurance plan that covers dental services such as cleanings, fillings, or tooth extractions, you might want to consider Medicare Advantage. These plans often offer extra benefits such as dental, vision, and hearing services. According to the KFF, about 94% of people enrolled in Medicare Advantage plans had access to dental care. Dental insurance: If either you or your spouse is still employed, you may be eligible to join the employer’s group dental insurance. If you buy a health plan under the Affordable Care Act, some of them include dental coverage, or you can purchase dental coverage separately. Dental discount plan: Think of this as a membership program that offers discounted dental services. Here’s how it usually works: Every year, you’ll pay a fee that gives you access to a network of dentists and dental specialists who charge members discounted rates for exams, cleanings, fillings, and more. Ready to get started? Find a plan that fits your budget and covers your doctor and prescription medications now. Dental care can be expensive. But nearly half of Medicare beneficiaries—about 24 million people—don’t have dental coverage, according to the Kaiser Family Foundation[1]Medicare and Dental Coverage: A Closer Look. kff.org. Accessed 10/1/2021. . Proposed legislation aims to change that: Democratic lawmakers hope to add dental coverage to Medicare, which would be a boon to the 62.7 million people enrolled in it for their primary health coverage. In the meantime, here’s what to know about how people enrolled in Medicare can get dental coverage. Review Your Personalized Medicare Options With A Dedicated Advisor Your one stop shop for navigating Medicare and finding the benefits you are looking for. Get Started For Free No. Original Medicare, which is managed by the federal government, does not cover most routine dental care, dental procedures or supplies. People insured by Medicare have to pay the full cost of cleanings, fillings,
tooth extractions and dentures. However, Medicare Part A—which covers hospital stays, care in skilled nursing facilities and hospice care—pays for certain medical dental services provided during a hospital stay. For example, if you suffered a traumatic injury to your teeth or jaw, Medicare would cover
hospitalization and procedures medically necessary for recovery. Sometimes, Medicare Advantage (often called Part C) plans are approved by the federal government and sold by private insurance companies. These plans often offer services not covered by Original
Medicare, such as dental, vision and hearing coverage, says Christian Worstell, a North Carolina-based licensed insurance agent. Enrollees might pay an extra premium for these benefits. However, not all Medicare Advantage plans offer dental coverage, so it’s important to read your
plan’s details carefully. Medicare Advantage plans tend to be the best way to get dental coverage, but you can also buy a separate dental plan offered by a private insurance company, says Worstells. Exactly what dental coverage includes varies depending on the Medicare Advantage plan you choose. Aetna Medicare Advantage, for example, offers three types of dental coverage: According to the Kaiser Family Foundation, 94% of Medicare Advantage enrollees have some dental coverage. Of those, 14% only have
preventive coverage, which includes oral exams, dental X-rays and cleanings. Meanwhile, 86% have access to more extensive benefits that cover fillings, root canals, dentures and oral
surgery[2]Medicare Advantage in 2021: Premiums, Cost Sharing, Out-of-Pocket Limits and Supplemental Benefits. kff.org. Accessed 10/1/2021. . Generally, the cost of Medicare Advantage plans and dental coverage specifically in cases where
there’s an extra premium involved vary based on factors like your age and where you live. Some have a $0 monthly premium while others cost more. In eastern Pennsylvania, for example, Medicare Advantage plan premiums range from $0 to $302 a month. In the Los Angeles area, they range from $0
to $397 a month. Low-cost Medicare Advantage plans that don’t include an extra monthly premium for dental coverage typically include basic dental services, such as checkups and cleanings, says Worstell. “The more expensive plans [with higher premiums] include coverage of more advanced dental services like extractions and dentures and other things more relevant to older patients.” Ready To Find A Personalized Medicare Plan? Keep your doctors, maximize
your benefits, and save money when you use CoverRight’s online platform to compare Medicare Plans. Get Started Do Medicare Supplement Plans Cover Dental?Medicare Supplement plans—also known as Medigap plans—don’t directly cover dental, but they “pick up some of the out-of-pocket costs like copayments, coinsurance and deductibles,” says Worstell. Plus, many insurance companies that sell Medigap plans “offer you the option of adding a dental or vision package for an additional premium,” he adds. “They don’t all do that, but a lot of carriers these days are now offering it.” “My advice to all incoming Medicare beneficiaries is to ask yourself, ‘How do I plan to pay for my dental care?’ Do you have the funds to pay for it out of pocket? If not, you should strongly consider a Medicare Advantage plan or a standalone dental insurance plan from a Medicare carrier or insurance carrier,” advises Worstells. Does Medicaid Cover Dental Care?Medicaid dental coverage depends on the state in which you live, as well as your age. Medicaid is required to provide children with access to dental coverage, but each state determines which dental benefits adults enrolled in Medicaid receive. Most states do provide coverage for emergency dental services for adults, but fewer than half currently offer comprehensive dental coverage to adult Medicaid enrollees. This list summarizes each state’s current Medicaid dental offerings for adults. What Is the Best Dental Insurance for Seniors on Medicare?Determining which dental insurance plan is best for you requires a consideration of your specific needs and preferences. It all boils down to what aspects of dental coverage are most important to you, be it the cost, network size or benefits that address specific dental issues that concern you most. Start by narrowing your plan options based on your geography and budget. Next, you can compare various plans’ customer satisfaction ratings, coverage limits and more. It’s also worth researching the top dental insurance providers before enrolling in coverage. How to Enroll in Medicare Plans That Include Dental InsuranceYou can enroll in a Medicare Advantage plan when you first become eligible for Medicare or during the open enrollment period, which runs from Oct. 15 to Dec. 7 this year, says Worstell. He suggests visiting Medicare’s plan comparison website and entering your ZIP code to see each plan you’re eligible for and whether they include dental benefits. You can click into each plan summary to learn more about what that dental coverage includes. You can also enroll in a Medigap plan at any time throughout the year, says Worstell. However, he suggests doing so when you first become eligible for Medicare, since that’s when you’re likely to get the best rate. Frequently Asked QuestionsDoes Medicare cover dental implants?No, Original Medicare doesn’t provide coverage for dental implants. However, some Medicare Advantage plans do offer some coverage for dental implants, so be sure to review your specific policy before pursuing any procedures. What dental services are covered by Medicare?Unfortunately, Original Medicare does not cover any dental services. However, some Medicare Advantage plans do cover basic dental services, including cleanings, fillings, tooth extractions and dentures. Which Medicare Advantage plan has the best dental coverage?To find the best dental coverage for you, use Medicare’s plan comparison tool by entering your ZIP code. View each plan you’re eligible for and whether they include dental benefits. Read each plan summary to learn more about what the dental coverage includes. Why doesn’t Original Medicare cover dental?Medicare’s key coverage points have changed very little since the program was established in 1965. Why dental coverage wasn’t included in the original package is a matter of debate, but introducing it now would require an enormous political effort and financial investment. The American Dental Association has also consistently opposed the idea of bundling dental coverage into Original Medicare, citing the threat of lower pay. Does Medicare cover tooth extraction?No. Original Medicare doesn’t cover the costs associated with tooth extractions, but some Medicare Advantage plans may help cover tooth extraction procedures. |
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