Do you dread dental work? Will Medicare pay for your dental work?
If you are like most Americans, you fear the dentist chair. It can be expensive, inconvenient, and sometimes uncomfortable. Unfortunately postponing dental work creates bigger problems for the long-term.
As a senior this can be a problem. Recent discoveries show that dental health is related to the immune system and even heart health.
Not having the ability to cover dental work is a problem for seniors. Surprisingly, nearly 66% of Medicare enrollees have no coverage.
The stats get worse:
- Oral Cancer is 7x more likely to be diagnosed in people over 65
- 20% of seniors have untreated dental cavities
- 25% of seniors are missing all of their natural teeth
- On average seniors have 9 decayed or missing teeth
So if you fall into one of these groups, where you currently don’t have dental coverage, but are a Medicare enrollee, how do you get coverage?
There are options for Medicare subscribers. In this article, we detail where you can find coverage inside and outside of Medicare.
Does Medicare A and B cover dental?
Medicare does not cover most dental care. This includes dental procedures and supplies such as cleanings, fillings, tooth extractions, dentures, or dental plates.
This may be bad news for many Medicare recipients, but there are exceptions.
Part A Medicare
There is an exception for Medicare Part A. They will pay for certain dental services you may receive while in the hospital. For example, if you are in an accident that damages your jaw and teeth and are hospitalized as a result. The dental work received in the hospital due to the accident would possibly be covered.
Other examples are:
- An oral exam in a hospital prior to a kidney transplant
- An oral exam prior to a heart valve replacement
- Services related to jaw diseases such as oral cancer
- Reconstruction when a facial tumor is removed
Be aware that Medicare will not pay for follow up dental care after the underlying condition has been treated in a hospital.
How do I get dental care with Medicare?
Medicare Part C
Medicare Part C often referred to as Medicare Advantage has plans that often cover dental coverage as an add-on coverage.
Medicare Part C combines Medicare Part A and Part B into one complete plan. These plans are distributed and managed through private insurance companies. Many of the plans may add extra benefits such as Part D prescription drug coverage, vision insurance, and even dental.
If you are eligible for a Part C plan, and dental insurance is a concern make sure it is part of the plan you choose.
Part C plans work similar to traditional health coverage in the private sector. There are networks of coverage and restrictions on using those networks. The plans are not available everywhere if there are no networks present where you live.
For the Part C plans that do offer dental coverage, the coverage can vary widely between plans. In our experience there is usually a basic level of care that is included when dental benefits are present.
Some of these services are:
- Teeth cleaning
- Routine X-rays
Again make sure you look at the policy and coverage language to understand what is covered under your chosen. Even if coverage exists there will be limits on services you can use along with deductibles and maximum costs covered.
Future Changes to Medicare and Dental Insurance
In 2018, the bipartisan Action for Dental Health Act was passed. Unfortunately, most of the changes were based around education and awareness for oral health rather than access to care.
Bills are routinely introduced by members of Congress to add dental care to Medicare’s list of coverages, but up to this point there has been little success for coverage expansion.
The most recent attempt was in 2019. Sen. Ben Cardin of Maryland introduced legislation to include dental coverage under Part B. It did not advance beyond the 2019 session.
Dental Insurance Options for Seniors
Before jumping in to the options, many seniors may think purchasing Medicare Supplement policies will provide dental coverage. Medicare Supplement policies (or Medigap) do not provide for Dental coverage. However, this does not mean you still can’t get it.
Medicare Supplements are designed to cover out-of-pocket expenses that are not covered by Medicare. Because Medicare does not cover dental issues in most cases, Supplement policies follow suit.
However, many of the companies that offer Supplement plans will also offer separate dental coverage.
What are your options for dental insurance outside of the Medicare system?
- Former Employer or Spouse’s employer
Many employers will allow you to extend dental coverage for a time after you retire. Many seniors access dental coverage this way. If your spouse continues to work, you can often be part of their plan as well.
Low-income seniors that are eligible for both Medicare and Medicaid can access limited dental benefits from Medicaid. Some of these coverages include dentures, but these can vary from state to state.
- Dental Schools / Community Health Centers
For seniors struggling to find coverage, you can find many dental schools that will offer care at reduced prices. Many community health centers offer services at a sliding scale based on income.
- Dental Lifeline Network
This charitable network coordinates dental care for the elderly. It is income based care, but there are options that help people who could otherwise not afford treatment.
- Dental Savings Plans
These plans are not insurance, but allow you to create a savings plan that often comes with discounts within a certain network of dentists. Each discount plan will offer different versions of reduced rates based on the services available.
- Private Dental Plans
Many insurance companies that offer Medicare products such as Medicare Supplements will also offer Dental plans as well. You will often find that a company will partner with a Dental insurance company such as Dental Dental as well. Within these plans you can find a wide variety of options such as HMOs that restrict your network or broader PPO plans.
Which Medicare plan has the best dental coverage?
Before jumping into the most popular carriers for senior insurance, you need to know a bit about how dental coverage works.
Coverage isn’t always immediate. For most plans, preventative care such as cleanings and x-rays will be covered immediately. But if you need other dental work such as fillings, implants, or dentures, there could be a waiting period. This will vary between companies, but you need to understand this feature before signing up.
Waiting periods tend to range anywhere from 6-12 months depending on the service needed. What this means for you as the insured is that you need if you need dental work beyond normal maintenance, you may have to wait for a period of time before you can schedule the work. The clock starts ticking the minute your policy becomes effective.
Keep this in mind as you think about the options.
Over the years, we have represented multiple companies and have even tested out their products ourselves.
Each company has a unique set of options and usually multiple plans. Once you narrow down what you need from dental insurance, contact an agent to discuss the options and they should be able to quote multiple companies and find the policy that fits you budget and coverage needs.
After sifting through the options, we narrowed our company lineup to Ameritas and Mutual of Omaha.
The Ameritas Dental network is one the largest in the nation, and is available in most states.
The biggest benefit of the Ameritas dental plan is they pay 80% for basic services. Most carriers only pay 50%. For seniors on a tight budget, this provides the ability to maintain their dental health at reasonable prices.
There is no deductible for preventative services and only a $50 deductible for major services. It is hard to find a plan with such generous deductibles.
Even during the waiting period for major services, Ameritas will still provide partial coverage. Many don’t provide any coverage until the waiting period is complete.
Mutual of Omaha
Mutual of Omaha is a well known brand for life insurance and Medicare products. They also have a competitive dental product as well.
Their national network includes over 375,000 provider locations.
One unique feature of their product is they offer a vision benefit rider that will pay $50 every calendar year for one eye exam and up to $150 every two years for eyeglasses or contacts.
They offer 2 different products: Mutual Dental Preferred and Mutual Dental Protection. The main difference is the deductible amount you are responsible for.
Dental care is critical to good long-term health. If you neglect this part of your health, you will see a cascade of effects in other areas of your life. Don’t let budget be a concern when thinking about whether you need coverage. You need it.
Like many health coverages, there are plenty of options to choose from when deciding on dental provider. As Medicare professionals, we provide access to a wide range of dental insurance companies.
Rather than being overwhelmed by your options, let us do the work for you.
Based on you location and coverage needs, we can provide multiple quotes from various providers doing business in your area. Once you look at the options, you can decide on which plan is right for you.
Our agents are experienced with many carriers and can help with recommendations based on our own experience and prior customer feedback.
Contact us, and let us help you find a dental plan that fits you needs.
Prefer to chat by phone? Give us a call at 1-833-309-2125.
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