Original Medicare covers many things, but it does not cover routine dental services. Routine services include things like cleanings, fillings, root canal treatments, extractions, crowns, bridges, and dentures.
Medicare Part A, your hospital insurance, does offer benefits for dental services if they are performed as part of emergency care in a hospital. It can also pay for inpatient hospital care when it is required for advanced dental procedures.
Otherwise, Medicare beneficiaries will have to look outside of Original Medicare (Part A and Part B) if they want to purchase a plan that includes routine dental coverage.
Let’s discuss why having dental coverage as part of your Medicare benefits is important and how to obtain coverage.
The Importance of Dental Insurance
Dental health is critical to one’s general health. Unchecked decay and disregard for oral hygiene can exacerbate a number of medical problems, including heart disease and diabetes. It can also raise the risk of Alzheimer’s disease.
Dental treatment, on the other hand, is still costly, which may lead to older adults who are on a fixed income forgoing dental care or even dental emergencies. The good news is that with so many low-cost solutions available, today’s older adults can preserve their teeth well into the future.
Dental insurance is an excellent method to save money on dental care. If you are a Medicare customer, there are several options for joining a dental plan.
Medigap Plans and Dental Coverage
Unfortunately, Medigap (Medicare supplements) do not offer any additional benefits for dental services. Coverage remains the same as it did with Medicare Parts A and B, limiting benefits to those performed on an emergency basis within a hospital setting.
Dental Insurance Options
Since Medicare supplement plans do not offer dental coverage, beneficiaries can purchase a separate plan to complement their Medicare supplements. This can be done in one of two ways.
One option is to enroll in an individual dental insurance policy. These policies will have their own deductibles and premiums and can vary significantly on the coverage they provide.
Typically, a plan will have a $0 – $100 annual deductible and up to a $1000 – $5000 maximum. Preventative services (cleanings and exams) should be covered at 100% of the allowable charge. Basic services like fillings and root canals are commonly covered at 60-100%, and major services like crowns and bridges are commonly covered at 60-80%.
Some plans offer more coverage, and some plans increase coverage the longer you are enrolled in the policy. And of course, some plans offer less than typical coverage. The example above is a great place to start when shopping for a policy.
Unfortunately, these plans usually have a one-year waiting period for any major treatment.
Dental, Vision, and Hearing (DVH) Plans
A DVH plan is a Medicare supplement insurance policy that covers dental care, routine vision exams, and hearing exams.
The maximum benefit of these plans varies. Some plans offer a maximum benefit of $1000, $1500, $2500, or $3000 depending on where you live.
A few of the major carriers are Aetna, Manhattan Life, National General (an Allstate Company), and Medico. Like individual policies, these plans may increase their coverage and benefits the longer you are enrolled.
A DVH plan offers its policyholders more benefits than a standalone dental insurance plan. In either case, you should consider who your current providers are and make sure that they are part of the network you are choosing to enroll in. You may also want to speak with your dentist to find out about any treatment that you may need in the near future.
Medicare Advantage Plans and Dental Coverage
If you have chosen to enroll in a Medicare Part C plan, you probably already have dental coverage. There are several big differences between Advantage Plans and Medigap (Medicare supplement) Plans, one of which is that Advantage Plans generally cover dental, vision, and hearing services.
Having all of your insurance rolled into one plan is a big reason these Part C plans are so appealing to many Medicare beneficiaries.
There are several factors to consider when making the initial choice to enroll in Medicare Advantage. Regarding your dental coverage, make sure there are providers in your area who are in-network with your Advantage Plan.
As in the examples above, the level of coverage, deductibles and maximums will vary.
How to Enroll
While you may enroll in a policy on your own by going to a carrier’s website, working with a licensed insurance broker can help you save time and effort when comparing plans and enrolling.
Our team is ready to assist you every step of the way. We’ll be there for you during the application process, answer your questions and help with any enrollment issues that might arise.
It’s important for older adults to have some form of dental coverage outside of the emergency services provided by Original Medicare. Seemingly small pieces of our body can cause major health problems down the line, so having an insurance plan that provides preventive services can keep you healthy.