Did you know that dental care is one of the most commonly skipped healthcare services in the United States? In fact, according to a report from the Centers for Disease Control and Prevention, nearly one-third of Americans didn’t see a dentist in the past year.
One of the main reasons for this is the high cost of dental care, which can be a significant financial burden for many individuals and families. And unfortunately, even those with health insurance may not have dental coverage. According to the National Association of Dental Plans, around 40% of Americans lack dental insurance coverage.
However, Medicare Advantage plans (Medicare Part C) may cover some dental services if you enroll in them. This article will examine typical dental services covered under Medicare Advantage plans, applicable restrictions or limitations, and how to maximize your dental benefits. So whether you’re a senior or researching for your Medicare-eligible loved ones, let’s dive in so you can be more educated on what to expect with dental and Medicare Advantage.
What is Dental Coverage in Medicare Advantage Plans?
Medicare Advantage plans may offer dental coverage as an additional benefit beyond what Original Medicare covers. There are several types of dental coverage available in Medicare Advantage plans.
- Preventive dental services: These services include routine dental exams, cleanings (prophylaxis), and x-rays. Preventive services are designed to help prevent dental problems before they become more serious.
- Basic dental services: Including fillings, extractions, and other minor dental procedures. Basic services are designed to treat dental problems that have already developed.
- Major dental services: These services include more complex dental procedures or nonroutine services, which are Prosthodontics (crowns, bridges, dentures, and implants), Endodontics (root canal treatment), and Periodontics (treatment of gum disease and oral inflammation). Major services are designed to treat serious dental problems that require more advanced treatment.
It’s important to note that not all Medicare Advantage plans offer dental coverage, and the specific benefits and coverage options can vary between plans. Your coverage under a Medicare Advantage plan may be limited, with some plans only covering one dental cleaning every six months, one extraction per year, or one set of x-rays per year.
Benefits of Medicare Advantage Plans with Dental Coverage
- Improved oral health: Regular dental check-ups and cleanings can help prevent serious dental problems from developing.
- Enhanced overall health: Poor oral health has been linked to serious health problems, including heart disease, stroke, and diabetes.
- Cost savings: Dental procedures can be expensive, and the cost of dental care is often not covered by Original Medicare. By providing coverage for dental services, Medicare Advantage plans with dental coverage can help seniors save money on out-of-pocket dental expenses.
- Convenience: Some Medicare Advantage plans with dental coverage offer access to a network of dental providers, making it easier for seniors to receive the dental care they need.
How Much Does Medicare Advantage Plan Dental Coverage Cost?
When it comes to Medicare Advantage dental coverage, there are a few things to remember. First off, you’ll typically be responsible for paying either a copayment or coinsurance. For example, you might have a 50% coinsurance requirement or a flat $50 copayment.
It’s worth noting that if your Medicare Advantage plan only covers “Medicare-covered” benefits, you may have to pay for routine dental services, like cleanings and fillings, entirely out of your own pocket. It’s worth noting. However, a majority of covered dental plans within Medicare Advantage plans to offer no-cost basic dental cleanings, x-rays, and exams. However, the coverage is entirely based on the carrier and plan and the county you live in.
Are There Dental Coverage Limitations with Medicare Advantage?
It’s important to understand that dental coverage is not a required benefit under Medicare Advantage. It’s up to your insurance companies to decide whether to include dental coverage in your plans. So, if you’re considering Medicare Advantage and dental coverage is important to you, be sure to review the plan’s benefits and coverage options carefully.
Even if dental coverage is included in your Medicare Advantage plan, there are often limitations to what is covered. For example, routine dental services like cleanings, x-rays, and fillings may be covered. Still, more extensive procedures like root canals, crowns, and implants may not be covered or have significant limitations.
It’s also important to note that Medicare Advantage plans typically have an annual maximum out-of-pocket limit, which can vary from plan to plan. This means that once you reach that limit for the year, your plan will cover the full cost of any covered services for the remainder of the year. Although this limit does not apply to dental coverage, so you may still be responsible for high out-of-pocket costs for dental procedures.
Can I Choose My Own Dentist with Medicare Advantage Plans?
When it comes to choosing a dentist under Medicare Advantage, the options can vary depending on the plan you choose. While some plans allow you to see any dentist who accepts Medicare patients, others may have a more limited network of dental providers.
If you have a preferred dentist that you would like to continue seeing, it’s important to check whether they are part of the network for the Medicare Advantage plan you’re considering. You can find this information on the plan’s website or by contacting their customer service department.
If your preferred dentist is not in the plan’s network, you may still be able to see them, but you will likely have to pay higher out-of-pocket costs, or your visit may not be covered at all. Some Medicare Advantage plans may allow you to see an out-of-network dentist, but again, be prepared for higher costs.
If you’re unsure about which Medicare Advantage plans to choose or which plan allows you to pick your own dentist, Southern CA residents can schedule a FREE consultation.
How to shop for Medicare Advantage plans with dental coverage?
Shopping for Medicare Advantage plans with dental coverage can seem overwhelming, but with a few key steps, you can simplify the process and make an informed decision.
Check star ratings
The Centers for Medicare & Medicaid Services (CMS) gather data on Medicare Advantage plans through surveys of plan members, submissions from the plans themselves, and information provided by medical providers. This information is then used to assign a star rating to each plan, with a scale of 1 to 5 stars, where 5 represents the highest rating.
Research available plans
Begin by researching the available Medicare Advantage plans in your area. One way to accomplish this is by accessing Medicare.gov, or if you live in Southern CA, you can use my Medicare Advantage Plan finder.
Determine your dental needs
Consider your current dental health and any upcoming dental procedures you may need. This will help you determine which plan may be the best fit for your needs.
Check for dental coverage
Once you’ve narrowed down your options, check each plan’s dental coverage. Some plans may offer basic coverage, while others may provide more comprehensive coverage for routine and major dental procedures. Southern CA residents can schedule a FREE consultation to explore their specific needs.
Review provider network
If you have a preferred dentist or dental provider, check whether they are part of the plan’s network. This can impact your out-of-pocket costs and the overall quality of care you receive.
Carefully review each plan’s costs, including premiums, deductibles, copays, and coinsurance. Consider how much you’re willing to pay each month versus how much you’re willing to pay out-of-pocket for dental care.
Understand your benefits
After enrolling in a Medicare Advantage plan that covers dental, review your benefits and understand how to use your coverage. This may include learning which dental services are covered, which providers are in-network, and how to submit claims.
If you reside in Southern California, you can use my Medicare Plan Finder to make an informed decision. Once you find a suitable plan, enroll yourself directly online by following the quick and easy steps, or reach out and ask for my assistance to help guide you if unsure. For those with general inquiries, you can also contact Medicare.gov (1-800-633-4227).
Check out the video below for enrolling online tutorial.
What Are Your Options if Your Medicare Advantage Plan Doesn’t Cover Dental?
If your Medicare Advantage Plan doesn’t offer dental coverage, here are some options to consider:
- You can enroll in a standalone dental insurance plan to help cover your dental expenses. These plans may offer more comprehensive coverage than what is available through Medicare Advantage plans. But be aware there will be monthly premiums associated with the plan you select.
- Consider switching to a different Medicare Advantage plan with dental coverage. Check to see if your current plan offers other benefits that you value before making the switch.
- Discount dental plans are not insurance plans, but they offer discounts on dental services at participating providers. These plans may be more affordable than standalone insurance plans.
- You may be eligible for dental care through Medicaid if you meet the income and eligibility requirements. However, eligibility requirements for Medicaid vary by state, and some states may not cover dental services for adults.
- Talk to your dental provider about payment plans or other options to make your dental care more affordable.
- Some community health centers or clinics may offer low-cost or free dental services. Consider reaching out to these resources for assistance.
Frequently Asked Questions
The frequency of denture coverage will depend on the specific plan and its policies. Assume you have a Medicare Advantage plan that includes dental coverage. The plan may cover the cost of a set of dentures once every five years. Although, another Medicare Advantage plan may have different coverage policies and may cover dentures once every seven years or may have an annual coverage limit for dental services, including dentures.
No, Original Medicare doesn’t cover dental implants or dentures. However, some Medicare Advantage plans may provide coverage for dental implants. It is important to check your specific policy to understand what is covered before considering any dental implant procedures.
If you are looking for the best dental coverage under Medicare, Southern CA residents can use this Medicare plan finder tool. Take the time to read each plan summary carefully to learn more about the specific dental coverage. Don’t forget to check if your preferred dentist or dental provider is included in the plan’s network, which can impact your overall satisfaction with the plan.
No. Original Medicare doesn’t cover tooth extractions or other dental procedures, but some Medicare Advantage plans may offer some coverage for tooth extraction costs. If you’re considering a Medicare Advantage plan, be sure to review its dental benefits carefully to determine whether it covers tooth extractions or other necessary dental procedures.