Does Medicare Cover Dental?

Does Medicare Cover Dental? Video & Blog

One of the most common questions we receive is, Does Medicare cover dental procedures or eye exams?

The short answer is that Medicare does not cover most dental care.  This includes cleanings, fillings, dentures, extractions and so on. It also does not cover eye exams for eyeglasses or contact lenses.

However, Medicare Part A, inpatient coverage, may cover certain dental services that are related to your inpatient hospital stay.  For example, it is not uncommon for your doctor to require an oral exam and treatment before an organ transplant or heart surgery.  This may also include emergency or complex dental procedures related to facial cancer, reconstructive surgery and so on. That is covered by Medicare.

Regarding vision, keep in mind that Medicare will cover eye diseases or conditions like cataracts and glaucoma.  But it does not cover corrective vision.

Because Medicare does not cover basic dental care and has very limited dental benefits, stand-alone dental, vision and hearing insurance coverage is very popular among those on Medicare.  But also very misunderstood.

In this video, I will review how you can get dental insurance coverage and how you compare one plan versus another.   You will want to be able to sort through the plans that are available to you and identify the best value.  So, grab a pen and paper and join me as we guide you through dental plans that improve upon your Medicare.

Link to cheat sheet mentioned in the video: https://medigapseminars.org/wp-content/uploads/2022/05/DVH_Consumer-Cheat-Sheet_2022.pdf

The Importance of Oral Health

It is no secret that dental health is linked to overall health.  Studies have also shown that the number one reason people do not go to a dentist as often as they should is cost.

Because Medicare does not cover regular dental checkups or dental care, there is a need for dental insurance specifically for people aged 65 and older.   Good dental insurance plans lower the cost of dental care and provide a low enough cost for preventive care to encourage regular dental visits.

Keep in mind, because Medicare does not cover dental services, neither do Medicare supplement plans.  Many Medicare Advantage Plans include some dental coverage, but as not as in-depth as dental insurance.

What Is the Connection Between Oral Health and Overall Health?

Our mouths are home to millions of bacteria.  That’s true with many area of our body, but our mouth is a gateway to digestive and respiratory tracts.  Without proper oral hygiene, the levels of bacteria can reach levels that result in gum disease or other infections.  Many studies have shown that Oral health is a strong indicator of overall health.

Our oral health can also be negatively impacted by certain medications.  There are many common prescriptions that reduce saliva.  Saliva is critical to neutralizing acids produced by oral bacteria.

Lastly, studies have shown links between oral health and diabetes, Alzheimer’s disease, cardiovascular disease and post operative joint replacement infections.

The bottom line:  seeing a dentist regular can significantly improve your quality of life in your senior years.

Does Medicare Cover Dental

Does Medicare Cover Dental?

Does Medicare Cover DentalIn general, Medicare does not cover dental care or vision and hearing.  Medicare will cover a person for disease or injury.  For example, Medicare will cover cataracts or glaucoma.  It will cover some reconstructive dental surgery in the case of an accident, and so on.

However, Medicare does not cover dental cleanings, procedures like root canals or implants.  Medicare will also not cover hearing aids or vision care relating to degenerating eyesight that happens to so many of us as we age.

This is where Dental, Vision & Hearing Plans Shine

Dental Insurance Plans

At Medigap Seminars we offer multiple dental plans as well as plans that include vision and hearing benefits.   The cost of the plans is relatively low, but the benefit they provide to your overall health is significant.

These dental  insurance plans typically offer much better insurance coverage than what you might find with a Medicare Advantage Plan.   Dental benefits often found in Medicare Advantage Plans are very basic, typically do not cover major services and change every year.  

Do Medicare supplements cover dental?  A Medicare supplement only covers what Medicare covers.  The supplement adds benefit by paying the copays and deductibles left as your responsibility.  The supplement does not cover additional benefits.

Characteristics of Dental Insurance Plans

Dental insurance plans are constructed differently than most health-related insurance.  Below are some of the characteristics of dental insurance that are common amongst the most popular plans.  Keep in mind that there are literally hundreds of different dental plans or dental, vision and hearing plans available.  What we have done sought out those that provide the best value for our Medicare clients.

  • Deductible: most dental plans have an annual deductible that must be met before benefits are paid.  A deductible between $25 and $100 is common.
  • Maximum Benefits: all dental plans will have a maximum annual benefit.  That cap is the most insurance benefit the plan will provide during a calendar year.  Often, you can choose your maximum benefit.  Common choices are $1,000, $1,500, $2,000 or $3,000.  Some plans have options that are higher.
  • Per procedure cap: in addition to the annual benefit cap, your insurance coverage will have a maximum benefit per procedure. This is actually the most important feature of the dental insurance plan.  For example, some will have a maximum benefit of 50% per procedure while one plan we work with is 80% per procedure.  Obviously, on a day-to-day basis the person with coverage of 80% per procedure will get more benefit out of their insurance.
  • Benefits ranked By Type of Procedure: Dental policies categorize place your benefits in certain categories that determine your coverage.  Common categories include Prevent Services which usually include cleanings, exams, and bitewing x-rays.  Basic Services which typically include diagnostics, comprehensive x-rays, and non-surgical extractions.  Major Services: this category includes Periodontal services, Crowns, Endodontic Services and may include Implants and other more costly services.
  • Graded Benefits: Dental policies are also constructed so that people do not wait until they have a major dental need before they purchase a policy.  Obviously, insurance will not work if people wait for a need before they purchase.  In the case of dental insurance policies, a graded benefit is when you benefits start small and increase over time.  A common graded benefit structure may include 100% on preventive services.  Basic services covered at 50% the first year and increasing to 65% or 80% after the first year.  Major services for most plans have no coverage the first year, increasing to 50% after the first or second year.  A couple of the plans we offer will provide 20% coverage the first year and increase to 50% thereafter.
  • Networks: most dental insurance policies have networks. Some do not allow a benefit if you see a doctor out-of-network.  Some policies will provide benefits regardless of network but provide you a better rate in-network.   Most dentist belong to either the Careington or Ameritas networks.
  • Vision & Hearing: There are plain vanilla dental plans that only provide dental insurance.  Then there are plans that also provide vision and hearing coverage.  Most dental insurance plans that provide vision and hearing only provide minimal benefits.  For example, the maximum annual benefit for vision or hearing may be as low as $250 or $500.  That said, one of our plans allows you to apply the full maximum annual benefit of the plan to either dental, vision, hearing or any combination thereof.  If you need vision and hearing coverage, there is no better plan available.

Does Medicare Cover Dental Cleaning?

No, but most dental insurance plans include two free cleanings and exams per year.

This is important:

Please keep in mind, the insurance policy that has greater insurance coverage for the expensive procedures and / or a higher percent per procedure payout will likely be your best value.

Does Medicare Cover Dental?  No, but that’s OK.  There are many stand-alone dental, vision & hearing policies with a variety of benefits and monthly premiums that will fit your budget and your needs.  I hope the information we covered in this video will help you to compare plans and find the best value for your needs.

If you are on the fence about these plans, research has shown that dental health is linked to overall health and those who have dental insurance coverage tend to have better dental health.  So please do not neglect your dental health. At least take a look at the dental policies available to you.

Call us or contact us through our website for personalized help.

If you have an interest in Dental insurance or Dental, Vision & Hearing Insurance please call us at 800-847-9680 or use the Contact Us form below and let us know you have an interest in dental insurance coverage.

Take a look at some of the dental plans we work with:

Ameritas: https://myplan.ameritas.com/id/010S4605

Protector Plus: https://myplan.ameritas.com/ppd/id/010S4605

GPM: https://myplan.ameritas.com/gpm/id/010S4605

Studies referenced in the video: 

https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/dental/art-20047475  https://dentistry.uic.edu/news-stories/the-many-costs-financial-and-well-being-of-poor-oral-health/

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Matthew Claassen, CMT and CEO of Medigap Seminars Insurance Agency. Medigap Seminars is an award winning premier national Medicare Insurance Brokerage, ranked among the top in the U.S.A. Matthew is considered a leading national expert on Medicare and Social Security. Mr. Claassen is a distinguished member of the Forbes Business council, an invitation only organization of business leaders and entrepreneurs. He and his team have received awards from many of the countries largest insurance companies including Mutual of Omaha, Aetna, Humana, Cigna, United American, United Healthcare and others. His videos have become the most popular Medicare educational videos on YouTube with millions of views. As a financial analyst Matthew lead a team of researchers to win the 2009 Best Equity Research & Strategy Award from The Technical analysis magazine.

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