- Dental Care is key to overall health and dental coverage has a positive impact on dental health.
- Comprehensive dental coverage can be purchased separately from Medicare, offered by a private insurance company.
- Most Medicare Advantage plans offer at least some dental coverage. But Medicare Advantage dental benefits change yearly.
Medicare Dental Coverage
One of the most common questions we receive is,
Does Original Medicare cover dental procedures, routine dental care or eye exams?
The answer is that no, Original Medicare does not cover routine dental services or most dental care. This includes cleanings, fillings, dentures, extractions and so on. It also does not cover eye exams for eyeglasses or contact lenses.
Original Medicare is designed to cover diagnosis and treatment of diseases and conditions. Dental care is not considered a disease or condition. Neither is corrective vision care. That is why dental benefits are not offered with Original Medicare, it does not fit within Medicare’s written mission.
Regarding vision, keep in mind that Medicare will cover eye diseases or conditions like cataracts and glaucoma. But Medicare does not cover corrective vision care.
Although technically there is no Medicare dental coverage, anyone can add dental coverage to their Medicare, whether they have Original Medicare or a Medicare Advantage plan.
Check Out Our Favorite Dental Plans
Below the video are links to what I consider the top dental insurance available to Medicare beneficiaries on Original Medicare. Use these links to find the standalone dental insurance plan that is right for you.
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 the cost of dental care. Dental services can be expensive.
Because dental services are not covered by Medicare, there is a need for dental coverage specifically for people aged 65 and older. Good dental coverage lowers the cost of dental services. Preventive services are often covered at 100%. This encourages regular dental visits and results in a healthier mouth.
What Is the Connection Between Oral Health and Overall Health?
Our mouths are home to millions of bacteria. That’s true with many areas of our body, but our mouth is a gateway to digestive and respiratory tracts. Without proper oral hygiene, 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.
What is a Stand Alone Dental Plan?
Because Medicare does not cover routine dental care, standalone dental plans are very popular among Medicare beneficiaries.
Standalone dental coverage is a policy that is separate from Medicare or any other medical insurance. It offers benefits, specifically dental benefits, in addition your other coverage. Anyone can get dental coverage not related to Medicare.
The best standalone dental insurance plans offers comprehensive dental coverage. This will include preventive care, basic and major dental services.
Medicare beneficiaries can purchase dental coverage, or cancel the dental coverage at any time. Because these dental services are not connected with your Medicare, the dental services offered by the plan have no impact on your medical benefits.
Unlike dental coverage within Medicare Advantage plans, with a standalone dental plan you own your own policy. The benefits will not change from year-to-year. No one can take the plan away from you, or alter the benefits as long as you pay the monthly premium.
Your best dental coverage comes from having your own separate dental plan that includes the dental benefits you find most valuable.
Does Medicare Cover Dental?
In 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 also cover some reconstructive dental surgery in the case of an accident, and so on.
However, Medicare does not offer cover dental services for 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 Coverage With Medicare Part A?
Interestingly, Medicare Part A (hospital insurance) may cover certain dental services that are integral to your inpatient hospital stay. For example, it is not uncommon for your doctor to require an oral exam before a kidney transplant or heart surgery. This may also include emergency or complex dental procedures related to facial cancer, reconstructive surgery and so on.
Keep in mind, because Medicare does not cover routine dental services, neither do Medicare supplement plans. Anything that is not covered by Medicare cannot be covered by a Medicare supplement.
Medicare Advantage Plan and Dental Coverage
According to the Kaiser Family foundation (KFF.org) 94% of enrollees in a Medicare Advantage plan have some form of dental coverage. Most Medicare Advantage plans offer dental coverage.
Unfortunately, nearly 60% of these people have a coverage limit of just $1,000. Many have dental coverage for only preventive and basic services like tooth extractions, with no dental coverage for more extensive services like root canals.
While having any benefits that lower dental costs for Medicare Advantage enrollees is good, the dental benefits of a Medicare Advantage plan do not compare the benefits of a standalone dental plan.
Weakness of Medicare Advantage Plans Dental Coverage
Medicare Advantage plans tend to change their dental care benefits annually. So the great benefits you have this year can be gone or severely limited next year. Advantage plans are managed by private insurance companies whose only obligation is to offer benefits from the same category as benefits offered by Original Medicare.
Please check your Medicare Advantage plans annual Summary of Benefits to see if it includes dental benefits. If so, does it cover major dental care, oral surgery, tooth extractions or just preventive coverage?
Our Standalone Dental Insurance Plans
At Medigap Seminars we offer standalone dental coverage as well as plans that include vision and hearing benefits. The intent is to offer dental coverage that will reduce your out of pocket costs for whatever dental procedure you need.
The cost to get private dental coverage is relatively low, but the benefit they provide to your overall health is significant.
These dental plans typically offer much better insurance coverage than what you might find with a Medicare Advantage Plan. Dental benefits often found in a Medicare Advantage Plan change every year.
Does a Medicare supplement plan cover dental? A Medicare supplement plan 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 coverage that are common amongst the most popular plans purchased by Medicare beneficiaries.
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 whether they have Medicare supplement plans or are Medicare Advantage enrollees.
- 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 coverage limits on dental care. 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. One plan we work with has an annual benefit of $10,000.
- Per procedure cap: in addition to the annual benefit cap, your insurance coverage will have a maximum benefit per dental care procedure. This is actually the most important feature of the dental coverage. For example, some will have a maximum benefit of 50% per procedure while another plan covers 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: All Dental policies place your benefits in certain categories that determine your coverage. This includes the dental care covered by Medicare Advantage plans. Common categories include Preventive 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 like emergency dental 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 policies, a graded benefit is when your percentage of 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 major procedures coverage at 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. There are policies that 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 coverage. Then there are plans that also provide vision and hearing coverage. Most dental 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.
- Keep in Mind that Medicare covers eye and mouth disease or injury, like cataracts, glaucoma, macular degeneration and more.
Does Medicare Cover Dental Cleaning?
No, but most dental plans include two free cleanings and exams per year.
Dental Supplemental Insurance for Medicare?
Standalone dental policies are not part of Original Medicare. They are private plans you own and control. That means you can take them with you when you move, change Medicare plans or are traveling.
This is the opposite of what you get with Medicare Advantage plans.
We like to think of dental plans as a “dental supplement plan” because of the synergy between these plans and Original Medicare. They work perfectly together to reduce out of pocket costs and keep you healthy.
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 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.
If you have an interest in Dental coverage 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 benefits.
Take a look at some of the dental plans we work with:
Protector Plus: https://myplan.ameritas.com/ppd/id/010S4605