You likely already know that millions of retirees rely on Medicare for health insurance coverage. However, doctor visits and hospital stays aren’t the only things seniors might need. Dental benefits are extremely important to most people, whether they just get regular cleanings or have more involved dental needs. So, does Medicare provide dental coverage? What options are available for Medicare recipients to add dental coverage? Keep reading as we give you all the details. We’ll tell you everything you need to know about getting dental services covered while receiving Medicare.
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Does Medicare Cover Dental Care?
No. Original Medicare does not cover dental care. Medicare Part A and Medicare Part B provide hospital insurance and health insurance, but they provide no coverage for dental services. So, what does Medicare cover? Part A covers most inpatient care and hospital stays, and Part B pays for things like doctor visits, preventive services, outpatient services, and lab tests. In some situations, Part A will pay for limited dental services received as part of your inpatient care in the hospital. This typically applies to emergency dental services related to an accident that are needed for your overall health. Medicare does not pay for routine services like cleanings, fillings, dentures, or extractions.
Since Original Medicare coverage does not include dental insurance plans, Medicare recipients have a few options. First, they could choose to simply pay out of pocket for any dental services they receive. They could also choose to sign up for a Medicare Advantage plan that includes dental benefits. Lastly, they could purchase standalone dental insurance through a private insurance company. Each of these options will be discussed in more detail throughout this article.
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Dental Coverage With Medicare Advantage Plans
Although Original Medicare does not provide dental coverage, many Medicare Advantage plans do provide benefits for dental services. Remember that Medicare Advantage plans, or Medicare Part C, are plans administered and managed by private insurance companies. These plans must provide at least the same minimum level of coverage provided by Medicare, but they can provide additional benefits as well. Many of these plans include dental insurance that covers a wide range of dental procedures. The cost and coverage details of these dental plans vary by provider since each provider is allowed to set its own rules.
If you decide to enroll in an Advantage plan that covers dental care, make sure you closely read through the details of the plan. Coverage details will vary by plan, and you want to make sure that your plan will meet your needs. Some plans might cover dentures, while others do not. Some plans might cover basic cleanings at 100%, while others might require a copayment. Root canals, X-rays, routine dental care, and other procedures are handled differently in different plans. Similarly, monthly premiums, copays, and coinsurance amounts will all vary. Make sure that you know the details of the plan before signing up. You should be able to make a decision on whether that plan will meet your needs according to your personal situation.
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Medicare Supplement Coverage Of Dental Services
Many people choose to enroll in Medicare supplement insurance, or Medigap, to help them cover out-of-pocket costs not covered by Medicare. So, does this mean that Medigap will pay for your dental care? Unfortunately, Medicare supplement insurance does not provide dental benefits. Medigap pays for out-of-pocket expenses that are not paid for by Medicare, although it does not provide coverage beyond Medicare’s covered services. So, what this means is that the service must be covered by Medicare for Medigap to help pay for it.
Medigap will help cover things like deductibles, coinsurance, and copays. For example, suppose you receive treatment in the hospital and are required to pay a $150 coinsurance amount. Although your Medicare plan covers much of the cost, you are still required to pay $150. This could be a financial burden for many people. This is where Medigap comes into play. Your Medigap policy could help you pay for the $150 coinsurance amount not paid by the Medicare program. Although private insurance companies manage Medigap policies, they are mostly standardized. There are approximately ten different plans available, and each one has slightly different coverage details and costs. As with most health plans, you should speak with a trusted insurance agent to help you choose the right plan for your situation.
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Dental Coverage With Medicaid
Now that you know there are no Original Medicare dental benefits, what about oral health coverage for those on Medicaid? Remember the difference between Medicare and Medicaid? Medicare is a federal healthcare program provided for those who have paid Medicare taxes into the system. On the other hand, Medicaid is a joint federal and state program. It is designed to provide health care coverage for low-income individuals and families who cannot afford their own coverage.
Dental coverage with Medicaid depends on a few factors. The first factor is age. For individuals under 21, Medicaid dental benefits are mandatory. This means that the Medicaid program must provide dental coverage for these individuals as part of the EPSDT benefit program. This coverage must include regular dental screenings performed by a dentist as well as any services required to treat a condition identified during the screening. This could include tooth extractions, fillings, or other services.
For individuals over 21, Medicaid is not required to provide dental coverage. They might be required to pay for dental work on their own. Whether or not Medicaid provides dental coverage to those over 21 is decided by each state. So, some states provide dental coverage to Medicaid enrollees, while other states do not. You should check with your state Medicaid office to determine whether you are eligible for dental benefits.
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Other Dental Insurance Options For Seniors
Now that you know the details of dental insurance coverage for Medicare beneficiaries and Medicaid recipients, what other options are available? Remember that many Medicare beneficiaries choose to enroll in a Medicare Part D prescription drug plan since prescription drug costs are not covered by Medicare. Similarly, you may choose to enroll in a stand-alone dental plan to help cover the cost of dental services. Many insurance companies, like Cigna, Delta, and others, sell dental plans to Medicare enrollees. Each of these plans has different costs and coverage details. You should always closely examine your options to make sure you select the plan that is right for your situation. You might find that your best option is selecting a Medicare Advantage plan that includes dental coverage.
You also have the option to pay for dental costs out of your pocket. Dental insurance is not required, so you do not have to buy dental coverage if you don’t need it. Perhaps you do not visit the dentist often or have other reasons for not needing dental insurance. In that case, your best option might be to go without coverage and pay for any expenses that might arise on your own. Again, only you can make this decision based on your personal finances and health situation.
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How To Enroll In Dental Coverage With Medicare
If you wish to enroll in dental coverage with Medicare, you have a couple of options. You may select a Medicare Advantage plan that includes dental coverage, or you may enroll in a stand-alone dental plan. If you choose a Medicare Advantage plan, you cannot just sign up for it at any time. If you are not already enrolled in one of these plans, then you will need to wait until the open enrollment period to sign up. Similar to group health insurance through your employer, the ability to sign up for coverage is limited to certain times of the year. During this period, you can also switch from Medigap coverage to a Medicare Advantage plan.
If you decide to sign up for a stand-alone dental policy and keep Original Medicare, you should contact the plan administrator to determine how to enroll. Many of these plans also have open enrollment periods during which you can sign up for Medicare coverage. A local insurance agent can help you find plans that will work for you, and they can also help you with getting signed up. Once you enroll in coverage, you should receive an insurance card that should be used whenever you receive dental treatments.
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The Bottom Line
Original Medicare does not provide any dental benefits to its beneficiaries. Likewise, Medigap will not help pay for the cost of dental services. However, there are several options that these people can choose from to obtain dental benefits. The most common options are Medicare Advantage plans and standalone dental policies from private insurance companies. You should examine your personal situation to determine which option is best for you. Some people even choose to completely forego dental coverage and pay for dental services on their own.
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Frequently Asked Questions
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What are the requirements for Medicare coverage of dental?
First, remember that Original Medicare does not provide dental coverage for routine dental care. In some situations, Part A might provide limited coverage for dental work that is required as part of overall health. This often occurs in the event of accidents or other situations that require emergency dental services. Even though dental coverage is not provided through Original Medicare, many Medicare Advantage plans include dental coverage. These plans are managed by private insurance companies, and the coverage details vary by plan.
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What is the price for dental coverage for seniors?
The price for dental coverage varies depending on the specific plan selected. Some Medicare Advantage plans are available for no monthly premium, even including dental coverage. However, most dental insurance plans require a monthly premium of anywhere from $20 to $50 per month. In addition to the premium, there are also other costs associated with dental treatment, such as copays, deductibles, and coinsurance amounts.
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What are the steps to getting dental coverage through Medicare?
To get dental coverage through Medicare, you will need to enroll in a Medicare Advantage plan. This can be done when you first become eligible for Medicare or during an open enrollment period. Remember that Original Medicare does not provide dental coverage, so an Advantage plan is the only way to get dental coverage with Medicare. Simply browse some of the best Medicare Advantage plans available and select the one that best fits your needs. Contact the insurance company that administers the plan to sign up. You will begin paying the monthly premium (if there is one), and your coverage will begin.
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Which dental services are covered by Medicare?
Remember from the overview of Medicare early in this article that dental services are not covered under Original Medicare. In some cases, Medicare may provide limited coverage for dental services that are medically necessary for one’s overall health. This is sometimes the case during accidents or emergencies when some type of dental care is required immediately. However, Medicare does not cover routine dental care, like cleanings, fillings, or other services. Some Medicare Advantage plans do cover these services.
