With millions of Americans receiving Medicare benefits, many wonder about their dental coverage on Medicare. Dental care is critical to one’s overall health, so visiting the dentist for routine cleanings and exams should not stop simply due to age.
Although Original Medicare does not include a dental plan, there are still several ways to get dental coverage while on Medicare.
Keep reading as we tell you everything you need to know about enrolling in Medicare dental coverage. We will give you all your options and explore some of the best Medicare dental plans available today.
Does Medicare Cover Dental Care?
No, Original Medicare does not cover dental care. This applies to nearly all routine dental services, like cleanings, fillings, crowns, extractions, dental X-rays, dental implants, and dentures.
If you have a dental procedure performed, you will be responsible for paying the entire bill out of your pocket. That is, of course, unless you have an alternate method of dental insurance. In the next section, we will discuss the available options for you while enrolled in Medicare.
So, what dental services are covered by Medicare? It is worth noting that there are a couple of exceptions to the Medicare rule on dental services. While Medicare does not cover basic dental care, it will pay for dental services in at least one situation.
- If the service is medically necessary to treat a condition covered by Medicare, then Medicare will pay for the dental service. This is usually most common in the case of accidents or emergencies. For example, suppose you are in an accident requiring emergency jaw surgery. If a tooth extraction is necessary to perform that surgery, then Medicare will pay for the extraction.
- Similarly, your Medicare Part A hospital insurance will pay for a hospital stay that results from a dental procedure. Imagine that you have oral surgery and require a stay in the hospital as a result of the surgery. Even though Medicare will not pay for the oral surgery, your Part A benefits will pay for the resulting stay in the hospital.
KEY TAKEAWAYS
- Original Medicare does not cover dental care; unless you have alternative coverage like Medicare Advantage, you will be responsible for all costs out-of-pocket.
- Original Medicare may cover some emergency dental services; however, you will need a Medicare Advantage or a stand-alone dental plan to cover routine procedures.
- Enrollment in Medicare Advantage plans with dental coverage only happens during open enrollment, while supplemental dental plans may have more lenient enrollment periods.
How To Get Dental Coverage On Medicare
If Original Medicare does not provide dental benefits, how can you get dental coverage while on Medicare? There are several different options available. You can use one of these options to get coverage and help pay your dental provider when you receive treatment.
Medicare Advantage Plan
Medicare Advantage plans, or Medicare Part C can be a great way to add dental coverage to your Medicare benefits. These plans are managed by private insurance companies that contract with Medicare to offer these plans.
By law, each Advantage plan must offer at least the same minimum level of coverage as Original Medicare. However, most Advantage plans provide many additional benefits. These extra benefits often include dental coverage, vision coverage, gym memberships, and other great benefits.
Some plans do not even require a monthly premium! If you are a Medicare beneficiary needing dental coverage, a Medicare Advantage plan might be your best choice.
Dental Supplemental Insurance
Since Original Medicare coverage does not include dental benefits, many people look for other ways to add a dental plan. If you are looking for a plan that covers routine dental care, like cleanings, fillings, and root canals, supplemental dental insurance for seniors might be right.
Instead of selecting a Medicare Advantage plan with costs and benefits you don’t need, you can add a dental-only plan to your Medicare coverage. This dental insurance plan would be in addition to your Original Medicare coverage, allowing you to maintain your oral health without incurring substantial out-of-pocket expenses.
Since a private insurance company manages each plan, the details of each plan will be different. This means they will have different premium amounts and cost-sharing models, like deductibles, copays, and coinsurance amounts.
Medicare Part A Emergency Services
We previously touched on this coverage earlier in this article, but there is a way to get your Medicare Part A hospital insurance to pay for dental services. However, the exclusions covered by this rule are pretty limited.
Even though Medicare will not cover preventive services at your dentist or routine services, like fillings, your Medicare Part A plan covers emergency care that is medically necessary to treat a Medicare-covered condition.
For example, suppose you are in an accident and require emergency surgery to repair your jaw. If a tooth extraction is medically necessary to perform the jaw surgery, then your Medicare benefits will cover the tooth extraction and the surgery.
Pay Out-Of-Pocket
Paying out-of-pocket is your last option for dental coverage. If neither your Part A nor Part B benefits will cover the service, and you don’t have a Medicare Advantage plan or supplemental dental policy, you will be forced to pay for your dental expenses independently.
Remember that Medigap will not cover these expenses since Medicare does not cover them. You might find that your Medicare Part D prescription drug plan will cover some prescription costs, even for dental procedures. Those could include antibiotics, pain medications, or other medicines that might be necessary when you obtain dental treatment. However, the amount owed to your dental provider will be incurred as out-of-pocket costs.
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Best Medicare Advantage Plans For Dental Care
So, which Medicare Advantage plans offer the best dental coverage? Here are the best Medicare Advantage plans if you are looking for dental coverage.
Humana
Humana offers plans in all 50 states, and its online capabilities are some of the best available. You can easily manage your plan, find a provider, or perform other tasks through your online account. In addition to dental, Humana also offers the Silver Sneakers program and other benefits that can be extremely helpful for seniors.
Kaiser Permanente
If you are looking for the best customer service, then Kaiser Permanente is the plan for you. This company consistently ranks at the top of the list for customer service, and they have some of the highest-rated Medicare Advantage plans on the market. In addition to dental, you also receive vision and hearing coverage with most of these plans. The main drawback is that these plans are only available in a handful of states.
United Healthcare
United’s plans offer the largest network of providers of any of the plans. Plus, you get access to many AARP benefits as well. They have plans with a wide range of premiums to meet your needs, and you can also choose to add other benefits, like hearing or vision coverage. While these plans are available in most states, they are unavailable everywhere. So, you should check to determine whether they are available in your area.
Cigna
If you have special dental needs, then Cigna is your likely choice. They offer a wide range of plans for seniors with unique dental needs. Their plans often include coverage for more extensive procedures, and they offer flexible plans that allow for coverage of regular checkups and more intense visits with dental specialists. If you wonder, “Does Medicare cover dental implants,” you might want to consider a Cigna plan. The Cigna plans are available in roughly half of the states today, so check your area to determine whether you can qualify for one of these plans.
TIP
Dental care is an essential part of your overall healthcare needs. Dental coverage is unavailable through Original Medicare and must be obtained through a stand-alone policy or Medicare Advantage plan.
Enrollment In A Dental Insurance Plan
Now that you’ve decided to enroll in a dental plan, how can you get signed up? The answer may vary a little depending on which type of plan you decide on.
- If you want to sign up for a Medicare Advantage plan, you will need to enroll during your initial enrollment period or the Medicare annual enrollment period each year. During this time, you can sign up for a new plan or change your existing plan.
Unfortunately, you cannot decide to switch to a Medicare Advantage plan at any time during the year. It must be done during one of the enrollment periods.
- Some supplemental dental plans may have enrollment periods, but many allow you to sign up anytime.
- Once you select a plan option, contact the insurance company that manages the plan. Ensure you have closely examined all the coverage options and details and the list of network providers.
Once you have chosen the right plan, the insurance company will gather your information and issue an insurance card. When services are performed, you will present that card to your dentist, and they will bill your insurance company.
You will then be responsible for any costs not paid by your insurance plan. Once you sign up, the process works much the same as traditional medical insurance.
Cost Of Medicare Dental Plans
So, how much does a Medicare dental plan cost? The cost varies greatly depending on the plan’s type and coverage details.
There are many different plan options available, like HMO and PPO. Some Medicare Advantage plans that include dental coverage have zero monthly premiums. However, make sure you read the fine print. They may have a limited number of network dentists, and the cost-sharing expenses might be extremely high.
- On average, a quality dental plan costs anywhere from $35 to $75 per month.
- If you opt for a Medicare Advantage plan with dental coverage, you can expect to pay $50 to $150 monthly.
Again, you might find cheaper plans, but those usually do not offer the same benefits as those with higher premiums.
Consult a licensed insurance agent if you need assistance selecting the right plan. They can assist you with finding the right plan for your situation by balancing overall costs with the benefits provided.
Remember that the monthly premium is not the only cost associated with the plan. You are also responsible for deductibles, copays, and coinsurance amounts when you receive service, so you must consider those costs.
The Bottom Line
Although Original Medicare does not provide dental benefits, there are several ways that you can enroll in a dental plan while on Medicare. Many people opt for a Medicare Advantage plan that includes dental coverage, while others choose a dental supplement plan to add to their Medicare coverage.
Remember that your traditional Medigap, or Medicare supplement insurance, will not cover dental services either.
There are a few limited circumstances under which your Medicare emergency coverage will pay for dental services. Still, you will usually need to pay out-of-pocket for dental expenses unless you have added another type of dental policy.
Frequently Asked Questions
Anyone who is eligible for Medicare can choose to enroll in Medicare dental coverage through Medicare Advantage or through a supplemental dental policy.
There are no other eligibility criteria that must be met in most cases. Unlike traditional health insurance, there is usually very little underwriting that must be done before you can enroll in a dental plan.
The main benefit of a Medicare dental plan is that your out-of-pocket dental expenses should be lowered. Since the plan pays for some services, like cleanings, fillings, or other dental work, you will no longer be responsible for paying 100% of the cost of the service out of your own pocket.
The coverage details will vary depending on your specific plan, but most plans will cover at least 40% of the cost of dental services. This can save you quite a bit of money. You should also be aware that most plans have an annual limit on how much money they will pay.
Once you hit that limit, you will have to pay for all services on your own for the rest of the year.
Absolutely! Remember that Original Medicare does not include dental coverage, and it also provides no option for dental coverage. Medicare does not cover dentures, dental implants, or even regular checkups.
If you wish to add Medicare dental insurance, you will need to select a Medicare Advantage plan that has this benefit or add a supplemental dental policy. Either of these options can be a great choice depending on your personal situation.
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