Routine dental care is an essential piece of your overall health care. With millions of Americans receiving Medicare coverage, many people wonder whether that coverage includes dental benefits. The answer is a little complicated because it depends on the type of Medicare plan you have and the type of dental service you are receiving. If dental coverage is not included with your plan, you can also choose to purchase a separate dental plan. If you have questions about dental coverage with Medicare, you are in the right place. We’ll explain everything you need to know about Medicare coverage of dental services.
Does Medicare Include Dental Coverage?
Are you wondering, “Does Medicare cover dental?” Unfortunately, Original Medicare does not include dental coverage for routine dental services. This includes preventive services, like cleanings and x-rays, as well as other services such as fillings, tooth extractions, or dentures. While most dental procedures are not covered by Medicare, some emergency dental work might be covered if it is necessary for your overall health. For example, if you are in an accident and require emergency jaw surgery, the dental work associated with the surgery would likely be covered under Medicare. Similarly, if you require a hospital stay as a result of dental work, your Medicare coverage would pay for the hospital stay but not the dental work itself.
While Original Medicare does not provide coverage for routine dental work, some other Medicare options do provide that coverage. Many Medicare Advantage plans offer additional benefits beyond traditional Medicare benefits. These additional benefits often include dental coverage. Even though these plans are managed by private insurance companies, many people often still refer to them as Medicare dental coverage or Medicare dental plans. Some Medicare beneficiaries choose to simply purchase a standalone dental plan in addition to their Medicare coverage. Dental insurance plans are usually inexpensive, and their covered services usually include a wide range of common dental services.
Dental Services Covered By Original Medicare
So, which dental services are covered by Original Medicare? Unfortunately, the answer is almost none. Remember that Original Medicare consists of Medicare Part A and Medicare Part B coverage. Medicare Part A is hospital insurance that covers hospital stays, inpatient services, hospice care, and care in a skilled nursing facility. Most dental services are performed on an outpatient basis. These services are not considered inpatient care, and hospital stays are generally not required. However, in the rare event that a hospital stay is required, your Medicare Part A benefits should cover the stay. For example, suppose you undergo oral surgery that requires a stay in the hospital. Medicare Part A would cover the hospital stay, although it would not cover the surgery itself.
Medicare Part B is medical insurance that covers doctor visits, outpatient care, durable medical equipment, and a few other items. However, Part B does not provide coverage for dental work. However, there are a few narrow exceptions here. Most of the exceptions occur during emergency treatment. Part B will cover some dental services if a doctor deems the service medically necessary to perform the overall treatment. For example, suppose that you require emergency jaw surgery after an accident. If a tooth extraction is required as part of the emergency surgery, Part B will cover the extraction.
Dental Care With Medicare Supplemental Insurance
Medicare supplement insurance, or Medigap, is used to help cover your out-of-pocket costs not covered by Original Medicare. You can think of Medigap as an extension of your Medicare coverage. It helps pay for things like copays, coinsurance amounts, and deductibles. There are approximately ten different Medicare supplement plans to choose from today, and these plans are standardized across most states. The coverage details of your Medigap plan depend on which plan you are enrolled in, and the average cost of a Medicare supplement plan depends on the level of coverage provided.
However, Medicare supplement insurance will not help you pay for dental services. Since Medigap only assists with the payment of services that are covered by Medicare, dental services do not fall in this category. Imagine that you visit the doctor and are required to pay a $50 coinsurance amount under your Medicare coverage. Your Medigap plan covers the $50 coinsurance payment. But since dental services are not covered by Medicare, those services are also not eligible for Medigap coverage. Many people who are enrolled in Medicare supplement insurance choose to purchase a separate dental insurance plan to cover those services.
Dental Coverage With Medicare Advantage Plans
Medicare Part C, or a Medicare Advantage plan, combines both your Part A and Part B benefits into a single plan. This makes the management of your coverage and benefits easier in most cases. The other added benefit of these plans is the fact that most Medicare Advantage plans provide additional benefits beyond the coverage the Original Medicare program offers. These health plans are managed by private health insurance companies. The plans must offer at least the same minimum level of coverage as that provided by Original Medicare, but most plans offer more coverage and benefits. These benefits often include dental coverage, vision coverage, gym memberships, Part D prescription drug plans, and many other great benefits.
Since each insurance provider is allowed to set its own rules about coverage details and rates, the coverage offered under each plan varies. The pricing of the plans also varies, although most plans are a low-cost option for obtaining dental coverage. Some plans require a monthly premium, while others do not. When it comes to dental coverage, most plans cover basic preventive services like cleanings and x-rays. Most Advantage plans also cover common dental services, like fillings, extractions, root canals, and other services.
While many Advantage plans cover the dental services mentioned above, your out-of-pocket cost for these services will vary depending on your coverage details. Some preventive services might be covered at 100%, while most other services are not. This means that you will be responsible for a coinsurance payment amount of anywhere from 20% to 60% of the service. Those amounts are still better than paying for 100% of the cost of the service out of your own pocket.
Enrollment In A Medicare Advantage Plan
So, how do you get signed up for a Medicare Advantage plan? The process is easy, although you should be aware of the timing. You cannot enroll in one of these plans at just any time. There are certain time periods during which you can enroll, and you might need to pay a late enrollment penalty if you miss your initial sign-up period. You can sign up for a plan during your initial enrollment period, which begins three months before your 65th birthday and runs until three months after your birthday. Medicare also has an open enrollment period each year during which you can sign up, although you might be required to pay the late penalty if you do not qualify for a special enrollment period.
The plans available to you will depend on where you live. You can easily compare plans using the Medicare plan finder tool. This tool allows you to find Medicare Advantage plans in your area, and you can easily determine which ones offer the dental coverage that you need. You can also speak to a licensed insurance agent in your area to help you find and compare plans. Once you have found the plan that meets your needs, you simply need to contact the insurance company that manages the plan. Provide the company with the details they need to start your coverage. The start date of your coverage will depend upon when you sign up. The insurance company that you select will be able to tell you the effective date of your coverage.
Finding The Right Dental Insurance
So, how do you decide which type of coverage is right for you? The answer really depends on your personal situation. You should take a look at your dental history to help determine your needs. Do you routinely visit the dentist for regular cleanings and preventive care? Do you have extensive previous dental work that causes you regular problems? You can likely take a look at your dental visits over the past few years to determine the types of services you are likely to need in the future.
You have several different options when shopping for dental insurance. You could choose to enroll in Original Medicare without any dental coverage at all. You could also choose to add a standalone dental policy to supplement your Medicare coverage. Another option is to enroll in a Medicare Advantage plan that combines your Medicare coverage with dental and vision benefits. You should look closely at the coverage details and the overall cost associated with each option. Remember those monthly premiums are not the only costs associated with an insurance plan. Copays, deductibles, and coinsurance amounts can really add up if you frequently need services. Also, remember that you have both HMO and PPO options when selecting an Advantage plan. You will want to make sure that your preferred dentist is in the network of the plan that you select.
Selecting the right plan involves balancing the overall cost of the plan, the size of the provider network, and the list of covered services. The right plan for your friend or neighbor might not be the right plan for you. It is usually wise to ask a licensed insurance agent for some assistance when selecting your plan to make sure that you get the coverage you need without spending money on things that you don’t need.
The Bottom Line
Routine dental care is extremely important for your oral health and your overall health. However, Original Medicare, unfortunately, does not provide coverage for regular dental services. If you need dental coverage, you will need to purchase a standalone dental plan or a Medicare Advantage plan that offers this benefit. Many Advantage plans provide dental coverage, and some of those plans do not even require a monthly premium payment. Coverage details vary from plan to plan, so make sure that you fully understand the details of the plan before signing up.
Frequently Asked Questions
How much are the fees for dental services covered by Medicare?
The fees for your dental service depend on the provider you use and the type of service you receive. Original Medicare does not provide coverage for dental services, so you will need to pay 100% of the cost of the service out of your pocket. The fees could range from less than $100 for a basic cleaning to over $500 for a root canal or other procedure. If you wish to purchase coverage for these types of services, you will need to purchase a standalone dental policy outside of Medicare or enroll in a Medicare Advantage plan that provides dental benefits.
What is the dental coverage for people who are under 65?
Medicare dental insurance coverage is the same for people under 65 as for those over 65. Remember that younger individuals can qualify for Medicare if they have received Social Security disability benefits for more than 24 months. However, Medicare still does not provide dental coverage to those individuals. They will still need to purchase a separate dental policy that will cover their dental work.
Does Medicaid cover dental services?
Since Medicaid is a state program, the services covered by Medicaid vary from state to state. Coverage of dental services by Medicaid is required for individuals under 21. So, any person under 21 who receives Medicaid benefits will have dental coverage included. However, dental services are not guaranteed for those over 21. Some states provide dental coverage, while others do not. If you are unsure about the details of your coverage, you should contact your state Medicaid office to determine whether you have dental coverage.
