Dental care and hygiene is a good indicator of your overall health, so it’s understandable that most people are interested in dental coverage while on Medicare.
Unfortunately, Original Medicare doesn’t cover most dental services. Not the usual dental care you are used to, such as cleanings, fillings, crowns, x-rays, implants, etc. Medicare Part A (hospital) does pay for certain dental services when you’re in a hospital, but that would only be in very limited situations. Think: dental care related to a serious accident that hospitalizes you.
how should you address this?
Cash Pay
Some Medicare beneficiaries go this route by paying cash, which typically comes at a discounted rate for dental services. Many dental offices provide a discount of at least 10% for not having to run the claim through an insurance carrier. Check with your dentist’s office to see if they offer cash discounts or potentially their own dental coverage program.
Stand-Alone Dental Insurance Plan
You can always purchase a dental insurance plan at any time while on Medicare. There are many dental insurance plans available, but you’ll want to confirm that your dentist is in-network with any plans you’re considering. Otherwise, out-of-network dental services can cost you more. Talk with your dentist first to narrow down your search. For more support, you can work with an independent insurance agent.
Keep in mind: It’s pretty common to see waiting periods for certain dental services when you initially purchase a stand-alone dental insurance plan. For instance, a 6- or 12-month waiting period could be required for major services like crowns and extractions. Also…except for routine cleanings, dental plans are not designed to cover 100% of the cost of services. It’s a cost-share. You pay a portion and the insurance company pays a portion. But once you reach your plan’s max benefit amount, the insurance plan is capped out for the policy year.
Dental Insurance Coverage Inside a Medicare Advantage (Part C) Plan
Medicare Advantage plans, which can combine Medicare Parts A, B, and D into one plan, do have the ability to provide extra benefits for dental services that Original Medicare doesn’t cover. Always confirm this in the plan’s Summary of Benefits (SOB) and Evidence of Coverage (EOC) documents. You’ll see dental plans in two variations inside a Medicare Advantage plan:
Built-in dental plan with no additional premium
You might receive one or two no-cost teeth cleanings per year, a set of x-rays, or a fluoride treatment. Some plans include comprehensive dental as well. There won’t typically be an additional premium for this option, but the coverage could be less than you would receive in a stand-alone dental plan.
Optional supplemental benefit dental plan with a premium
If you prefer a more comprehensive dental insurance plan, some Medicare Advantage plans will include Optional Supplemental Benefits at an additional premium each month. This could help beef up your dental coverage to a higher level…and sometimes include no waiting periods! Again, verify the offerings in the plan’s Summary of Benefits document.
In both variations, the plan could use a specific dental network of providers, so be sure to check your dentist’s participation in the network.
Reference Links
www.medicare.gov
Medicare Dental Services
Neither Medicare Mindset LLC nor its agents are connected with the Federal Medicare program.
