One of the most common questions we hear from people going on Medicare is this: “Will Medicare cover my dental?” Since so many people ask us this question, we’ve decided to address it here today. We’ll first briefly explain how dental coverage works in Medicare, then show you how to get dental benefits on Medicare.
Original Medicare A & B Dental Coverage
The first thing you need to realize is that there is essentially zero dental coverage on original Medicare A and B. That’s right, zero. Now, on very rare occasions, Medicare A and B might chip in and pay.
For example, if someone has jaw cancer and had to have part of their jaw removed, Medicare might participate in the cost of teeth and jaw reconstruction surgery. But you’ll never see original Medicare covering things like root canals, crowns, or fillings. So what are your options for dental insurance on Medicare?
Advantage Plan Dental Coverage
Statistically speaking, about half of you reading this will get an Advantage plan. Advantage plans almost always include some kind of dental benefit. Let’s talk about the different aspects of Advantage dental plans.
Dentist Networks
Most of the Advantage plans have a network of dentists. This means you can only go to a dentist within the Advantage plan’s approved network. So as long as your dentist is in the network or you’re willing to switch to a dentist within the network, you’re good to go. If not, you probably won’t want to rely on the embedded dental Advantage plan.
Dental Benefits
The benefits of Advantage dental plans will vary from plan to plan. For example, some plans may only cover preventive benefits. This means your cleanings and X-rays will be covered about two times a year. But that’s all your plan will cover.
Other plans might add some comprehensive benefits like fillings, extractions, or maybe root canals. But even if they add a few extra benefits, keep in mind that embedded Advantage dental plans always have a limit (usually about $1,000 worth of dental benefits). They do not cover everything.
Some Advantage dental plans will have the dentists file the claim directly with the plan, while others will make you pay the bill and then you’ll turn in a form to the insurance company to get reimbursed.
Some Advantage dental plans offer 50/50 benefits. This means they typically provide a set of X-rays and a couple of cleanings at no cost to you. After that, they will split the expense with you 50/50 up to the plan limit.
There are a few Advantage plans throughout the country that allow you to add dental benefits to the plan. This means they don’t include any dental as part of the package and it’s up to you to buy separate dental benefits. Typically, your monthly payments for added dental coverage will be in the $25 to $50 range.
Supplemental Plan Dental Coverage
If you decide to stay on Original Medicare and get a Supplemental plan, you will most likely have to add a dental benefit to your plan. Now sometimes the Supplemental plan will offer dental coverage with your plan, but typically it is not included and you will have to look for a standalone plan yourself.
Let’s now look at some of the things you’ll need to consider when purchasing a stand-alone dental plan.
Network
First, you’ll want to begin with the network. If you already have a dentist you like, start by asking him or her which plans they prefer and accept. This will help you get better pricing and ensure you go with a plan your dentist works with.
Now, if you don’t have a dentist or you’re willing to change to a different dentist, start by shopping for a plan you like. Once you find a great plan that works well for you, you can find out which dentists in your area accept that plan.
Premiums
Stand-alone dental plans have different premiums depending on the plan you choose. Typically, the premiums range between $30 and $60 each month. But of course, when you’re considering premium amounts and which plan to go with, keep in mind that a lower monthly premium means lower annual benefits, just like a higher monthly premium means higher annual benefits.
Benefits
Every add-on dental plan is going to have preventive, basic, and major benefits. You can access your preventative benefits (which cover things like cleanings) immediately. This means as soon as you have the plan, you can go get your teeth cleaned and the plan will cover the cost.
Basic benefits (which cover extractions, fillings, and other low-cost items) do not cover all your costs. Instead, you typically have to pay 20 percent of the cost, and the dental coverage will take care of the remaining 80 percent. Some plans will make you pay premiums for six months before they’ll step in and cover these basic dental services.
The third type of dental benefits are major services and this coverage is for things like root canals, crowns, and dental implants. Typically, the dental plan will cover 50 percent of major services and you’ll be responsible for covering the remaining 50 percent. Some major service dental plans will make you wait 12 months before you can take advantage of the major dental coverage.
Sometimes, however, if you can prove that you’ve had dental coverage in the past and that it hasn’t lapsed for more than 60 days, the company will waive the basic and major waiting periods.
Conclusion
Since original Medicare does not cover dental benefits, you will have to rely on either Advantage plan dental coverage or an add-on Supplemental dental plan. For those of you who have very healthy teeth and only get cleanings, you may never get your money back from a dental plan. However, for those who have ongoing teeth issues, purchasing a good dental plan will be an important investment for your future.
We understand how difficult making the right Medicare decisions can be. To take the next step, watch our full course here or schedule a free one-on-one call with a certified Medicare School Guide who can answer your questions, compare plan options, and even help you enroll. Click here to get started.
