Does Medicare Cover Dental Care?
More than 60-million retirees and other people with Medicare benefits need routine oral health care. However, as far as Medicare is concerned, dental coverage is not part of our overall health preventive care needs.
For most of us, the cold, hard fact is this: The government will not help us maintain good dental health, repair our teeth, or replace our missing teeth. This includes dentures. In fact, there's no coverage through Original Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. for any type of dental work unless it’s deemed Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.. Even Medicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. policies purchased to help with Medicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. A copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., do not cover dental. By law, they can’t.
In other words, seniors, we're on our own when it comes to maintaining our teeth. Unlike prescription drug coverage, Medicare itself does not approve plan options like they do with Medicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... or Medicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B).. To get coverage, you need to find affordable dental insurance or a dental discount plan.
What's the Best Dental Plan for Seniors?
Most people want to get right into it, so let's address the question that's probably on your mind, what's the best dental insurance for seniors on Medicare? Is it AARP, DeltaCare, Aetna, Cigna, or someone else?
We're sorry to say, there’s no single “best” solution. What’s best for you depends on two individual and equally important factors:
- Your budget; and
- How badly you need dental work right now.
We want to help you save as much money as possible and get some peace of mind. So, let’s discuss your options.
For most seniors, there are four basic choices:
- Pay full price out-of-pocket each time you go to the dentist.
- Join a Dental Savings Plan and pay 20-60% less on most procedures.
- Buy individual dental insurance that limits your coverage.
- Enroll in a Medicare Advantage plan with limited dental benefits (at an additional monthly cost).
If you are a low-income senior and qualify for Medicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States., you may have additional options that will help you get low-cost or no-cost dental care. The availability of this care is all based on where you live. More on this later.
For obvious reasons, paying full price for your dental care isn’t a smart thing to do. Even if you don’t believe you can afford dental insurance, and you don’t qualify for low-income assistance, you can get a very hefty discount for a small, annual fee, by enrolling in a Dental Discount Plan.
If you can afford dental insurance, it’s important to take the time to understand the limitations. Unlike Medicare and private health insurance, which covers you completely to the limits of the policy on day one, most dental insurance policies don’t. Dental insurance is one of those things that people like to buy, use, and then cancel. Wise to this, most plans have annual limits.
Most dental insurance plans use a 3-year graduated benefit model. For example, with a $500|$750|$1,000 plan, your maximum benefit in year one is $500, year two $750, and year three $1,000. After year three, if you stay with the plan, your annual maximum remains $1,000 per year.
In addition to the annual maximum benefit, many policies have a lifetime maximum benefit. The insurance company’s goal is a long-term relationship with clients who maintain their oral health through regular checkups and cleanings. Plans are intentionally designed to prevent high claims for dental restoration work by people with serious dental issues.
WARNING: You may pay much higher A premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. or be rejected for dental insurance outright if dental problems have already manifested themselves.
When considering your dental care budget, think about both:
- the monthly or annual cost of a plan, and
- how much you’ll pay out-of-pocket with a plan.
With dental insurance, you might pay less when you see the dentist, but you pay for the policy every month, even when you don’t need it. I say you might pay less because some dental policies have Coinsurance is a percentage of the total you are required to pay for a medical service. as high as 75% in the first year.
If you do the math, basic dental insurance may not be such a great deal. Basic plans cost an average of $29 to $45 per month ($480 per year, on average), plus you’ll pay 20 to 75% coinsurance. And that’s just a basic plan. Premium plans are in the $60 to $75 per month range, and up.
The alternative to dental insurance for seniors is a dental discount plan. It isn’t insurance, it’s a pre-negotiated rate plan with dentists. Most plans are in the range of $120 to $150 for an individual and $170 to $200 for a family. The typical savings is 20-60%.
Research the type and amount of dental procedures you think you’ll need. Let’s say you know you need to have a deep cleaning, five fillings replaced, and a new crown. Here's a sample of what you'd pay with a discount plan:
|Full Mouth X-Rays||$128.00||$128.00||45%||$70.40|
|Perio Scaling and Root Planing (Per Quadrant)||$260.00||$1,040.00||55%||$468.00|
|1 Surface Silver Filling for Primary or Permanent Tooth||$149.00||$596.00||64%||$214.56|
|Single Crown - Porcelain on Noble Metal||$960.00||$960.00||43%||$547.20|
When you add in the annual cost of the dental discount, $149.99, the total cost for the work is about $1,450. That’s a 47% savings!
Here's an example of the exact same work done using a basic dental insurance plan:
|Full Mouth X-Rays||$128.00||$128.00||50%||$64.00|
|Perio Scaling and Root Planing (Per Quadrant)||$260.00||$1,040.00||75%||$780.00|
|1 Surface Silver Filling for Primary or Permanent Tooth||$149.00||$596.00||75%||$447.00|
|Single Crown - Porcelain on Noble Metal||$960.00||$960.00||75%||$720.00|
Most basic plans only cover cleanings and checkups in the first two years. And that’s fine because most plans offer two or three free cleanings per year, which average $140 to $180 (full price). If you take advantage of the cleanings and have an annual checkup with full mouth x-rays, you’re breaking even on the monthly dental plan premiums.
How Badly You Need Dental Work
Budget is the first decision, and it’s important. However, it may get trumped by your need for immediate dental care.
Above I mentioned that most dental plans, particularly those with a monthly premium less than $60, have a graded A benefit period is a method used in Original Medicare to measure a beneficiaries use of hospital and skilled nursing facility (SNF) services. With each new benefit period, the beneficiary is charged a new benefit.... Others have a waiting period for just about everything except cleanings. That means you could end up paying your monthly premiums for 12 months before the policy will pay for any kind of restorative work, periodontics, oral surgery, etc.
If you find yourself in this situation, a dental savings plan is a must. There are no waiting periods, no A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., no ongoing monthly premiums, and no dental insurance company referrals. Simply show your card and save 20-60%.
A Third Option
An option you may want to consider, if you need work now and want insurance for the long-term, is to buy both a dental savings plan and dental insurance. Here’s why.
If insurance is what you really want, but you don’t have the budget for a premium policy with no waiting periods, then get a discount plan now while the waiting period on your basic dental insurance policy tics down. This way, you can start getting your teeth fixed now at a discount.
Choosing a Dental Discount Plan
At last count, there were more than 45 different dental discount plans on the market. None of them are available nationwide, but some of the best plans cover 40 or so states.
If you’re thinking that it will take some time to find the best discount plan, here’s some good news. We've done the research for you. After hours comparing features and reputation, the plans we recommend include:
- CIGNAPlus Savings Dental Network Access Plan
- Careington POS Dental Plan
- Aetna Vital Savings Plan
- :DP SmartHealth Plan
Here’s a brief overview of each of these plans:
CIGNAPlus Savings Dental Network Access Plan – CIGNA is one of the biggest names in healthcare, including dental. They offer two plans, but for just a little more, the CIGNAPlus plan offers vision, hearing, and wellness services. CIGNA claims average savings of 37% on most dental services including braces, cleanings, x-rays, root canals, crowns, dentures, implants, and more. The discount plan network includes general dentists, endodontists, orthodontists, oral surgeons, and other specialists. The list price is $149.95/year for individuals and $199.95/year for families.
Careington POS Dental Plan – Careington is a pioneer in the dental industry, delivering discount dental plans to more than 15 million members. They have the largest network of providers and a reputation for excellent customer service. We like this plan because of its discounts, including FREE added benefits for vision/LASIK, hearing, prescriptions, and specialty healthcare (not available in Florida). Careington claims their plan offers up to 20-50% at more than 62,000 participating dental locations, including orthodontics and implant specialists.
Aetna Vital Savings Plan – No doubt you already know that Aetna is one of the biggest names in Medicare. They offer Medigap plan, Medicare Advantage plans, Part D for prescriptions, and regular dental insurance, too. With their large provider network, it's really no surprise that they offer a DSP. What is a surprise is the value. The list price is $139.95/year for individuals and $179.95/year for families, making it a very good buy if you don't care about a lot of extras. Aetna claims an average of 15-50% savings on most dental services including cleanings, X-rays, root canals, crowns, dentures, implants, braces, and more!
:DP SmartHealth Plan – DentalPlans.com is the #1 name in discount dental. For more than 15 years, they've been committed to making care more accessible and more affordable for seniors. While they offer all leading DSP brands, they also have two plans of their own. We're impressed with the :DP SmartHealth Plan based on how much value it offers for the price. In addition to great dental discounts, you get discounts on:
- Telemedicine via eDocAmerica
- Emergency Medical Travel Assistance
- Vision Care and LASIK
- Hearing Care
Are you ready to see which dental discount plans are available where you live? Visit DentalPlans to choose from 40+ affordable dental savings plans. Join today and receive 1 additional month of membership free! Use promo code 1FREE.
Choosing the Best Dental Insurance Company
No dental plans that we've researched cover all costs. Due to the restrictions that most insurers put on dental insurance, it's critical to understand what you’re getting into before jumping in and buying a policy.
If your mouth is already healthy, basic dental insurance will help you keep it that way. If your oral health has declined, a basic dental plan will help you get it back to where it should be over a period of a few years.
It won’t take you long to realize that not all dental insurance is created equal. Even two policies that make similar claims like “Up to $3,000 in coverage!” have different meanings. You need to read the terms and conditions.
Dental Insurance Work Classifications
Most dental plans divide their coverage into several different classes. This makes it easier to see what’s covered and what isn’t. The common classes of coverage are:
- Class 1: This is your preventative dental care. This includes basic exams, X-rays, and cleanings. Most good plans cover 100% of these costs.
- Class 2: This is basic restoration dentistry. It includes fillings, root canals, and periodontal work. In this class, most commonly 80% of your expenses are covered by insurance.
- Class 3: This is your major restorative dental care, which most seniors need. This includes crowns, bridges, and dentures. Some plans don’t cover this at all, while others cover up to 50%.
- Class 4: This is your orthodontic services like braces, implants, and teeth pulling. Some plans will cover Class 4 work up to a certain amount per year (usually capped around $1,000) while many dental programs won’t cover it at all.
Now that you know the different classifications of dental work, you should have a good understanding of what to look for.
Compare Prices and Coverage
You might be tempted to compare plans based on monthly premiums or on coverage. If you want the best plan, you’ll need to look at coverage and cost together. When you do this, you’ll discover that one plan offering $2,000 in coverage only takes care of fillings, x-rays, and general cleanings while a different plan, that costs a little more for the same annual coverage, includes root canals, crowns, and bridges.
Therefore, the first step is to use the dental work you already know you need or anticipate needing in the future to eliminate the plans that don’t provide the coverage you need. You’ll be really upset if you buy a plan that won’t pay for that crown you just broke or a root canal to get rid of a bad toothache.
Research Your Local Network Providers
After you have narrowed your plan choices, it’s time to verify that your dentist will accept them. Unfortunately, most dental insurance, like health insurance, uses network providers. Just because you have insurance doesn’t mean your dentist will accept it.
Even if you don’t currently have a dentist, do your research. Read some online reviews. For this, we prefer Yelp.com. Call a few top-rated network dentists and ask them about the insurance policies they accept. You need to make sure you can find a good, local provider who accepts the coverage that you want.
Read the Fine Print
All dental insurance plans are different. They’re not standardized like Medicare. For this reason, it’s important to read the fine print to understand the limitations that any policy has.
There’s often a yearly limit to what insurance will cover in the first three classes of dental care. It’s also common for insurers to put a lifetime limit on what they're willing to cover from the fourth class, such as oral surgery. The fine print doesn’t just reveal limits and the type of dental work covered, it also explains the amounts you pay and coverage changes based on how long you’ve had the policy.
Medicare Advantage Plan Dental Insurance
There are a growing number of Medicare Advantage plans that offer dental coverage. It's most commonly found in HMO and PPO plans as an option, with a corresponding uplift in your monthly premium.
The most common coverage level is $1,500 per year with full coverage on basic procedures and partial coverage on major services. For example, Humana offers the most plans with a dental coverage option.
What Other Resources Are Available?
If you need dental services, and you can't afford to pay, there are resources available:
Medicaid: In some states, Medicaid covers limited dental services. You may qualify for Medicaid if you have income below the poverty level and limited assets. Check with your local Medicaid office.
Reduced-Cost and Free Clinics: Dental clinics are available in many states, but their availability is spotty in rural areas. You can research what's available near you by visiting NeedyMeds, healthcare.gov, freeclinics.com, and hhs.gov.
Federally Qualified Health Centers (FQHCs) sometimes offer dental care. These are health clinics located in under-served areas. Anyone with Medicare benefits is eligible to receive services from an FQHC, including some services that Medicare does not cover.
Community Health Centers, funded by the Health Resources and Services Administration (HRSA), offer free or reduced-cost health services, including dental care. You can find centers near you on the hrsa.gov website.