Finding the right health care plan can be a daunting process. When determining your health care needs, don’t forget to include dental services in the overall equation.
Even if you’ve been fortunate enough to have a healthy smile, oral health becomes more of an issue as we age. Yet, almost half of all Medicare beneficiaries did not visit the dentist in 2019, according to a KFF report published in 2021.
“It is surprising how many seniors forgo dental insurance since periodontal disease is very common among seniors and can be very expensive to pay for out of pocket,” says Mary Johnson, a Medicare policy analyst with The Senior Citizens League, a nonpartisan group advocating for seniors, in Alexandria, Virginia.
Importance of Dental Health for Seniors
It’s often said that oral health is a window into our general health.
“Good dental care is an important part of maintaining your overall health,” Johnson emphasizes.
This is particularly true as we age. Older adults need to be aware that dental issues – such as cavities, gum disease and tooth loss – can lead to a multitude of costly dental procedures, including fillings, root canals, tooth extractions and gum surgery. After these procedures, you may have the added cost of any necessary dental appliances, such as implants, crowns or dentures.
When deciding if you need coverage, also consider that gum disease is more common in people with diabetes and cardiovascular disease.
Medicare Dental Coverage
Original Medicare (Parts A and B) does not cover most dental services.
Since Medicare was created in 1965, dental care has never been included in the program. Congress has attempted to add dental, vision and hearing to the program, but federal legislation has never been passed. Several major groups, like the American Dental Association, oppose including dental benefits in Medicare coverage.
What’s covered?
Certain dental-related procedures are covered under Medicare Part A and Part B as long as it is integral to another Medicare-covered procedure or service. Examples include:
- Dental or oral exams as part of a complete workup for organ transplant, cardiac valve replacement or valvuloplasty procedures or cancer treatment
- Dental ridge reconstruction as part of or after surgically removing a tumor
- Dental services to treat a jaw fracture
- Dental splints for dislocated jaw joints
What’s not covered?
Medicare does not cover routine dental care or oral procedures, such as:
- Annual exams
- Dental cleanings
- Fillings
- Extractions
- Implants
- Dentures
- Root canals
Paying for Dental Treatments and Associated Costs
Just as important as finding out what is and is not covered in any dental plan is finding out how much the coverage will cost. Keep in mind that cost includes any monthly premiums plus deductibles, cost-sharing, annual maximums and other out-of-pocket expenses.
According to the KFF report, about half of Medicare beneficiaries who received dental care in 2018 paid an average of $874 out of pocket, and 20% of beneficiaries paid more than $1,000 for dental care. (The overall spending average, which includes beneficiaries who didn’t receive any dental care in 2018, was $454.)
“Most dental benefits in Medicare Advantage plans share costs with their members. While preventive services are usually covered at 100%, major and restorative services usually are not. Seniors should understand how costs will be shared in the dental benefit of the plan they choose,” advises Mike Adelberg, the executive director of the National Association of Dental Plans in Dallas.
When considering any dental plan, not just Medicare, pay attention to annual maximums. If you know you need major dental work, paying more for a higher annual maximum may make sense. Many expensive dental procedures lead to the need for costly dental appliances, such as crowns, dentures and implants. Hitting your annual maximum comes quickly with major dental work.
Unfortunately, there is no crystal ball to help you figure out next year’s needs, but the next best thing is to speak to your dentist about anything specific they see coming up and plan accordingly.
Do Medicare Advantage Plans Cover Dental?
Most Medicare Advantage plans offer dental coverage.
Also referred to as Medicare Part C, Medicare Advantage plans are offered by private insurance companies that offer comparable coverage to Medicare. According to KFF, the average Medicare beneficiary has access to 43 Medicare Advantage plans, 97% of which provide some dental coverage.
“Nearly every Medicare Advantage plan offers dental benefits, which are generally more comprehensive than they were five years ago,” Adelberg says. “Keep in mind, plans differ in their networks and coverage of specific services. If there is a particular provider or procedure that is important to you, ask about it before selecting a plan.”
Find Medicare Advantage plans in your area by using the U.S. News search tool and typing in your ZIP code.
Do You Need a Supplemental Dental Insurance Plan?
Medicare is not the only option you have when looking for dental insurance.
You may be eligible for coverage through employer-sponsored retiree plans or Medicaid.
Alternatively, if the Medicare plan that is right for you does not include the dental benefits you need, consider a private dental plan to cover these services. These plans typically cost $25 to $60 a month, depending on the type of coverage that is selected.
Preventive services, such as routine cleanings, are usually 100% covered under private dental insurance. Other services, such as comprehensive dental work, offer cost sharing options. For example, if you were to undergo a bridge procedure, then private health insurance would typically cover 50% to 80% of the cost.
There is a possible waiting period for most comprehensive dental procedures under private insurance plans. A good place to begin your search is the Health Insurance Marketplace. You can also ask your dentist which plans they accept.
Private dental insurance options include:
- Dental HMO (health maintenance organization): These plans allow members to visit dentists in their approved network at lower costs. HMO plans typically do not charge any deductibles, but there usually is a certain amount you must pay before insurance will start covering your treatment.
- Dental PPO (preferred provider organization): Whether you visit an in-network or out-of-network dentist, you will be covered with a PPO. However, the standard fees at a dental office for patients that are out-of-network can be more expensive than the in-network contracted fees.
- Discount dental plans: These plans are not insurance but do provide access to dental services at a discounted rate for a monthly or annual fee. There is generally no paperwork, annual limits or deductibles, but you must visit a participating dentist to receive the discount. Additionally, you might pay more for treatment costs than with HMO or PPO plans.
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