As your trusted independent Medicare agents in Lakeland and greater Polk County, Wandacare’s team of knowledgeable Medicare Advisors is here to assist you with all your Medicare coverage needs. That includes your options for dental care coverage.
In this blog, we’ll walk you through Medicare’s coverage for dental services and the type of plans available in Polk County.
Understanding Medicare’s Dental Coverage
First, it’s important to keep in mind that Original Medicare does not provide coverage for dental services. The federally funded and managed Original Medicare only provides Part A hospitalization and Part B medical coverage. If you elect Original Medicare for your coverage, you can buy a stand-alone dental plan from a private insurer, like these custom dental plans available through Wandacare. The process is similar to how you buy a Part D prescription drug plan, but unlike a Part D prescription drug plans, there are no Medicare dental plans with set costs, supplements, or reimbursement from Medicare.
If you find yourself needing to buy additional plans to get the dental benefits coverage you want, you may want to consider a Medicare Advantage Plan over Original Medicare. Medicare Advantage Plans, also known as Medicare Part C, are offered and managed by private insurance companies approved by Medicare, which pays the insurance company to cover your Medicare benefits with your healthcare services coordinated through the Medicare Advantage Plan.
Medicare Advantage Plans provide Part A and B coverage, but usually also include prescription drug coverage (Medicare Part D), as well as additional benefits like vision plans and dental coverage. In fact, 98% of individuals enrolled in Medicare Advantage for 2023 had plans that included dental coverage.
Common Questions About Dental Coverage with Medicare
Medicare Advantage Plans can provide you with additional benefits like dental services all in one place. But what dental benefits do these plans cover? The specific dental care and procedures covered can vary widely between Medicare Advantage Plans, as well as between the different stand-alone dental plans from private insurers.
Let’s answer some questions about the most common dental benefits and procedures these plans cover:
Do Medicare Dental Plans Cover Routine Dental Checkups?
Yes, the majority of Medicare Advantage Plans and stand-alone dental plans include routine dental care as part of their covered Preventive Services. This usually includes your annual checkup and exam, cleanings, and X-rays. Most plans cover these preventive services 100%.
Do Medicare Dental Plans Cover Fillings and Extractions?
Yes, basic dental procedures like fillings, extractions, and root canals are covered under a plan’s Basic Restorative Services. However, most plans often only cover a percentage of Basic Restorative Services, usually at 75-80%.
Do Medicare Dental Plans Cover Dental Implants?
Dental implants are considered more extensive dental work and, along with crowns, bridges, and dentures, are covered in a plan’s Major Restorative Services. Similar to the coverage for Basic Restorative Services, Major Restorative Services are only partially covered, with some plans covering only 50%.
For any services that are partially covered, you are responsible for paying the remaining percentage out of pocket. Additionally, your dental plan coverage may come with an added monthly premium, waiting periods and preauthorization requirements for some services and procedures, and annual maximums limiting the amount the plan will pay for covered dental services in a calendar year.
Medicare Dental Coverage in Polk County
Your cost and coverage for dental benefits, whether through a Medicare Advantage Plan or a stand-alone dental plan from a private insurer, are based on your location. These private plans operate within defined geographic regions called service areas. Available plans, their network coverage and premium costs can vary from state to state—even from zip code to zip code—based on the service area.
This may sound limiting, but in reality, your dental plan options and benefits coverage will be specific to Polk County, down to your zip code in Polk County.
If you’re looking at dental coverage through a Medicare Advantage Plan, the type or structure of that plan can also determine your available dental benefits coverage. Medicare Advantage HMOs (Health Maintenance Organization) with DHMO components only cover dental services from approved providers. Preferred Provider Organization plans (PPOs) have “preferred provider” lists of in-network dental care providers to choose from, with higher out-of-pocket costs if you go to a provider that is out of network.
A plan’s approved dental care providers and any network restrictions on the providers you can see are also based on location. For example, a plan’s provider network can vary between Polk County and Hillsborough County, while the list of in-network providers can vary from plan to plan within Polk County.
Let Wandacare Guide You Through Medicare’s Dental Coverage in Polk County
As Central Florida’s trusted independent Medicare agents, Wandacare knows Polk County. We can help you compare the plans available in Polk County—from stand-alone dental plans to the dental coverage in various Medicare Advantage Plans—to ensure you’re getting the dental benefits you want at the best price.
Ready to explore your dental care options? The Wandacare Team has the dental plans to complement your Medicare coverage. Our licensed Florida agents are ready to pair you with your perfect plan.
