As you consider your healthcare needs and how the various Medicare parts and plan options can best meet these needs, don’t overlook your dental health. If you currently have dental coverage through an employer or other insurance plan and want to still have dental coverage once you become eligible for Medicare, you have some decisions to make.
First, 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 plan, there are no Medicare dental plans with set costs, supplements, or reimbursement from Medicare.
If you’re needing to buy additional parts and plans to get the benefits coverage you want, you may want to consider a Medicare Advantage Plan over Original Medicare. These plans can provide you with more choices for additional coverage, like dental services, all in one place. The Wandacare Team can assess your coverage needs and desired benefits to ensure you have the best dental plan option. Let’s start by looking at the dental coverage many Medicare Advantage Plans offer.
Dental Coverage with Medicare Advantage Plans
Medicare Advantage Plans, also known as Medicare Part C, are offered and managed by private insurance companies approved by Medicare. Essentially Medicare pays the insurance company to cover your Medicare benefits and your healthcare services are 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.
What dental services do these plans cover? The specific dental care and procedures covered can vary widely between Medicare Advantage plans. The majority of Medicare Advantage Plans offer some form of coverage for these dental benefits:
· Preventive Services: Routine dental care like your annual checkup and exam, cleanings, and X-rays.
· Basic Restorative Services: Basic dental procedures like fillings and root canals.
· Major Restorative Services: More extensive dental work, such as crowns, bridges, implants, and dentures.
· Oral Surgery: Surgical procedures, such as wisdom tooth extraction.
· Emergency Dental Care: Covering services in emergency situations, like losing a tooth in an accident.
Dental Coverage Costs and Restrictions
In looking at the dental services a Medicare Advantage Plan covers, it is important to look at the amount of coverage provided for each service. Most plans cover preventive services 100% but often only cover a percentage of basic and major restorative services. This could range from 75-80% coverage of basic restorative services to just 50% of major restorative services and only partial coverage of emergency dental care. That leaves you responsible for paying the remaining percentage out of pocket.
Additionally, your Medicare Advantage plan’s dental coverage may come with an added monthly premium, network restrictions on which dental care providers you can see, 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. Some plans may have restrictions on coverage outside a set geographic area, so if you travel frequently or have residences in different locations, this could affect your dental coverage, especially in an emergency.
Your dental benefit coverage, costs, and restrictions all depend on the type of Medicare Advantage plan you have. As Medicare Advantage Plans are structured like private health insurance plans, it’s important to understand the different structure types and how that affects your coverage. There are Medicare Advantage HMOs (Health Maintenance Organization) with DHMO components that only cover dental services from approved providers. Preferred Provider Organization plans (PPOs) have “preferred provider” lists of in-network dental care providers you choose from and levy higher out-of-pocket costs if you see a provider that is out of network. Others may be a “fee-for-service” structure with a set, pre-negotiated rate between the insurance plan and the provider.
The Wandacare Team can help you compare plans to ensure you’re getting the type of coverage and benefits you want at the best price. In comparing the costs of stand-alone dental plans and different Medicare Advantage Plans’ dental coverage, also consider the cost of not having dental coverage. Nearly half of Medicare recipients do not opt for some form of dental coverage and face an average out-of-pocket cost of $874 for dental services, with 20% spending more than $1,000 on their dental care, according to the Kaiser Family Foundation.
Ready to explore your dental care options? The Wandacare Team has the dental plans to complement your Medicare. Our licensed Florida agents are ready to pair you with your perfect plan.
