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Medicare Dental Coverage Options Program Recap

Home Medicare Dental Coverage Options Program Recap

Thank you to Mark Brownstein from Emerald Medicare for his presentation on dental coverage options in retirement, specifically as it relates to Medicare enrollees.  Nearly half of Americans 65 and older do not have any dental coverage, yet oral health has far-reaching implications; 1 in 5 adults 65 and older have untreated tooth decay and over two-thirds have gum disease.  For those that had dental coverage, many seek to maintain the same level of coverage in retirement and after their coverage ends, yet plans and coverage vary so widely, it can be difficulty and overwhelming to replace that coverage.

 

Dental and Original Medicare

One of the most common myths associated with Medicare is that it maintains many of the same coverage options as traditional medical insurance; this can not be further from the truth.  In reality, original Medicare (Parts A & B) does not provide any coverage related to dental care, including preventive care like cleanings.  If you want any type of dental coverage, you need to purchase a rider plan from a third party or enroll in a Medicare Advantage or Medicare Supplement plan that provides dental coverage.

Dental Coverage Options

Another very common myth is that coverage options and costs are the same across Medicare Advantage or Supplement plans.  There is no standardized coverage plan or pricing that Part C providers must adhere to in order to offer a dental coverage plan.  Some may have dental coverage incorporated into their Part C coverage, while others may offer dental as an additional coverage option with additional costs.  Additionally, each Part C provider may have several different options available that provide different levels of dental coverage at varying costs to you.  Before making any decisions related to enrolling or adding a dental coverage plan, first determine what your dental needs are and make sure that those plans correspond to your needs and financial situation.

When it comes to coverage options there are terms and coverage areas that you should be familiar with:

  • Premium – The monthly cost of the dental coverage policy
  • Annual Coverage Cap – The amount of money the coverage provider will cover per year.  This number can change from year to year.
  • Deductible – The amount of money you must pay for a service out-of-pocket.  Some plans may cover all or a portion of a procedure, with you picking up the rest.  Additionally, you may be required to pay in-full at the time of the service and then submit a reimbursement to the coverage provider.
  • Waiting Period – Some plans have a waiting period for certain procedures where you must be enrolled in the plan for a certain period of time before that procedure will be partially or fully covered.
  • Pre-existing Condition – Most policies don’t have pre-existing condition exclusions, but some may not cover dental problems you have before enrolling in their coverage, especially if you did not have any dental coverage previously.
  • Preventive Services – Routine exams, cleanings, bitewing x-rays, fluoride treatments, spacers
  • Basic Services – Full mouth x-rays, fillings, oral surgery (simple extractions), emergency exams, pain treatment, recementation of tooth restorations
  • Major Restorative Services – Most complex oral surgeries, root canals, periodontic maintenance, crowns and onlays, partial/full dentures, bridge or crown repairs

Another coverage consideration that can have a big impact on your decision is whether your dentist is covered under the plan.  Some plans require you to use a dentist in their coverage network to receive full benefits.  For example, if your dentist is now out of network, you may need to pay a percentage of the costs rather than having the entire preventive care procedure covered.  Additionally, plans may change providers they work with from year to year so it is important to check with your dentist annually to determine if they are still accepting your dental coverage provider.

More Information

If you have any questions about Medicare and dental coverage options, please reach out to Mark Brownstein at mark@emeraldmedicare.com.   You can view a recording of the webinar at https://youtu.be/S__BbbqSYEE.

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