Did you know routine dental care isn’t covered by Original Medicare? If you’re shopping for a Medicare health plan, you may be wondering whether or not you need to buy a dental insurance policy for dental benefits. While hospitalization and doctors’ services are covered by Original Medicare (Part A and Part B) and by Medicare Advantage plans (Part C), there are other services such as routine dental and vision coverage that are trickier to navigate and will depend on which plan you choose.
Medicare Parts A and B, will not cover most dental services. This means Medicare does not cover most dental care, dental procedures, and dental supplies. So, if you’re getting a routine checkup, cleaning, getting a filling, tooth extraction, dentures, dental plates, or other dental devices – you’re out of luck. The only exception is Medicare Part A may provide coverage for various types of dental services that you receive if you are in the hospital and you need to have an emergency and / or a complicated dental procedure. So in other words, if your jaw is injured in a car accident and they fix you up at the hospital, Medicare may cover it. But essentially, anything other than an injury to your teeth or jaw – dental isn’t covered.
While there are several options to buy stand-alone dental policies in the marketplace, they’re usually very expensive, hard to find and don’t have wonderful benefits. Most have premiums between $30 and $60 per month, and only cover up to $1000 or $1,500 worth of benefit annually. Plus, they throw a bunch of deductibles and cost-sharing coinsurance amounts on top of that so if you math, it really doesn’t make sense most of the time. These days, many people are getting their dental insurance needs covered through their Medicare Advantage plan.
Unlike Original Medicare (Part A and Part B), Medicare Advantage plans are offered via private insurance companies. These plans are required to offer the same benefits that are found in Medicare Parts A and B. However, a Medicare Advantage plan can also provide additional benefits – including dental services.
If you opt to go with a Medicare Advantage plan, you may be able to receive dental care as a part of your plan – which could include routine services like fillings, x-rays, extractions, dentures, and even your annual cleanings. If this is especially important to you, read the plan description very carefully. Or, you can ask your agent to go over the Summary of Benefits or Evidence of Coverage with you in detail. Many times companies will list dentures and bridge coverage as a benefit, but only cover a very small portion of the actual cost. The details matter!
Just like with other types of insurance coverage, what is included in a Medicare Advantage plan will depend on the policy itself. Likewise, the premium that is charged for Medicare Advantage coverage can differ from one plan to another, and one insurance carrier to another.
Oftentimes, those who have coverage through Medicare Advantage will be required to use the services of providers that are listed within a particular network. With that in mind, be sure that you compare several different Medicare Advantage plans before making a purchase in order to determine where you can receive your care, as well as what you need to pay in terms of premium and other costs.
In some cases, the information regarding what is covered may be difficult to determine. This is particularly the case if the plan has “embedded” dental benefits. In a stand-alone dental plan, for example, the policy will typically identify the deductible and coinsurance information, as well as the details with regard to in- or out-of-network coverage. On the other hand, in a plan that has embedded dental benefits, it may not be quite as easy to decipher what is covered and what isn’t, as well as what your cost responsibilities will be.
Original Medicare doesn’t provide dental coverage. While standalone plans exist, it’s usually best to get a Medicare Advantage plan that includes dental coverage. That said, it is important that you or your agent read over the plan thoroughly in order to determine whether you know what’s covered and what isn’t before setting your dentist’s appointment. Call the insurance company, talk to your agent or ask for a copy of the plan’s Summary of Benefits section.
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Author Bio: Ben started Prepare for Medicare in 2014 to help people help people get objective answers to questions about Medicare. He’s held leadership roles at numerous Fortune 500 Medicare health insurers in product development, sales, marketing and strategy for over 20 years.