Finding the right health care plan for you 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 report by the Kaiser Family Foundation.
“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 Citizen League, a nonpartisan group advocating for seniors, in Alexandria, Virginia.
[READ: How Do You Apply for Medicare?]
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 adds.
This is particularly true as we age. Older adults need to be aware that dental issues — such as cavities, gum disease and teeth 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 dental appliances — like implants, crowns or dentures — that are needed.
When deciding if you need coverage, also consider that gum disease is more common in people with diabetes and cardiovascular disease.
[READ When Do You Need a Medicare Supplemental Insurance Plan?]
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 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.
[Read: Medicare Enrollment Deadlines You Shouldn’t Miss.]
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 not just in any monthly premiums, but also in deductibles, cost-sharing, annual maximums and other out-of-pocket costs.
The Senior Citizens League surveyed 617 Medicare-eligible Americans in 2010 about how much they spent on dental insurance. More than half of respondents did not have dental insurance due to rising costs. More than half or 53% of respondents did not have dental insurance due to rising costs. Of those who did have insurance, 42% spent between $800 and $2,000.
“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,” says 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 approved by Medicare. According to the Kaiser Family Foundation, the average Medicare beneficiary has access to 43 Medicare Advantage plans, and 97% of them 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.”
Many Medicare Advantage plans cover preventive dental services, like cleanings and x-rays. If you need more extensive benefits, read the summary of benefits for each plan to be sure they are also covered.
Find plans in your area by going to the Medicare Plan Finder and typing in your zip code. If a plan includes dental coverage, you will see a green check mark beside the word dental. Look at “extra benefits” in the plan details to see a summary of dental benefits, both preventive and comprehensive.
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, like routine cleanings, are usually 100% covered under private dental insurance. Other services, like 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 these plans. A good place to begin your search is the Health Insurance Marketplace or look at what AARP has to offer. 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 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.
Bottom Line
Keeping up with dental health as you age is an important step in maintaining not just optimal dental health, but overall good health.
While the original Medicare plan does not cover routine dental care, many Medicare Advantage plans offer broader dental benefits. Basic dental care, like cleanings and x-rays, are generally covered. Seniors can find plans that offer some coverage for more extensive benefits, such as dental surgery or dentures.
Seniors have many dental plan options both in and out of the Medicare system to choose from, including private plans, employer-sponsored retiree plans, Medicaid or discount dental plans that offer alternative options to cover dental expenses.
Talk to your dentist to help you find the best plan to maintain your oral health.
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Does Medicare Cover Dental in 2024? Benefits and Eligibility originally appeared on usnews.com
Update 02/02/24: This story was previously published at an earlier date and has been updated with new information.
