If you’re new to the world of Medicare, you’ll soon discover that original Medicare (Part A and Part B) doesn’t cover most routine dental care. Nor do many Medigap plans, though some may. (Medigap is extra insurance that you can purchase from a private health insurance company to help pay for out-of-pocket costs that you’ll incur with original Medicare.)
Dental coverage is part of the appeal of getting a Medicare Advantage plan, known as Part C. Many Medicare Advantage plans offer dental coverage and are quick to promote that. Still, other Medicare recipients opt to buy a separate dental plan to cover their oral health needs.
Most seniors, however, have been leaning toward choosing Medicare Advantage plans in recent years, says Whitney Stidom, vice president of sales enablement with eHealth, a health insurance broker and online resource provider.
“Medicare Advantage plans are popular today, with over half of all Medicare beneficiaries enrolled, but benefits can vary quite a bit from one plan to another,” Stidom says. “I wouldn’t recommend beneficiaries enroll in Medicare Advantage solely because they want dental benefits. However, if they find that Medicare Advantage is the best option for their overall health care needs and budget, it is a good idea to look for one that also includes dental coverage.”
So if you’re looking for some sort of dental care, here’s what you need to be thinking about.
[READ: Medicare vs. Medicare Advantage: How to Choose.]
Is Dental Coverage Worth It?
Yes. It doesn’t really matter if your teeth look like you were on the losing end of a boxing match, or if you flash a smile that belongs in a teeth whitening commercial — either way, it’s hard to argue that you shouldn’t have dental coverage. Poor oral health has been connected to everything from diabetes to cardiovascular disease, strokes, sinus infections, dementia and even cancer.
So if you want to keep your teeth in excellent shape, you’re going to have to find a stand-alone dental insurance plan or a Medicare Advantage plan.
[SEE: Best Toothpaste for Sensitive Teeth]
Call a Medicare Broker, SHIP and Your Dentist
While talking to a Medicare broker can do wonders in terms of finding a Medicare Advantage plan that offers dental coverage, if you currently have a dentist, ask the office manager what plan they would recommend. You should quickly get an earful on which Medicare Advantage plans work well in the office and which don’t, due to claims being denied.
Still, if you call a Medicare broker, they can also recommend a variety of Medicare Advantage plans and, if you tell them what you’re looking for, hopefully steer you to a good one.
In addition, use resources like a State Health Insurance Assistance Program (SHIP) to compare options and find the best fit. SHIP is a volunteer-staffed free helpline for seniors, their families and caregivers who need help with Medicare questions and problems.
[READ: How SHIPs Can Help With Your Medicare Questions and Problems]
Assess Your Dental Needs
Before you talk to a Medicare Advantage broker — or sift through Medicare Advantage plans and do the research yourself — you really should think about what you want out of dental insurance coverage, so you know what you want to look for. There are a number of criteria you may be particularly interested in:
— $0 premiums. If money is an issue, finding a plan with $0 premiums may be a top priority. Just remember that some Medicare Advantage plans with higher premiums may be even more affordable in the long run. “It’s important to look at deductibles, co-pays, coinsurance and annual maximums, rather than only the premium,” Stidom says. “A lower premium plan might cost more overall if it has high out-of-pocket expenses when you need dental care.”
— High annual benefit limits. The annual benefit limit is the most an insurance company will pay for your treatment within a year. So if you’re worried you may be in for a considerable amount of dental expenses, way beyond what an insurer will pay for an annual exam and some X-rays, you might want to prioritize this instead of, for instance, $0 premiums.
— Coinsurance. This is the portion of your insurance that you’ll pay after you meet your deductible. You’re sharing the cost of the dental work at that point, and if, for instance, your insurance is going to pay 20% of a root canal, you still are responsible for 80%. If that makes you uncomfortable, you may want to prioritize what you pay for coinsurance rather than focusing on the annual benefit limits of the size of your premium. Really, as Stidom says, you want to look at the entire picture and probably aim for a healthy balance when it comes to determining how much you should pay for dental coverage.
— Availability. Your dental coverage doesn’t do you much good if your dentist isn’t in your plan’s network. Remember to call your dentist and see if they take the dental plan you’re considering.
— Comprehensive or basic? Some Medicare Advantage plans only offer preventive help, paying for annual exams and X-rays. That certainly can help with your budget, and you may feel like that’s all you want covered and you’ll take care of the rest if you have cavities or other issues. However, if you do have a track record of tooth decay or believe fillings, extractions, crowns, dental implants and gum disease could be in your future, you probably will want to consider getting a plan that offers comprehensive care.
[SEE: The Best Toothache and Tooth Pain Relief Products, According to Pharmacists ]
Pay Attention to the Details
It isn’t hard to find an Medicare Advantage plan that covers oral health.
“It seems like every Medicare Advantage plan is now offering some sort of dental benefit,” says Mara Woloshin, an insurance broker, certified retirement coach and Medicare and Medicaid consultant based out of Portland, Oregon.
But it is hard to find a Medicare Advantage plan that generously pays for everything beyond cleanings and basic treatment.
“While most plans are sticking to preventative dental, some plans have capped limits and are combining comprehensive and preventative dental under one cap, like $1,000 total,” Woloshin says.
Stidom adds that “it’s important for beneficiaries to understand that dental insurance works differently than health insurance. It’s not open-ended coverage. Dental plans provide specific, defined benefits on a specific calendar-year basis, including for preventive cleanings, fillings and crowns, root canals and more. Some dental plans have waiting periods, requiring enrollees to pay their premiums for a certain number of months before services are covered.”
As an example of what’s out there, UnitedHealthcare offers some dental plans that pay for major services, such as fillings and bridges and root canals, on the first day of coverage, but it only pays 10% after the deductible (though it pays 40% after the deductible, after one year). Aetna has a comprehensive dental plan that includes coverage such as paying 20% to 50% for periodontic services (treatment involving the gums and the bone that supports your teeth) and 20% of endodontic services (procedures like a root canal). Pick just about any Medicare Advantage plan, and you’ll find that there’s some sort of dental coverage.
As mentioned above, however, a Medicare Advantage plan is likely to pay 100% of preventive dental work, such as dentist visits, fluoride treatment and X-rays, but you’re not likely to find the same coverage on substantial dental work. But that’s a good argument for staying on top of dental visits and trying to keep your teeth in as good of shape as possible.
It’s also worth noting that if your health is poor, you may be able to find more dental coverage than you might imagine in a Medicare Advantage plan.
“The really good news for those who may have diabetes or heart disease are Medicare Advantage chronic special needs plans,” Woloshin says. “For a modest premium, like $26 monthly, this group of beneficiaries can enjoy as much as $3,500 for dental and $0 for any and all diabetic supplies.”
She adds that these plans require a diagnosis verification from an attending physician.
Bottom Line
If you are getting Medicare or already have it, and you want your dental work to be paid for, you can certainly find good coverage. But in the spirit of the dentist’s office, you may have to do a lot of drilling into the details before you find one you’re satisfied with.
Find the Best Medicare Advantage and Medicare Part D Plans With U.S. News
Start your search for the right plan for you with U.S. News’ Best Medicare Advantage Plans and Best Medicare Part D Companies. You can also look for and compare Medicare Advantage, Medicare Part D, bundled Medicare Advantage and Part D plans and Medicare supplement plans near you with the U.S. News search and compare tool.
To determine the top-rated insurance companies, U.S. News consulted with Medicare experts to identify and weigh the most important quality measures for Medicare Advantage consumers, applied these weights to data from the Centers for Medicare & Medicaid Services and then adjusted for enrollment.
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What to Look for in a Good Medicare Dental Plan originally appeared on usnews.com
