Perhaps, prior to becoming eligible for Medicare, you were on an employer-sponsored dental plan. Perhaps you purchased a plan through the federal health insurance marketplace or just on your own. Or maybe you’ve never had a plan and visited a dentist only rarely. No matter what your dental history may be, it’s necessary to understand the importance of maintaining good oral health.
Taking care of your teeth isn’t just about having a nice smile. People who practice good oral hygiene, notably by brushing, flossing, and seeing their dentist regularly, are generally better protected against periodontal bone and tooth loss. Additionally, poor oral health has been linked to a number of other health problems, including gum disease, rheumatoid arthritis, and even some cancers.
If you’re new to Medicare, you may be wondering if your crisp, new, red, white and blue Medicare card covers routine dental visits as well as other dental treatments. We’ll address those concerns here.
About original Medicare
Original Medicare is a two-part program, Medicare Part A and Part B. Part A provides insurance coverage for hospital care, while Part B provides medical insurance for medically necessary services. If you get no other plans when you go on Medicare, then you’ll have only the coverage provided under Part A and Part B.
This is important because, for the most part, original Medicare does not cover dental services. Nor does it cover dentures, implants, orthodontics, or root canals. You’d even be out of luck for coverage if you had an abscessed tooth.
There are a few exceptions where Medicare might cover dental services. This could include dental work in a hospital for emergency jaw surgery following an accident, but only if the physician deemed it medically necessary. Another exception might be dental work done prior to a heart or organ transplant procedure. In each instance, such services might be covered by Medicare Part A while a patient is being treated in the hospital. The exception for the second example is because an untreated oral health issue prior to heart or transplant surgery could lead to an infection that might cause serious complications with those procedures afterward.
So, if I can’t get dental coverage under Parts A or B, are there other options?
Yes, there are. If you want your Medicare coverage to include dental coverage, you have a few options, including purchasing a separate, stand-alone dental plan or obtaining a dental discount plan. Dental discount plans are not actually insurance plans, but they do offer participants dental services at reduced costs.
The most commonly used option, however, is to purchase a dental plan provided under Medicare Part C. These plans, commonly known as Medicare Advantage Plans, are offered by private insurers. Insurers bundle together all the coverage one would receive in Parts A and B, and they often offer extra benefits not covered under Parts A and B, such as vision, hearing, and–you guessed it, dental services.
Some Medicare Advantage Plans have no upfront monthly premium, while others do. Additionally, Medicare Advantage Plans vary by region and between insurance companies, so it is important to check to see what benefits each plan offers.
While we’re discussing the various parts of Medicare, this is a good time to mention Medicare Part D. Part D plans, like Medicare Advantage Plans, are plans provided by and purchased from private insurers. Part D plans provide prescription drug coverage; however, most Part C plans include prescription drug coverage in their bundles.
What dental services are typically covered under Medicare Advantage Plans?
As noted earlier, the services offered in Medicare Advantage Plans across the country vary by state and region. If you’ve ever seen television commercials about such plans and wondered why they always ask for your zip code, now you know why.
Despite the variations in dental services offered in Part C plans, most tend to include preventive services, such as cleanings, exams, and x-rays, often at 100 percent coverage. Other plans may include more comprehensive dental services.
Another Option
Medical Savings Accounts (MSAs) are a type of Medicare Advantage Plan where a certain amount of money is deposited in a savings account for the Medicare recipient to be used toward Medicare-covered costs. The dollar amount of the deposits is determined by the plan. In some cases, the monies in these MSA plans can be used toward vision, hearing, and–you guessed it again!–dental expenses. However, there may be an additional premium for that coverage.
Can I get help finding the right Part C plan for dental coverage?
Because plans vary, it’s in your best interests to do your homework to determine which plan is the right one for you. And one of the best places to begin is at the Medicare.gov website. All insurers that offer Medicare Part C plans are required to provide an outline of the benefits they offer. The Medicare.gov website provides side-by-side comparisons of various plans to help make choosing a plan easier.
Medicare also offers free, personalized counseling to help new or not-so-new Medicare recipients get the answers they need.
