With Medicare, coverage for dental services is generally not available with Medicare. However, with increasing age certain medical services such as dental and the need for dentures become a necessity, which can get very costly.
It is possible that Medicare will cover a dental-related emergency if it requires a trip to the emergency room at a hospital, however general dentistry such as regular check ups, cleaning, dentures, and other services from a dentist is not covered under Medicare Parts A & B. Basic private dental insurance can typically have low monthly premiums, but out-of-pocket costs can still be high especially if you need dentures.
Options For Dental Coverage Through Medicare
There are still ways to receive dental care while using Medicare and still saving on the costs. Each way has it’s own limitations and one should evaluate their dental needs and circumstance to determine which method would be best for getting dental coverage. The biggest determining factor should be as to whether or not you or your spouse will need dentures now or in the near future.
Some ways to get dental coverage on Medicare:
- Medicare Advantage Plans that offer dental coverage (known as Medicare Part C)
- Dual Enrollment in both Medicare & Medicaid (subject to qualification & availability)
- Individual Dental Insurance with Medicare Discounts
- Health Savings Account
- PACE Program for Seniors
Dental Coverage Through Dual Enrollment With Medicaid
In most states, some form of dental coverage is offered under medicaid. Currently, only 3 states do not offer any type of dental assistance under medicaid. Being Alabama, Delaware, and Tennessee. Medicaid dental coverage for adults can tend to change periodically depending on federal budget and dental can be one of the most commonly eliminated benefits in tight circumstances. States can also determine what dental benefits are and are not available to adults who accept Medicaid. While most states programs provide at least emergency dental care for adults requiring a trip to the hospital, less than half of the states currently provide basic dental care such as cleaning and checkups by a dentist. There is no minimum requirements regulated by the government with dental coverage for adults. Types of Adult Dental Services Covered for Adults available under state operated Medicaid Programs:
- Emergency Only – Extractions, dental procedures for immediate pain relief. Offered in 18 states.
- Preventive – Examinations, periodic cleanings, and fluoride treatment or sealants. Offered in 28 states.
- Restorative – Fillings, crowns, Root Canal treatment. Offered in 26 states.
- Periodontal – Surgery, scaling, cleaning below gum lines. Offered in 19 states.
- Dentures – Full and partial for seniors (may require Medicare advantage). Offered in 26 states.
- Oral Surgery – Standardized Extractions, oral-related surgical procedures. Offered in 25 states.
- Orthodontia – Braces, & retainers. Offered in only 2 states.
Be mindful however that Medicaid does have certain eligibility requirements and is primarily reserved for those with a very limited income and/or limited resources. Check your state’s Medicaid program to see if you will qualify. If you do, do apply and take advantage of the available benefits for dental.
PACE Program For Seniors
PACE, also known as Program of All-inclusive Care for the Elderly, is a provisional health program that is jointly operated by both Medicare and Medicaid. It is also another option that can help individuals get the dental care they need as PACE provides all services that are covered by Medicare or Medicaid, and dental services may be covered under your state’s Medicaid program. This program is specialized in assisting senior adults to remain independent and extend time in a nursing-home for as long as possible. If Dental is available in your state, dental care would be automatically included in this program without additional cost.
Medicare Advantage Plans (Part C)
Medicare Part C is known as Medicare Advantage. Medicare Advantage typically involve the purchase of extended health insurance offered by a major insurance providers such as Humana. These types of insurance plans are designed to be low-cost and offer extended coverage for the things that Medicare Part A & Part B do not cover. With that some major insurance providers also offer dental insurance as an add-on or inclusive on their Medicare advantage plan. When chosen with the right provider, this can allow optimal dental coverage and even coverage for dentures at a very low-cost. Each provider will have their own unique, various plans with a wide range of coverage or limitations when it comes to dental care.
Health Savings Accounts For Dental
If you’re still working and enrolled in Medicare, you may be able to qualify for a Health Savings Account. To qualify you may have to prove that you have a high deductible with your insurance to be eligible in most situations, but there are other ways to become eligible as well. With HSA’s you contribute money from your from your payroll or through your taxes every year to pay into the savings account. An HSA will help cover costs that your insurance does not pay, including deductibles, coinsurance, and co-pays including dental care. It’s advised that a simple cleaning may need to paid out of pocket, while your HSA is reserved for more serious emergencies dental or not. Since your HSA can be applied towards any type of medical expense, the need to pay for a dental insurance plan is not entirely necessary.