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 its 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 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 are 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 the 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 involves the purchase of extended health insurance offered by a major insurance provider 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 pay 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.
Understanding Medicare Dental Plan Options Offering Both Full or Partial Coverage
Medicare insurance is for most people over 65 but is also given to the disabled if they qualify. The Medicare you receive at aged 65 is called Part A and Part B. The health insurance program is administered by the Social Security Administration and is paid for by tax dollars. Every working American pays into Medicare through their working lives. This money is then kept in trust and used to fund essential medical care for the elderly. The Medicare you are given when you turn 65 doesn’t cover everything. This is where you as the individual have to step in and buy other coverage for yourself. If you want dental coverage this is an additional part to your Medicare and that is called Medicare Part C or a medicare advantage plan that covers more than the basics.
What Medicare Dental Plans are Available to me?
Most dental plans for seniors are health savings plans, but the majority of the plans available are like any regular dental plan. You are offered your check-ups and have the same limits and exclusions as any other program. Sometimes, depending on your oral health you may not have to worry with a dental plan and rather just participate in a dental savings plan. More often than not it is cheaper to pay out of pocket for a cleaning.
Do I have any options to buy partial dental coverage or Medicare dental plans through the Affordable Care Act?
The Affordable Care Act is predominately for people pre-65, but you cannot purchase stand-alone dental plans through the ACA. You can keep insurance and dental that you had pre-65, however, you have to pay full price for it. There are not many options for Medicare customers through the Marketplace.
Medicare Dental Advantage Plans
Medicare Dental Advantage Plans are available to Medicare customers at free to low cost and a federal run programs that allow patients to choose from a wide network of providers thus allowing the patient to make an informed choice about their oral care. You can only see someone in the network in order to use the benefits under the advantage plan. Be warned if the Medicare Advantage Plan you are in doesn’t cover routine dental care, then you must pay for this.
Partial Dental Coverage Versus Full Dental Coverage for Medicare Customers
Traditional Medicare doesn’t usually cover any dental, but there are exceptions to the rule. Say if you were injured in a car wreck and your jaw was displaced, then this is something that may be considered as medically necessary and might be covered by traditional Medicare. The best option for any Medicare customer is to buy full dental coverage rather than going with health savings accounts and partial coverage plans such as Advantage Plans. This will help you avoid billing headaches and allow you the peace of mind when seeing to your oral health. Private insurance also allows you more freedom to choose a dental provider without the headaches of pre-approvals and unexpected bills. If you are not in a position to pay for full coverage or are only looking for partial coverage, then there are still many options out there for you. You should base the decision on your overall oral health as well as your budget. Many of the partial coverage plans are cheap or free, but that doesn’t always better you in the long run. be aware that most dental plans lock you in for a year, so make sure you do your research before signing up for a plan.
Dental plan options for Military Retirees
If you were ever in the service or your spouse was, you may qualify for the Tricare Retiree Dental Program. This program offers dental coverage up to $1200 a year per person and offers low deductibles.
Consider a dental discount card
Discount is music to the ears of elderly people. With a fixed income, you have to find ways to stretch the pennies. What better way than with a dental discount card. For a small monthly fee, you can see 10-60% off most services provided by your dentist.
Consider Doubling down on dental insurance
Whilst a lot of the options for Medicare customers are fabulous, no one seems to remember that these programs (unlike health insurance) have coverage limits. Most Dental companies won’t pay for more than $2000 of work per calendar year and the average cost of dentures is $1500. With a supplemental dental policy, this might ease any burdens, think what you would do if your dentures broke before the end of the calendar year.
I Have Dentures Should I Still Buy Dental Insurance?
It is so important that people with dentures still see the dentist for check-ups are profoundly important as the structure of your mouth must be regularly checked to ascertain if the dentures still have the right amount of support based on the bone structure and overall oral health. When it comes to dentures and the other check-ups that surround them, it is important to have full coverage as some denture procedures can be expensive and not covered under partial plans. There are many Medicare supplemental policies out there, some are good, and some are bad. If you would like some direction as to whom you should buy from contact an agent broker or 1-800 Medicare for more information before you make a choice.
MyGov Healthcare Staff
