Medicare Dental Plans (Basic, Advantage & Supplemental): What Exactly They Cover?

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You’d think every American has dental coverage of some sort. But, nope, that’s not true.

Also, you’d think that every person participating in the government’s health care programs (Medicare and Medicaid) would have dental coverage. Again, that’s not always true.

According to the American Dental Association, about 38% of children ages 2-18 have dental benefits through Medicaid or the Children’s Health Insurance Program (CHIP) while over 10% do not have any type of dental benefits. And 7.4% of adults have dental benefits from Medicaid and a staggering 33.6% have no dental coverage.

So as you can see, people either don’t prioritize dental coverage or they can’t afford it. Fortunately, there are other options besides private insurance and Medicaid.

Does Medicare Cover Dental Services?

If we’re talking traditional Medicare, it’s not typical for it to include standard dental services, like cleanings and exams. But there are some exceptions to that.

Original Medicare Coverage (Part A & Part B)

Original Medicare includes Part A (which is for hospital coverage) and Part B (which is for medical coverage). It does not cover things like regular teeth cleanings, exams, fillings, dental crowns or bridges.

An example of something that could be covered by Medicare is if you were to have an accident that damages your jaw area. Original Medicare would cover the reconstruction of your jaw, and it may cover any tooth extractions related to jaw disease.

And if you experience a dental emergency or a complication with a dental procedure, Part A of Original Medicare would cover the costs. Also, Part A would cover any dental exams required before a complicated surgery, like kidney or heart transplant.

Otherwise, if you need routine and standard dental care, you’ll unfortunately have to foot the bill if you don’t have other dental coverage.

Original Medicare Coverage has two parts: Part A for for hospital coverage and Part B for medical coverage. These can help pay for the cost of dental care under certain circumstances, like emergency dental procedures.

Medicare Advantage Plans With Dental (Part C)

There’s a third part of Medicare called Part C, also known as Medicare Advantage. These plans are actually offered by private insurance companies, the plans’ benefits and costs varying depending on where you live. Some of the plans may have a premium on top of the premium of Part B of Medicare.

We mention Part C because these plans can sometimes have dental benefits included.

Medicare Advantage is offered by private insurance companies and may include dental benefits, depending on what is offered where you live.

Medicare Supplemental Dental Plans

There’s also a supplemental Medicare insurance called Medigap, which is also a type of plan offered by private insurance companies. Thes plans can help pay some of the costs that Original Medicare won’t cover, like deductibles, co-pays, and hospitalization.

Some private insurance companies even have special coverage options, like standard dental and vision care. Some plans may have discount programs for insured members. Even though these are not built into a Medigap, the insurance companies may offer them as add-on benefits.

So how can you get this type of dental coverage? Well, it depends on where you live.

The federal government standardizes the coverage in these plans, so costs and availability can change by location. For example, in Massachusetts, Minnesota, and Wisconsin, they standardize plans differently.

To see if there’s a Medigap plan available in your area, check out the Medigap Policy Search website or contact your State Health Insurance Assistance Program.

Medigap can help pay for services that Original Medicare won’t cover, like deductibles, copays, and hospital stays.

Medicare Dental Coverage For Seniors

Seniors, more than any age person, need dental care. The most common dental issues among seniors, according to the National Institute of Health (NIH), are:

  • 93% of seniors 65 and up have or have had cavities
  • Seniors 65 and up have an average of about 19 remaining teeth (adults 20-34 average about 27 teeth)
  • Periodontal gum disease
  • Oral cancer rates go up as we age, reaching its peak between ages 60 and 70
  • Temporomandibular muscle and joint disorder (TMJD), which leads to facial pain

These reasons are why seniors need dental care, and therefore, dental coverage.

PPOs And Indemnity Plans

Seniors can get coverage through Medicare, but they can also qualify for many private dental insurance plans. Some of those plans are called preferred provider organization (PPO), and they offer a network of dental professionals for you to visit.

Another type of plan is called an indemnity plan, which allows you to go to many dentists outside of your network. With these, you’d pay an extra fee and the plan would pay a portion of the cost. These are often called “fee-for-service plans.”

Neither PPO plans nor indemnity plans have out-of-pocket maximums, meaning there’s no limit to what you might end up paying for dental care. Plus, they may have an annual max benefit, which is the most the plan will pay for the cost of your dental care.

One thing to note: waiting periods for these types of plans. They may have a waiting period of a few months, meaning you’d have to wait a certain length of time before getting care that the plan would cover. Some plans can have up to a 15-month waiting period. Even more reason to get coverage now rather than when you need it.

Program of All-Inclusive Care for the Elderly (PACE)

Another coverage option for seniors is the Program of All-Inclusive Care for the Elderly (PACE). It’s actually a joint program between Medicare and Medicaid that offers healthcare services for folks living in a seniors community. This allows them to delay the possibility of staying in a nursing home.

And any service covered under Medicare or Medicaid is covered under PACE. This includes prescription drugs, doctors visits, and hospital care. Depending on your benefits package and your specific situation, you may be able to get dental care coverage.

To be eligible for PACE, you’ll need to be 55 years or better and also enrolled in Medicaid, Medicare, or both. You’ll also need to live where PACE is available, be living in or able to be living in a safe community, and also require nursing care. For more details on eligibility and plans, you can visit Medicare.gov.

PPOs, indemnity plans, and PACE are all programs specifically for seniors, usually 55 years and up. It’s not a guarantee that they will cover your dental care costs, but many of the plans in your area may.

Medicare vs Dental Discount Plans

Medicare, Medicaid, PACE, and other government programs are great ways to get coverage on dental.

But the biggest problem with these programs is that they’re super specific about who does and does not qualify. You need to fit a niche of the population in order to reap the rewards.

That’s why dental discount plans are another great option to think about. Anyone can qualify, regardless of pre-existing conditions, previous dental health history, and current health. And these plans can save you up to 60% on any dental service.

You can use a dental discount plan as either a substitute for the aforementioned options, or you can use it supplementally. So really, regardless of your current coverage, you may want to check out the available discount plans.

Medicare, Medicaid, and PACE work well for many seniors, but not everyone’s oral health can benefit from them. That’s why dental discount plans, whether or not you already have dental coverage, can be a great option.

Summary

  • Original Medicare Coverage has two parts: Part A (hospital coverage) and Part B (medical coverage) — these can help pay dental care in case of emergency
  • Medicare Advantage may include dental benefits, depending on what’s offered in your area
  • Medigap can help pay for services that Original Medicare won’t cover
  • PPOs, indemnity plans, and PACE are programs for seniors, and they often cover dental care costs
  • Medicare, Medicaid, and PACE aren’t good options for some people, which is why a dental discount plan can be a great option.