Medicare Dental Coverage For Seniors
Medicare dental coverage is confusing because the Medicare language is confusing. The word Medicare is used to describe “Original Medicare,” which is Medicare Part A for the hospital and Medicare Part B for doctor visits and outpatient procedures. Medicare is also used to describe Medicare Part C (or Medicare Advantage plans). Yes, the language is not precise. Each type of Medicare program deals with Medicare in a completely different way.
Does Medicare Cover Dental?
Medicare dental coverage does not exist. When Medicare or any licensed insurance professional refers to “Medicare,” they usually mean Original Medicare. I know it seems wrong. People are always surprised when I mention there is no Medicare dental coverage. Original Medicare–Part A & B–does not cover anything dental with a few surgical exceptions. There has never been dental coverage under Medicare–Original Medicare.
The confusion comes because people hear many advertisements that claim “Medicare” covers dental. Those advertisements refer to Medicare Advantage (or Part C) plans. There is dental coverage under Medicare when it is in a Medicare Advantage plan.
So when people ask, ‘Will Medicare cover dental?’ I always clarify the two ways to get Medicare and how dental fits in with each.
Why Doesn’t Medicare Cover Dental?
When Medicare Part A and B were first set up, they did not cover dental. The demand for dental was not high at that time. Also, to add more benefits to Original Medicare means raising the payroll (FICA) taxes. The Medicare tax is currently 1.45% for employees and 1.45% for employers. I’m self-employed, so I pay both sides of the tax. My Medicare tax rate is 2.9%. To add more benefits, like dental, vision, hearing, etc., would result in a much higher payroll tax. So when will Original Medicare cover dental? I suppose when raising taxes is more popular.
As the demand for dental grew, the insurance companies that got into the development of the Medicare Advantage / Part C space found they could add dental, vision, hearing, and additional benefits in an efficient enough manner without raising the cost of the plans they offered under Medicare’s sponsorship.
How to get Medicare Dental Coverage
Many Medicare Advantage plans have some minimal dental services, such as teeth cleaning and x-rays. Other plans include fillings or extractions. Crowns and root canals are part of very generous plans. I’ve even seen some Medicare Advantage plans now cover dentures. In 2022, the plans give some minimal coverage for implants in a few rare counties.
Each year Medicare Advantage plans can change their benefits. They raise copays, increase maximum out-of-pockets, and lessen or even drop the additional benefits, like dental. Don’t assume the dental benefit will be the same as last year. Double-check your Medicare dental benefits for 2022.
Where Do You Find Medicare Dental Plans that Cover Dentures?
Dentures are expensive. They also come in various types. Full dentures are just as they sound–a full set of teeth. The other kind of denture is a partial denture that fits between the teeth. Both of these kinds of dentures are removable.
The second type of denture is an implanted denture. This type is surgically implanted in the jaw. Implanted dentures are like tooth implants but done with a bridge. Dentists use titanium roots and screw-down caps to secure the denture.
Look at the Medicare Advantage plan’s Evidence of Coverage to confirm what the coverage is. I would not take the word of the agent or dentists. Plans change each year, and the Medicare plan may have dropped or added this benefit. Also, the Evidence of Coverage will give the details on cost coverage.
Dentures and implanted dentures are expensive. High-population areas usually have richer Medicare Advantage plans than other lower population areas. Review how much the plan covers the dentures and implanted dentures. The coverage could be a percentage or a flat amount.
Does Medicare Cover Dental Implants For Seniors?
Dental implants are enormously expensive, so a dental plan that gives $1,000 to the cause is not much when one implant is between $3,000–$5,000 on average. That is just for one! When replacing 4 or 5 teeth, you are talking about the price of a small used car. Medicare dental plans that will cover dental implants are very few at this time. Check with your agent to see if they are offered in your county.
To compound the confusion, some Medicare plans or supplements will offer some minimal dental services for an additional charge, but those are actually separate dental plans tacked on to the supplement or advantage plan. They are not part of Original Medicare or the Medicare Advantage plan. For the lack of a better term, they are Medicare dental insurance supplements.
Medicare Dental Insurance Supplements
The problem with these “Medicare dental insurance supplements” is they are not what they seem. The Advantage plan gives you some added dental insurance for an additional $16 or $23 a month. People mistakenly think this is a full dental plan, like they had with their employer.
When they go to the dentist, the plan might only cover two fillings and/or one extraction per year. It doesn’t cover crowns, root canals, bridges, etc. In a rush to get dental coverage and sign up for a Medicare plan, the agents do not go into detail on the plans, and clients are overwhelmed with all the Medicare information they are digesting. The clients do not find out until months or even years later, after paying all the monthly premiums, that the Medicare dental insurance supplement is very limited.
When people tell me Medicare is confusing, they say it with an attitude of apology. No apology is necessary; this is confusing!
Medicare Dental Coverage Plans
The bottom line is that if you want some sort of dental coverage, dental plans for people on Medicare are available. The plans are similar to the dental plans you experienced with your employer group health plan. They cover the same sorts of services with similar co-pays. You can add dental coverage to Medicare at any time. There is no special season for adding dental to Medicare. The cost, however, is usually higher for individual stand-alone dental plans compared to an employer group dental plan.
A group of a thousand employees commands lower premium rates from insurance companies than a single individual asking for the same coverage. Also, remember that you are paying for the whole premium. Your employer is no longer sharing the cost of the dental plan once you leave. Usually, you paid half, and the employer paid half or more. That is why your cost seems to be so much more. You are paying for the full load.
If you don’t want to pay the additional monthly premium of a stand-alone dental plan, you may wish to consider Medicare Advantage with the dental coverage included. The Medicare Advantage plans range in cost from zero to a very small premium.
Is Medicare with Dental Insurance Worth It?
You would want to get dental insurance when you go on Medicare because you had dental insurance before you were on Medicare. You have teeth, and teeth cost something to maintain and, at times, repair. The need is even greater when we go on Medicare because you are older. Things wear out–sorry to tell ya. As we age, fillings come loose. Teeth crack. A crown will cost a $1,000-$1,500. On a $30,000 annual income once retired, a $1,000 crown is a large percentage of your income, especially for something that doesn’t put food on the table or gas in the car.
Dental insurance does what insurance does. It protects you from unplanned, sudden, and big expenses. If a $500, $1,000, or $2,000 bill is a concern, then insurance is the solution to safeguard against those unwanted costs.
No Dental Coverage is More Expensive
Your teeth still need to be cleaned. An average teeth cleaning with x-rays and a full exam will average between $100-$175. Most people get their teeth cleaned twice a year. You almost break even with the premium you will pay on a dental plan at that price. However, the difference is that if you have a dental plan, you will not pay full freight when you go in for a root canal, crown, or other high-dollar dental procedure. You will only pay half or less. That is much easier to swallow on a fixed income. It makes the lack of Medicare dental coverage fixable.
How Do You Get Dental Coverage With Medicare?
We represent all the major dental plans. We are happy to show you the best Medicare dental plans in 2022. See the stand-alone dental plans in your price range that cover the services you want. If you are interested in a Medicare Advantage plan that offers dental, we will walk you through the plans in your area. We put the plans up on the big screen side-by-side to see the differences in costs, coverage, and networks.
Let’s give Medicare and dental coverage a closer look. Call us at Omaha Insurance Solutions at 402-614-3389 to learn more about Medicare dental coverage in 2022.