What Type of Dental Care Will be Covered by Medicare?

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Contributor, Benzinga
October 11, 2022

As we near the annual enrollment period for Medicare (October 15 – December 7), people may be wondering whether dental benefits are now included in their coverage. There was a push to add dental to Medicare for 2023, but it was ultimately unsuccessful.

There are still a number of options for Medicare recipients who are looking for ways to reduce the cost of dental care. But figuring out which option works best for you can be challenging.

Understanding Medicare Options for Dental Coverage

Original Medicare does not cover regular dental care or routine dental treatments such as checkups, cleanings, fillings, tooth extractions, bridges, dental implants or dentures. Medicare may, in very specific circumstances, cover hospitalization costs for dental procedures that must be performed in a hospital.

Medicare Supplement insurance (also called Medigap) is intended to fill in the “gaps” in original Medicare. It helps you pay for Medicare’s out-of-pocket costs (copayments, coinsurance, deductibles). Like Medicare, it does not cover regular or routine dental care.

Medicare Advantage plans are a private insurance alternative to original Medicare. These plans often include dental coverage, either as part of the plan or as an optional add-on (costs vary based on plan and location). Medicare Advantage dental coverage works the same as dental insurance, you get reduced rates on dental care after you reached your deducible, and your coverage has an annual cap – typically $1000-$1,500. Some plans may only cover basic/preventive dental care, while others include comprehensive dental coverage such as oral surgery and restorative services (bridges, dental implants, dentures, etc.) It’s important to check each plan’s documentation for full details on costs and coverage. If you don’t already have a treatment plan from your dentist, you may want to consider scheduling a checkup and talking to your dentist about your anticipated treatment needs over the next year. You can compare the costs of these procedures to the annual maximum coverage offered by the insurance plans you are considering. For instance, one root canal and a crown can exhaust your dental insurance maximum for an entire year.

Note: Medicare Advantage Plans must cover emergency and urgent care anywhere in the U.S., but regular care may or may not be covered outside of a plan’s service area. Check to see if dental is covered under your plan when you travel within the U.S. You may only be covered if you see dentists within a specific zip code, region or state.

Options for Adding Dental to Medicare Coverage

If you are on Original Medicare, or your Advantage plan doesn’t include sufficient dental benefits, you can still save on your dental care.

Dental Insurance – you can purchase your own dental insurance (you don’t qualify for ADA dental coverage if you are on Medicaid, as ADA dental must be purchased with ADA health insurance). Dental insurance is great for people who have excellent oral health, as it typically provides good discounts on preventive care likeannual checkups and cleanings, along with fillings and other basic procedures. But since, as noted above, dental insurance has annual caps on coverage (typically $1,000-$1,500) it may not fit your budget for restorative care such as root canals, crowns, bridges, dental implants, and dentures.

The cost of an individual dental insurance policy is around $350-400 a year. For a family, the cost is around $600. Be aware that you are likely to save more if you purchase dental insurance as part of a Medicaid Advantage plan. But if Medicaid Advantage doesn’t meet your needs (for example, if you move to another home seasonally, or travel throughout the U.S. extensively), you may want to consider private insurance.

Dental Savings Plans – These plans are an affordable alternative to traditional dental insurance. Plan members can save 10-60% on most dental procedures, including preventive and restorative care from any of the 140,000 participating dentists nationwide.

While insurance has annual caps, deductibles, waiting periods, and pre-existing condition restrictions, dental saving plans do not. You can use your plan within days of joining, and as often as needed. This can make expensive restorative care more accessible financially, allowing you to receive your treatment when you need it, without worry of having to pause and wait for your annual limit to reset before continuing your treatment. Plan members pay a discounted rate directly to the dentist when they receive care. DentalPlans.com offers more than 30 plans ranging from $79.95 for a single person to $199.95 for a family, annually. Select plans also include savings on vision and hearing care, as well as prescription drugs, at no additional cost.

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Get Ready for Open Enrollment

As we approach open enrollment, it’s important to remember that poor dental hygiene has been linked to an increased risk of life-threatening heath conditions, such heart disease and stroke. There are a variety of options you can consider when it comes to maintaining your oral health, so you can join the one that best meets your needs and budget.

For additional information on Medicare plans, head to Medicare.gov. To find out more about dental savings plans, you can visit DentalPlans.com.