As we age, continuing to care for our dental health is extremely important. Not only does good oral health prevent issues like toothaches, tooth decay, gum disease, and tooth loss, but it can also guard against a whole host of health issues. Poor oral health can increase the risk of heart disease, stroke, diabetes, pneumonia, and lung disease.
Because caring for your oral health as you age is a vital part of aging well, understanding which dental services are covered by your insurance becomes paramount. Unfortunately, there is a lot of confusion regarding dental coverage and Medicare, a program that provides health insurance for people over the age of 65.
Medicare coverage for dental procedures is limited and can vary depending on the specific circumstances and the type of Medicare plan you have. In this blog post, we’ll delve into what dental procedures are covered by Medicare, what options are available for additional coverage, and how you can navigate your dental care needs under Medicare.
What Type of Medicare Do You Have:
The first thing to figure out when determining what types of dental services are covered by your insurance is to find out what type of Medicare you have. You can find out what type of Medicare you have by checking your Medicare card, calling 1-800-MEDICARE (1800-633-4227), or logging into your account at medicare.gov. The lower left corner of your medicare card will say “Hospital (Part A) if you have Part A, or “Medical (Part B)” if you have Part B. If you still need help, please call our office and we can help determine which medicare you have.
Part A & Part B
Unfortunately, original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), generally does not cover routine dental care, such as cleanings, fillings, extractions, or dentures. Medicare Part A may cover dental services if they are received in the hospital as part of an emergency dental procedure that is necessary to protect a patient’s life.
Medicare Part B only covers medically necessary dental services such as:
- Dental Services Related to Other Medical Treatments: For example, if you need dental exams before certain medical procedures like kidney transplants or heart valve replacements, Medicare Part B may cover those exams.
- Limited Emergency Dental Care: Medicare Part B may cover emergency dental services if you visit an emergency room for issues like severe bleeding or trauma to the mouth.
If you only have Part A and Part B, the chance of getting any dental services covered is quite unlikely unless the situation fits one of these unique circumstances.
Part C: Medicare Advantage Plans
Medicare Advantage plans (called Part C) is a type of Medicare insurace that may actually cover routine dental services. These plans are offered by private insurance companies that have been approved by Medicare. They provide all the benefits of Medicare Parts A and B, but can also include dental, vision, and prescription drug coverage. Many Medicare Advantage plans offer dental coverage that includes routine dental exams, cleanings, fillings, and other preventive and restorative dental services such as:
- Preventive dental exams
- Teeth cleanings
- X-rays
- Dental fillings
- Anesthesia
- Dentures
The specifics of dental coverage can vary widely between different Medicare Advantage plans. Some plans may have a network of dentists that you must use to receive coverage, while others may offer more flexibility in choosing a provider. For more information check out our blog post on how to find a dentist who takes medicare plans.
In addition, you may have premium payments, co-pays, and deductibles, so it is very important to review all the options and shop for the best Advantage plan for your specific needs and budget.
Other Options:
If you’re enrolled in Medicare, but do not have adequate coverage through Parts A or B, and do not have a Medicare Advantage plan, there are still several options available that can help you manage your dental costs. Neglecting dental care or ignoring dental issues will lead to larger problems down the road. So even without dental insurance, it’s important to continue to seek dental care. Here are some options to finance the care that you need.
Stand-Alone Dental Plans
Since Original Medicare does not cover routine dental care and Medicare Advantage plans may have limitations, some people purchase stand-alone dental insurance plans. These plans are offered by private insurance companies and are designed specifically to cover dental services such as cleanings, fillings, crowns, dentures, and more.
Stand-alone dental plans vary in cost and coverage options, so it’s important to compare plans carefully to find the one that meets your needs and budget. Some plans may have waiting periods before certain services are covered, so it’s a good idea to review the plan details before enrolling.
Medicaid Coverage
Medicaid is a joint federal and state program that provides health coverage to eligible low-income individuals and families. While dental coverage under Medicaid varies by state, it often includes comprehensive dental benefits for adults, including preventive and restorative dental care.
If you qualify for both Medicare and Medicaid (dual eligible), you may be able to receive dental coverage through your state’s Medicaid program. It’s important to check with your state Medicaid office to understand what dental services are covered and how to access them.
Dental Savings Plans
These plans, also known as dental discount plans, offer discounted rates on dental services at participating dentists. Unlike insurance plans, dental savings plans involve paying an annual fee to access discounted services throughout the year.
Community Health Centers
Some community health centers and clinics offer dental services on a sliding fee scale based on income. These centers may provide basic dental care such as cleanings, fillings, and extractions at a reduced cost for eligible individuals.
Negotiating Fees
In some cases, your dentist may offer discounted rates or payment plans for patients paying out of pocket. It’s worth discussing options with your dentist to see if there are any ways to reduce costs for necessary dental treatments.
Importance of Dental Health at Every Age
Maintaining good oral health is essential for overall well-being. Poor dental health can contribute to other health issues such as heart disease, diabetes, and respiratory infections. While Medicare’s coverage for dental care is limited, there are options available to help manage costs and access necessary dental treatments.
For individuals approaching Medicare eligibility or currently enrolled in Medicare, understanding the coverage options for dental care is crucial for planning and managing your dental health needs. Whether through Medicare Advantage plans, stand-alone dental insurance, or other resources, there are ways to ensure access to dental services that support long-term oral health. Exploring these options and understanding which dental procedures are covered by Medicare can help you make informed decisions about your dental health and overall well-being.
We can help
Call the office at White Rose Family Dental today. We can help you determine what type of coverage you have. If dental care is not covered in your plan, we can discuss flexible payment options to help make your dental care affordable.
Carriers We Accept
We are in direct network with these providers:
- Aetna
- Highmark/United Concordia
- Capital Blue Cross
- Delta Dental
To learn more about what dental options are available to you, call us today at (717) 822-0272 or click here to schedule your appointment.