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Medicare Dental Coverage & How to Get Care

Published February 8, 2023

According to a survey conducted in January 2019, 83% of adults in the U.S. stated that their current health-related priority was their oral health. Good dental hygiene, in fact, was rated higher than mental health, exercise, and even diet.

If you’re part of the 83% who prioritize your oral health, you may be wondering: does Medicare cover dental? Dental benefits aren’t typically covered by Original Medicare, but if you have a Medicare Advantage Plan, you may be covered in some areas. The notable exception for Original Medicare is if your health situation has created the need for these services. Medicare Part B covers only a limited number of dental services that are medically necessary to treat a medical condition or injury.

How to Get Dental Coverage with Medicare

Let's examine the main options and discuss the guidelines on how to obtain these benefits at the best possible cost. Two ways that dental coverage can be obtained include:

  • Medicare Advantage
  • Private Dental Coverage

Both of the routes mentioned above will be your best bet for covering procedures such as:

  • Oral surgery
  • Root canals
  • Crowns
  • Oral Exams
  • Dentures
  • Cleanings
  • X-Rays

Dental Coverage Through Medicare Advantage

Medicare Advantage plans frequently offer dental benefits. Preventive care such as exams and x-rays are typically covered in Medicare Advantage Plans. Some may offer either minor or major restorative benefits. Typically there is an annual maximum benefit that will vary by Medicare Advantage Plan. In addition, the coverage may only cover a percentage of the total cost, and it will entirely depend on your Medicare Advantage Plan.

The coverage within each Medicare Advantage plan may vary. To ensure you’re covered, you’ll need to verify that the dentist will accept your plan and the specific service is included within it. Importantly, what’s covered within one plan can be expected to vary amongst others. For example, extractions may be covered as an embedded benefit within a particular Medicare Advantage plan, but not a different Medicare Advantage plan. A standard “list” of what will be covered and what won’t doesn’t exist across all Medicare Advantage plans, so it’s always important to check with your specified plan first.

There are two additional features to consider when considering dental benefits within a Medicare Advantage plan. The first is the idea of “enhanced benefits,” which can be purchased separately. These enhanced benefits may include improved benefits for major dental work and higher maximum benefits, which may be useful.

The second feature, which also exists within the embedded dental benefits within a Medicare Advantage plan, is the idea that there is no waiting period involved. It means you can receive both the benefits embedded within a Medicare Advantage policy and the enhanced benefits on January 1st, or the first day you become a Medicare Advantage member.

Dental Coverage Through Private Insurance

Dental insurance premiums in the private market, purchased individually, can vary as low as $10 per month to $90 per month and beyond. Dental insurance language is unlike any other insurance you may have encountered. Generally speaking, there are minor and major dental services. Based on the type of service you require, the coverage of these services can vary. Most notably, there can be a waiting period for major restorative or other services, although each policy can differ greatly.

A key component in selecting any dental coverage is knowing that the value of benefits that you receive, in any policy year, can be capped at a stated dollar amount. The maximum benefit amounts can vary, based on the length of time that you own a specific policy. This can be important for those that know in advance that they may require substantial dental work in the future.

Unlike Medicare, the calendar for individually purchased dental insurance differs from the schedule used for Original Medicare, Medicare Advantage, and Part D plans, which always end on the last day of a calendar year. However, an individually-purchased plan may have a different policy anniversary date, which will determine whether you have met the annual deductible or maximum benefit amount for the policy year. This means that all of the stipulations of a deductible or out-of-pocket maximum benefit will reset on a date that may not be January 1st.

Does Original Medicare Provide Dental Coverage?

As mentioned earlier, Original Medicare does not generally cover routine dental care, such as cleanings, fillings, and extractions. However, it may cover certain types of dental services in specific circumstances, such as if the services are medically necessary or if the individual has a medical condition that affects the teeth or jaw.

Does Medigap Provide Dental Coverage?

Medigap relies on Original Medicare. Therefore, if Original Medicare does not provide a specific benefit, the Medigap carrier is not obligated to provide coverage. The number of carriers that are offering extra benefits — which might include dental, vision, or hearing benefits — within a Medigap policy is very small and declining. Certain carriers offer discounts on separate dental coverage or dental insurance. It’s important to keep the difference in mind. The cost of these additional policies may be less expensive than dental insurance when purchased privately.

How Can OpenMedicare Help You?

Dental coverage is an important aspect of healthcare, and it's important to find a plan that meets your needs and budget. Call us at 844-910-2061 for further assistance, or visit us at OpenMedicare for expert guidance on comparing dental plans and making it convenient to get the coverage you need.

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