Medicare’s coverage of dental care is very limited. Generally, Medicare will not cover preventative dental care, that is care you need primarily for the health of your teeth or your gums and jaw. For example, Medicare will not cover routine checkups, cleanings, or fillings, and will not pay for dentures.

Medicare will cover some dental services if they are required to protect your general health, or if you need dental care in order for another health service that Medicare covers to be successful. Such as dental services that are necessary for radiation treatment, or if you need surgery to treat fractures of the jaw or face, Medicare will pay for these types of “medically necessary” dental services. 

It will not, however, pay for any follow-up dental care after the underlying health condition has been treated. So, if Medicare paid for a tooth to be removed as part of surgery to repair a facial injury, do not expect Medicare to pay for any other dental care you may need later because you had the tooth removed, and Medicare will not pay for dental implants or dentures to replace the extracted tooth.

This is an unexpected reality for most people that I meet with who are leaving an employer insurance plan and have had dental insurance. When you’re used to your insurance covering these types of things it can be frustrating to find out that you will no longer have this coverage. But…

Some Medicare Advantage Plans Include Dental Coverage

There are a few Medicare Advantage plans available in Maine and New Hampshire that cover routine cleanings and other work at the dentist.  When it comes time for you to enroll in Medicare or during the Annual Open Enrollment Period (October 15th – December 7th in 2016) it is a good idea to review these plans if dental care is important to you.  Plans change every year and your plan may have added dental coverage and you may not know it.

Dental insurance is also an alternative.

You can get a free quote from Delta Dental by clicking here.(link is external)  The monthly premiums equal what most people pay out of pocket for their 2 cleanings each year so why not spend that money on the insurance now so when you need a filling you will have the coverage.   [Click here to see plans](link is external)

Dental Discount Plans are another popular option.

Discount plans are gaining in popularity.  For a yearly membership fee (roughly $10/month,) you can buy into a discount dental plan, which allows you to get some pretty significant discounts (up to 60% and 70%) and the only catch is that you use dentists that are in your plan’s network.  [Click here to see plans](link is external)

“Discount dental plans work like a BJ’s or a SAM’S Club membership,” says Edan Barshan, president of Universal Dental Plan.  In return for the membership fee, you can choose among a network of dentists who will give 15 to 60 percent rate reductions for certain services.  A $1,000 crown might only cost $600 for a member of a plan.”

“And unlike dental insurance, which may not cover preexisting conditions or have waiting periods, you can shop for a discount dental plan knowing you need a root canal and select the plan that offers the cheapest price,” says Buddy Johnson, chief executive officer of national discount dental provider DentalPlans.com(link is external).  “You could sign up today and go to the dentist tomorrow,” he says.

Dental discount plans differ in several ways from dental insurance plans:

• Discount plans generally cost less than traditional dental insurance.
• You have to pay for the service in full, or negotiate a payment plan with the provider.

There are generally no restrictions on how many procedures you can get at a discounted price in a given year. Discount plans generally run for one year, so you can switch plans as your needs change. If you have a dentist already, you should ask whether he or she will accept the plan. Otherwise, you’ll need to find a provider who will. A number of discount dental plans include elective services, which are often not covered by insurance plans. Cosmetic dentistry, for example, is almost always excluded by insurance, but cosmetic procedures like tooth whitening are included in many discount plans’ list of services. 

To search for discount plans in your area CLICK HERE(link is external) and put in your zip code.

As with any important financial decision, do your homework first.  Find out what providers in your area are on the plan and what procedures are covered.  Make sure that costs and benefits add up to a net plus for your particular situation.  And if you need help or have any questions just give me a call or send me an email.  I am happy to help you!

Would you like my help?

If you would like help finding the right dental plan or ask a few questions, you can call me directly at 207-370-0143 or use my simple form on the CONTACT page of this site to send an email message.  The best part about working with me is that it will not cost you anything to talk with me to discuss your options and review the plans that are available.  I am paid by the insurance companies in the form of a commission when you enroll in a plan.  You will not pay anything to meet with me and you will pay the same price for your insurance that everyone pays whether they had my help or not.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

Acupuncture and Chiropractic are alternative ways to help with pain management, as well as other wellness benefits – some people find acupuncture helps them to quit smoking. Out of pocket costs for chiropractic and acupuncture can be hard on your wallet, so many of my clients often ask if Medicare covers acupuncture and chiropractic?

Let’s Talk About Acupuncture First.

Medicare does not cover acupuncture. Medicare offers some coverage for physical, occupational, and speech therapy but no acupuncture as of yet. But don’t get discouraged by this answer! Some insurance plans do cover acupuncture. Read on.

Does Medicare Cover Chiropractic Care?

Medicare does cover medically necessary chiropractic services. According to the Center for Medicare & Medicaid Services (CMS), Medicare Part B now covers 80% of the cost for “manipulation of the spine to correct a subluxation.” There is no cap on the number of medically necessary visits to a chiropractor.

Under Original Medicare, without any additional insurance, you would have to pay your part B deductible and 20% coinsurance for all medically necessary chiropractic appointments.

Do Supplemental Plans Cover Chiropractic and Acupuncture?

Traditional Medicare Supplements (also known as Medigap plans) do not cover acupuncture either. These plans will help pay the left over costs once Medicare has paid their share so if it’s not covered by Medicare then the Medigap plan will not pay either.

Medigap plans do cover chiropractic care. Medigap plan “C” and plan “F” cover 100% of your Part B deductible and will also pay the 20% coinsurance. Combined with Medicare there will be no charge for any medically necessary chiropractic work.

Do Medicare Advantage Plans Cover Chiropractic and Acupuncture?

Yes, some plans in Maine and New Hampshire do offer coverage for these treatments and More!

Some Medicare Advantage (Part C) plans will reimburse you for certain services not covered by Original Medicare. These include Acupuncture, Dental, Fitness Benefits, and Naturopathic Services. Since Part C plans are not standardized, each plan can offer a very different set of fees and benefits. Plans that have these wellness benefits are rare but worth searching for if that is a high priority. Chiropractic is usually available with a Medicare Advantage plan but how much you will pay can vary by plan.

For help tracking down which Medicare Advantage plans offer the benefits you need or if you have additional questions about other alternative treatments, send me a message using the CONTACT ME page on the menu above or call me at 207-370-0143.

Related Content

> > Compare Medicare Advantage and Medigap

> > Help is there – When you need it!

Each year I hear from retirees in Maine and New Hampshire who have purchased expensive Medicare Supplement (Medigap) policies.  They have talked to a friend or neighbor who has worked with me and want to know why they are paying so much more.

If you have a Medicare Supplement then last year was particularly painful because there was no cost of living increase to your Social Security check yet the insurance companies still increased your rates.  And it looks like that will happen again this year with trustees projecting a 0.2 percent increase for 2017 and insurance premium increases are expected to be 3-5%.

So, what are your options?

Option #1 – Look at Medicare Part C (Medicare Advantage)

The first and most obvious choice for lowering costs is to look at Medicare Advantage plans, also known as Medicare Part C. These plans are required to offer everything that’s covered under Original Medicare, Part A and Part B, and may include other benefits as well, such as prescription drug coverage, dental, and vision.

These plans have much lower monthly premiums and unlike your Medicare Supplement the monthly premiums for Medicare Advantage plans have been going DOWN with a few plans now charging $0 per month.  These plans have cost shares that you pay when you go to the doctors or hospital but if you are only seeing a few doctors each year the savings can be big.

Click here to compare Medicare Advantage rates in your area.

Option #2 – Shop Around

Your second option is to shop around and find out if there is a less expensive plan that will suit your needs.  There are many plan choices that offer lower monthly premiums with more out of pocket costs.  If you have Plan F then you are on the most expensive plan available.

Look at the differences between Plan N, Plan G and Plans K or L to see of those would be better.  Be careful when changing plans and make sure you talk to your agent to make sure you are aware of all the costs.  Click here to compare Medicare Supplements in Maine and New Hampshire.

Option #3 – Change Insurance Companies

Another option is changing insurance companies.   Medigap plans are standardized and the coverage is identical from one carrier to another.  If you have Plan F with Company A and see that Company B is offering Plan F for less, you can switch to the lower cost plan and your benefits will not change.

Again, when changing plans it’s always best to talk to your agent to make sure you are aware of all the costs.  Click here to compare Medicare Supplements in Maine and New Hampshire.

Click here to contact me for more information on Medigap plans or more information on how to easily change plans.

Option #4 – Work with a local Independent Agent to help you.

Last but not least, if you are not working with a local agent then you should.  Unlike purchasing auto, home or life insurance, buying a health insurance policy is just the beginning, not the end of the process.  Why? Your health and that of your family can change constantly — and so can your insurance needs.

About 80 percent of what an agent does comes after you are enrolled in the insurance plan.  With health insurance, an agent remains your advocate. Since most people receive their health insurance through an employer before retirement, they see very little of the ongoing services that agents provide. To give a few examples, agents:

• Assist clients with claim issues, and answer questions throughout the year.
• Review rates and plan changes each year.
• Explain plan designs, benefits and options.
• Assist in resolving billing issues.

Licensed agents act as a single point of contact between you and the insurance company.  There is no cost to work with an agent.  Agents are paid in the form of a commission based on your enrollment in a plan.  These commissions are paid by the insurance company, not you!

“It really is a win-win situation for all my clients!”

If you don’t have an agent and would like one on your side then send me a message or give me a call.  I would love to help you save money!

You can reach me at (207) 370-0143 or by email using the form on my CONTACT page here.

“My goal is to help people and I have found great joy in being able to offer my services to people who need my help.”

There are two Social Security scams you need to watch out for at the moment.

The first one is where you receive an official-looking email from the Social Security Administration with an invite to create an account so you can receive your benefits. You land on a webpage where the scammers hope you will fill out all your confidential information. Don’t fall for it.

Never click on links in any of these emails. If you want to sign up for a My Social Security Account go directly to https://ssa.gov/myaccount/

Thomas Farrington of Maine Web Service, a provider of computer maintenance and security services advises, “It is a good practice to not follow links received in an email.  Instead, type the address in your browser to go directly to the site.  This is particularly important when going to a site where you enter any personal information.”

In the second scam, identity thieves obtain your personal information and use that information to open a ‘my Social Security’ account on SSA’s website. If successful, they then use that account to redirect your direct deposit benefits to an account controlled by the thief.

This should in no way discourage you from using SSA’s ‘my Social Security’ feature, which enables you to view your earnings history and estimated benefits.

in fact, establishing your account eliminates the risk of a new account being opened by an identity thief. This type of crime does, however, serve as a reminder to protect your personal information as you would any other thing of value. Once thieves have your personal information, they can use it to open credit accounts, buy homes, claim tax refunds, and commit other types of fraud.

Mr. Farrington’s advice when creating your MySSA account, is to go into the settings and choose the option that any changes to the bank account into which your check is electronically deposited only be done physically at a Social Security branch office and not using your online account.

If you receive information from SSA indicating that you have opened a ‘my Social Security’ account, and you did not open an account, you should contact Social Security so that appropriate action may be taken, and the matter may be referred to the Office of the Inspector General. You can do so by visiting or calling a local SSA office or calling SSA’s toll free customer service at 1-800-772-1213. Deaf or hearing-impaired individuals can call Social Security’s TTY number at 1-800-325-0778.

Has this ever happened to you?

You sign up for new insurance online and you pick a plan that you think is great because the price is right and all the copays are low, then you get a huge bill from your doctor’s office saying that the insurance did not pay.  What gives?

I recently talked to someone who was told by a customer service agent on the “Obamacare” Healthcare.gov helpline to call her doctor’s office to find out if they accept the insurance.

“This is a big mistake.”

Often times the staff at your doctor’s office sees many different insurance cards.  They may see a card from the company who has the plan that you chose and it will sound familiar to them so they may say, “Yes, we accept that insurance.”

The problem is that your new plan may be an HMO (Health Maintenance Organization) and if that’s the case, this plan has a network of doctors that will accept the insurance.  Any doctor not participating in this network will not accept the plan.

What’s the problem if they say they accept it?

The problem is that they may not know it’s an HMO plan.   See, there are many different types of plans and some are PPO (Preferred Provider Organization) plans.  These PPO plans have coverage for out-of-network doctors (usually at higher rates.)

Read more about the differences between HMO, PPO and other plans here.

So, if someone has a PPO plan with the same insurance company then they could see any doctor because it covers doctors visits whether they are IN or OUT of the network.  The staff at your doctor’s office may have seen people with cards from this insurance company so the staff at your doctor’s office might have the impression that they accept ALL plans from this company which may not be the case.   If your doctor is not in your new plan’s network then your new HMO plan will not pay the bill and you will either have to find a new doctor or pay the bill on your own.

How can you be sure your doctor accepts your new insurance plan?

Work with an agent or call the insurance companies directly before you sign up for any plan and make sure all your doctors, hospitals and Medications are covered by the insurance.   This is why I believe everyone should work with an insurance agent when shopping for health insurance.  I look at the overall costs associated with the plan when I meet with a new client.  We check to make sure any doctors or services you need are covered by the new plan before we enroll.  And we make sure to check to see if all prescription medications are covered because each of the plans covers medications differently.