Do you need dental insurance?

I am asked all the time if Medicare covers dental?  The short answer is No, Medicare does not cover any routine dental care.

Medicare will only pay for dental services that are an integral part either of a covered procedure (reconstruction of the jaw following an accidental injury), or for extractions done in preparation for radiation treatment for diseases involving the jaw or if the tooth poses a health risk due to decay.  Medicare will not cover replacement of the tooth or a root canal or crown to save the tooth, nor will Medicare cover dentures.

According to a recent study by Boston-based discount dental service provider Universal Dental Plan, nearly half of Americans age 65 and older did not visit a dentist in the previous year, the number one reason being cost. The consequences of that decision can be dangerous. Poor oral health increases one’s risk of heart disease by 180 percent, risk of stroke by 300 percent and risk of respiratory infection by 500 percent – not to mention gum disease! Some folks opt to pay out of pocket for regular cleanings rather than pay for dental insurance, thinking that unless they were having major procedures done every year they would pay three or four times in premiums what they spend on the work needed.  But this not the best idea.

Medicare Advantage Plans May Include Dental

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 a 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 don’t even know it.

Dental insurance is an alternative.

You can get a free quote from Delta Dental by clicking here.  The monthly premiums equal what most people pay out of pocket for their 2 cleanings each year so why now spend that money on the insurance so when you need a filling you will have coverage.   [Click here to see plans]

Dental Discount Plans are a popular option.

Discount plans are gaining in popularity. For a yearly membership fee, you can enter into a discount dental plan, which allows you to get significant discounts (between 15% and 60%) on dental costs, provided that you use dentists that accept these plans.  [Click here to see plans]

“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 monthly fee, you can choose among a network of dentists who will give 10 to 60 percent rate reductions for certain services. That $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. “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 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.

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.”

Find out which insurance companies sell Medigap policies in your area.

Medicare Supplements (Medigap) policies are standardized.

Every Medigap policy must follow federal and state laws designed to protect you, and it must be clearly identified as “Medicare Supplement Insurance.” Insurance companies can only sell you a “standardized” policy identified in New Hampshire and Maine by letters, A – N. (See Chart Below)

All policies offer the same basic benefits but some offer additional benefits, so you can choose which one meets your needs.  Each insurance company decides which Medigap policies it wants to offer and the insurance companies don’t have to offer every Medigap plan.  So first choos the plan that’s right for you and then find out which companies offer that plan.

Note:  The Medigap policy covers coinsurance only after you’ve paid the deductible (unless the Medigap policy also pays the deductible).

Medigap Plans

* Plan F is also offered as a high-deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicare-covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,180 in 2015 before your policy pays anything.
** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($147 in 2015), the Medigap plan pays 100% of covered services for the rest of the calendar year.
*** Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

Compare Medigap Plans and Rates

Shop Around for the Best Medigap Policy

Look for a Medigap policy that you can afford and that gives you the coverage you need most.  As you shop for a Medigap policy, keep in mind different insurance companies may charge different amounts for exactly the same Medigap policy, and not all insurance companies offer all of the Medigap policies.

Watch Out for Illegal Insurance Practices

You should know it is illegal for anyone to pressure you into buying a Medigap policy, lie or mislead you to switch to another company or sell you a second Medigap policy when they know that you already have one. It is also illegal to sell you a policy that cannot be sold in your state.  Work with someone local that has a good reputation and who you can trust.

Click here to learn about Medicare Advantage Plans under Part C of Medicare and how they differ from these Medigap plans.

Would you like my help?

If you would like to talk to me, ask a question or schedule a meeting at your home or a nearby meeting place, 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 any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you talk with me.

“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.”

Medicare Part A covers institutional care in hospitals and skilled nursing facilities, as well as certain care given by home health agencies and care provided in hospices.

Any person who has reached age 65 and who is entitled to Social Security benefits is eligible for Medicare Part A without charge. That is, there are no premiums for this part of the Medicare program.

Medicare Part A covers up to 100 days of “skilled nursing” care per illness. However, the conditions for obtaining Medicare coverage of a nursing home stay are quite stringent.

Here are the main requirements:

• The Medicare recipient must enter the nursing home no more than 30 days after a hospital stay (meaning admission as an inpatient; “observation status” does not count) that itself lasted for at least three days (not counting the day of discharge).
• The care provided in the nursing home must be for the same condition that caused the hospitalization (or a condition medically related to it).
• The patient must receive a “skilled” level of care in the nursing facility that cannot be provided at home or on an outpatient basis. In order to be considered “skilled,” nursing care must be ordered by a physician and delivered by, or under the supervision of, a professional such as a physical therapist, registered nurse or licensed practical nurse. Moreover, such care must be delivered on a daily basis. (Few nursing home residents receive this level of care.)
• As soon as the nursing facility determines that a patient is no longer receiving a skilled level of care, the Medicare coverage ends. And, beginning on day 21 of the nursing home stay, there is a significant copayment equal to one-eighth of the initial hospital deductible ($157.50 a day in 2015). This copayment will usually be covered by a Medigap insurance policy, provided the patient has one or there pay be a different copayment structure with a Medicare Advantage plan (Part C).

A new spell of illness can begin if the patient has not received skilled care, either in a skilled nursing facility (SNF) or in a hospital, for a period of 60 consecutive days. The patient can remain in the SNF and still qualify as long as he or she does not receive a skilled level of care during that 60 days.

Nursing homes often terminate Medicare coverage for SNF care before they should. Two misunderstandings most often result in inappropriate denial of Medicare coverage to SNF patients. First, many nursing homes assume in error that if a patient has stopped making progress towards recovery then Medicare coverage should end. In fact, if the patient needs continued skilled care simply to maintain his or her status (or to slow deterioration) then the care should be provided and is covered by Medicare.

Second, nursing homes may wrongly believe that care requiring only supervision (rather than direct administration) by a skilled nurse is excluded from Medicare’s SNF benefit. In fact, patients often receive an array of treatments that don’t need to be carried out by a skilled nurse but that may, in combination, require skilled supervision. In these instances, if the potential for adverse interactions among multiple treatments requires that a skilled nurse monitor the patient’s care and status, then Medicare will continue to provide coverage.

When a patient leaves a hospital and moves to a nursing home that provides Medicare coverage, the nursing home must give the patient written notice of whether the nursing home believes that the patient requires a skilled level of care and thus merits Medicare coverage. Even in cases where the SNF initially treats the patient as a Medicare recipient, after two or more weeks, often, the SNF will determine that the patient no longer needs a skilled level of care and will issue a “Notice of Non-Coverage” terminating the Medicare coverage.

Whether the non-coverage determination is made on entering the SNF or after a period of treatment, the notice asks whether the patient would like the nursing home bill to be submitted to Medicare despite the nursing home’s assessment of his or her care needs. The patient (or his or her representative) should always ask for the bill to be submitted. This requires the nursing home to submit the patient’s medical records for review to the fiscal intermediary, an insurance company hired by Medicare, which reviews the facilities determination.

The review costs the patient nothing and may result in continued Medicare coverage.

While the review is being conducted, the patient is not obligated to pay the nursing home. However, if the appeal is denied, the patient will owe the facility retroactively for the period under review. If the fiscal intermediary agrees with the nursing home that the patient no longer requires a skilled level of care, the next level of appeal is to an Administrative Law Judge. This appeal can take a year and involves hiring a lawyer. It should be pursued only if, after reviewing the patient’s medical records, the lawyer believes that the patient was receiving a skilled level of care that should have been covered by Medicare. If you are turned down at this appeal level, there are subsequent appeals to the Appeals Council in Washington, and then to federal court.

If you need legal assistance you can contact the following elder law attorney’s in your state.

Elder Law Offices in Maine

Click here to find a law office in your area.

Find Elder Law Offices in New Hampshire 

I would be happy to answer any questions you might have about this, or any other Health Insurance topic.  I can be reached at 207-370-0143 or at  http://www.mainemedicareoptions.com/contact

Every beneficiary is given a Medicare number. This number is your Social Security number followed by a letter.  Your Medicare number is often referred to as a Medicare claim number.  The letter codes at the end of your Medicare claim number may appear on correspondence you receive from Social Security or on your Medicare card.  These letters represent how you earned your benefit, either through taxes you paid or taxes a spouse may have paid, etc…

Still have questions?  Would you like my help?

If you would like to talk to me or schedule a meeting at your home or a nearby meeting place, you can reach me at 207-370-0143 or use my simple form on the CONTACT ME 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 meet with me to discuss your options or to review the plans that are available.  I am paid by the insurance companies in the form of a commission if you enroll in a plan.  You will not pay any more than anyone else and you are under no obligation whatsoever to enroll in any plans if you meet with me.  

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

When you’re shopping for health insurance, you have a lot of options to choose from.

Knowing the differences between plans can help you choose the one that’s right for your health care needs and budget.

As you look at plans, you may notice that some plans have letters after their names (HMO, PPO, POS, PFFS, SNP, Etc…) but what do they mean?

Health Maintenance Organization (HMO)

• An HMO is a type of health-care plan that generally requires you to select a primary care doctor.
• In most cases, you need to get a referral to see a specialist.
• If you don’t follow the plan’s rules for services, you may have to pay the full costs of care.
• Except under certain circumstances, you’re typically not covered for services obtained outside of the plan’s network of Medicare providers.
• While the rules of an HMO health policy may be relatively restrictive compared to other plans, the restrictions may be offset by lower plan costs.

Preferred Provider Organization (PPO)

• With a PPO plan, you can generally go to any doctor or hospital, but will pay less if you use doctors and hospitals that belong to the plan’s network.
• PPO health plans typically don’t require a referral for care by a specialist. However, if you use out-of-network health care providers or specialists, you may be required to pay a higher portion of the cost for covered services.
• Compared to an HMO plan, a PPO plan may be less restrictive. However, the monthly premium for a PPO plan may be higher.

Private Fee-For-Service (PFFS)

Special Needs Plans (SNP)

• You have a severe or disabling chronic condition, such as chronic heart failure or dementia.
• You’re enrolled in both Medicare and Medicaid.
• You live in an institution such as a nursing home.

HMO Point-Of-Service (HMO POS)

Which one is right for you?

Need more help comparing the different health insurance plans?  I can help you.

When Do You Become a Senior Citizen?

So what does the term “senior citizen” mean, and when exactly does an individual become one?

The term first was coined during a 1938 political campaign as a euphemism for “old person,” and now enjoys widespread usage in the common vernacular, legislation, and business. Some dictionaries define “senior citizen” as a person over the age of 65. In everyday speech, the term is often shortened to “senior.”

“I truly enjoy working with folks over 65.  It’s the most rewarding job I’ve ever had!”