Dental Insurance

Dental Coverage Under Original Medicare

Original Medicare (Part A for hospital coverage and Part B for medical coverage) typically does not include routine dental coverage, such as dental exams, cleanings, fillings, crowns, and bridges. There are, however, some exceptions to this rule.

For example, it you suffer an accident that results in damage to the jaw, Medicare would cover the medical reconstruction of the jaw. Or if you have a disease involving the jaw, Original Medicare might cover a tooth extraction that is directly caused by the disease.

For emergency and complicated dental procedures that require a hospital stay, Medicare Part A covers the hospital stay but, in general, not the dental procedure.

If you're having a kidney or heart transplant or another complicated procedure that requires a preliminary dental exam, Medicare covers the dental exam either under Medicare Part A or Medicare Part B, depending on whether the dental exam is performed by hospital staff or an in-office physician.

Since routine dental coverage is not available under Original Medicare, you are generally responsible for the full cost of your dental care unless you have other dental insurance.

Dental coverage through Medicare Advantage plan

You may be able to get dental coverage under some Medicare Advantage plans. Medicare Advantage plans (Part C) can include extra benefits like routine dental, routine vision, and Medicare prescription drug coverage. You can check out Medicare Advantage plans in your area by visiting www.Medicare.gov or looking in the back of your Medicare & You Handbook.

Other dental coverage options

As mentioned, unless you enroll in a Medicare Advantage plan that includes routine dental coverage, you'll typically have to pay the full cost for routine dental care. However, there are other ways to cover dental costs outside of what's covered by Medicare, including dental insurance and dental discount cards. It is important to note that these types of dental coverage are not part of Medicare.

Dental insurance

For complete dental coverage, click here to shop online and find a dental insurance plan that fits your personal needs. You may also have group dental insurance available, if either you or your spouse is employed. Be sure to read the plans carefully. Most dental plans require you to stay within a network of dental care providers. The premiums may be a bit higher for this type of plan, but the costs are offset by lower out-of-pocket fees, like copayments, coinsurance and deductibles, mainly because network dentists usually agree to charge discounted rates to members of the dental plan. Other plans let you go to any licensed dental professional, but you may have to pay more at the time of service. Click here to see Dental plans and rates in your area.

Dental discount cards

Some dental care provider organizations offer dental discount cards. This is neither Medicare nor dental insurance, and there are no dental benefits payable to you or the dentist.  With a dental discount card, you get access to a network of dental professionals who agree to discounted rates for dental exams, cleanings, fillings, and more. You pay one annual fee to be in the program and then use the card whenever you receive dental care. Ask your dental care provider if he or she offers these discount cards. These plans also do not require waiting periods when you enroll so you can schedule your procedure the day after you enroll in the discount plan.  Click here to find a discount plan in your area. 

"Isn't it cheaper to pay for my cleanings myself instead of paying for insurance?"

I get this questions a lot.  When deciding on a dental plan it's wise to consider all costs with and without the insurance.  Most people who go without dental insurance only pay for their cleanings two times each year which most times works out to about the same cost as the insurance.  If this is your scenario then you should consider enrolling in dental insurance.   If you pay for the insurance and the insurance pays for your cleanings and x-rays you are not paying any more than you would have without insurance and you will have insurance should you need any work done later on.  If you go without insurance and try to enroll when you need it you will have either a 3 month or 6 month waiting period and it may not be something that can wait.  Also, if you enroll in a basic plan that covers your cleanings and low costs procedures such as fillings and crown lengthening but does not cover more expensive things like root canals or full crowns, you have the option to change to the higher coverage plan when you need those services and the insurance carrier will waive the waiting periods!  So, again, if the cost of your two cleanings and x-rays every year is almost equal to the total cost of the insurance, why not pay the same amount for the insurance and gain the benefits of having insurance coverage if you ever need it?  Click here to see the rates for you in your area or call me at 207-370-0143 and I can help you over the phone.