Medicare wasn’t designed to include coverage of routine dental care and coverage of expenses is very limited.
Here’s what you need to know.
For just over 50 years now, Medicare has provided health insurance coverage to America’s seniors. But dental coverage was never included in Original Medicare.
So even with a very solid health plan via Original Medicare + Medicare Supplement (Medigap) + Part D prescription drug coverage, dental care is an out-of-pocket expense.
Coverage for dental care is limited
Medicare’s coverage of dental expenses is limited to situations where the dental treatment is integral to other medical treatment (for example, an extraction prior to radiation treatment for oral cancer, or jaw reconstruction following an accident).
While health insurance plans generally pick up the tab for large medical bills, it’s rare to find dental coverage that doesn’t leave enrollees on the hook for significant bills if they need extensive dental work.
This is generally true across a wide range of plan types, including Medicare Advantage plans which often have added dental coverage or stand-alone dental plans which commonly have benefit maximums of $1,000 or $1,500 per year, and a single root canal can cost between $800 and $2,000, while an implant can be $2,000 to $3,000 per tooth.
But some coverage is better than nothing. Even with low benefit maximums, people who have dental insurance are more likely to receive routine preventive dental care, and are less likely to have untreated dental problems that get worse over time.
Sources of dental coverage
Some retirees can retain dental coverage from their former employer or a spouse’s employer. But there are other options available for seniors who don’t have access to employer-sponsored dental coverage.
Medicare Advantage is an alternative to Original Medicare for enrollees who want dental coverage. The three top plans in Maine offer some routine dental coverage and one plan offers additional comprehensive coverage.
If you’re considering Medicare Advantage instead of Original Medicare + Medigap + Medicare Part D, be sure to familiarize yourself with the pros and cons of both options.
Stand-alone dental plans are available for purchase, and some carriers offer dental plans that are specifically designed for seniors. But again, it’s typical for them to have relatively low annual benefit maximums (here’s an example of such a plan, offered by Delta Dental in Maine and New Hampshire – the benefit maximums range from $1,000 to $2,000 per year, depending on the plan selected, and the premiums range from $30 to $90 per year, including vision discounts).
For low-income seniors who are dual-eligible for Medicare and Medicaid, limited dental benefits (including dentures) may be provided by Medicaid, but coverage varies considerably from state to state.
Programs that can help
For seniors who have no dental coverage, a variety of programs can help them obtain dental care:
Dental schools will often provide treatment at a reduced price.
For low-income seniors, dental care is available on a sliding fee scale at community health centers. You can use this tool to find a community health center near you: http://findahealthcenter.hrsa.gov/
The Dental Lifeline Network (http://dentallifeline.org/our-state-programs/) coordinates dental care nationwide for elderly, disabled, and medically fragile populations. More than 15,000 dentists donate their time to provide dental care for patients who would not otherwise be able to afford treatment.
Many dentists offer payment plans, or will refer patients to a credit source, often with low initial interest rates. Read the fine print though, because interest rates can reach credit card-levels after the introductory period is over sometimes going up by as much as 30%!
Dental savings plans are readily available, without waiting periods or restrictions on their use. But they are not considered insurance, and they don’t pay anything on your behalf when you receive treatment.
Instead, dental discount plans simply utilize a network of dentists who agree to charge a reduced rate for plan members. And although some discount plans offer significantly reduced rates for routine care like x-rays and exams, they typically provide smaller rate reductions for more extensive dental work.
The good news is that they discounts are upfront and published before you enroll so you know what to expect. You can see the dental plans available in your area here.
Would you like 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 online form to send an email message. The best part about working with me is that it will not cost you anything to meet with me and have things explained to you. I am paid by the insurance companies in the form of a commission when you choose a plan and enroll. 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.
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