Medicare & Dental

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 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.”

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