A common question for new Medicare beneficiaries is “will Medicare cover my dental services?” Well, the answer to that question is no- Medicare doesn’t cover dental services. When you enroll in Medicare you enroll in traditional Medicare that consists of Parts A and B and parts will rarely pay for dental expenses.
However, it can pay for it on the occasions that are medically necessary because Part A and B must cover all medically necessary services. For example, if you have some type of cancer and need to get your teeth reconstructed after surgery, Medicare will participate in that cost, but those are really rare situations. If you need preventive care like fillings, cleaning root canals, and crowns, Medicare won’t pay for that, so you’ll need dental insurance to get covered for those things.
How To Get Dental Insurance?
You are not obligated to have dental insurance if you don’t think you need one but, if you are aware that you will need dental services more often we recommend getting dental coverage to avoid additional costs. There are a couple of ways to include your dental coverage – through Medicare Advantage Plans or Medicare Supplement Plans.
First way: Medicare Advantage Plans
Medicare Advantage Plans unlike Original Medicare, almost always include some kind of dental benefits. Most of the Advantage plans are going to have a network of dentists, and you will have to make sure that the dentist you pick is part of that network. If you choose to cooperate with the dentist within the network this plan may be good for you.
However, you’ll need to consider that amount of the benefits will vary from plan to plan. Some of the Advantage plans may cover only preventive care services which means that your screenings and x-rays may be done only two times in one year. On the other hand, some plans may have more comprehensive benefits, such as fillings, extractions, cleaning root canals, etc. Also, be aware that with those plans, there will always be some kind of limit.
For example, if it is a first-dollar coverage, which is very common, plans have up to a thousand dollars of dental benefits and when you receive your services you will be reimbursed up to that amount. Some plans may give you fifty-fifty coverage and they typically provide x-rays and maybe a couple of cleaning with no cost. If you seek coverage beyond that you’ll need to split the expenses to the plan limit. With some plans, you could choose the dental benefit option by yourself, but you’ll have to pay an extra premium for the added plan.
Second way: Medicare Supplement Plans
If you choose to stay on Original Medicare rather than take Medicare Advantage, you can add a Medicare Supplement plan to your traditional Medicare which includes Parts A and B. You can add dental benefits to your supplemental plan because they are typically not included if you don’t add them on your own. You will have to pay monthly premiums for stand-alone dental plans and the cost of the premium vary from plan to plan.
Those plans will include preventive benefits which start immediately when you get your plan, like getting cleanings. With the basic services like extractions and fillings, your plan will cover 80% of the services and you’ll be responsible for the other 20%. With major dental services, like root canals, implants, and crowns most of the time you will need to cover 50% of the service.
However, with preventive care, there are no waiting periods for your coverage to start but with basic and major services some plans will make you wait up to 6 to 12 months before your coverage kicks in and you will need to pay for premiums while you are waiting.
In some cases, insurance companies may waive the waiting periods if your coverage has not lapsed more than sixty days. The annual limit for dental services is between 1000-2000$ and you will be responsible for coinsurance that depends on whether is it an 80:20 dental insurance plan or a 50:50 dental insurance plan.
Conclusion
If you visit dentists and specialists regularly, you should consider getting dental insurance coverage which can help you reduce the massive costs. If you aren’t sure which plan would be good for you, our Medicare expert in Jersey Insurance Solutions can help you find the best dental insurance plan that fits your budget and needs.
Call us or text us today, we are happy to help!
Thomas M. Brzezinski is one of the founding partners of WMAG William & Michael Advisor Group LLC and Jersey Insurance Solutions. He has been involved in the insurance industry for over ten years and specializes in developing client relationships that last a lifetime.
