What Dental Services Does Medicare Cover?
Medicare was designed to be a health insurance program and originally didn’t provide any dental coverage at all. However, in 1980, changes were made that allowed for coverage of dental services in some limited circumstances.
The change provides for coverage of a few services if they are provided in a hospital setting. Original Medicare will cover dental services in these circumstances:
- Oral exams in the hospital before a kidney transplant
- Dental services related to certain treatments for oral cancer, such as radiation
- Reconstruction when an oral tumor is removed
- Surgery and recovery for broken jaws
Aside from these emergency-type services, Medicare won’t help with your dental needs. Medicare offers no help for preventative services or dental maintenance. To get help paying for these services, you’ll need to look to the private market.
Medicare Advantage Plans
If you want to find something like Medicare dental plans, you’ll have to look into Medicare Advantage. These plans, which are sometimes called Part C plans, often offer dental coverage.
Dental coverage can come in two different forms with Medicare Advantage plans:
- Included in the plan with no additional premium
- Available for an additional premium
As you might expect, coverage that’s available for no additional premium is fairly basic, providing mostly routine, preventative coverage such as cleanings and X-rays.
Medicare Advantage plans that offer dental services for an additional premium often have more comprehensive benefits. These plans sometimes come with the choice of two coverage levels: a standard or value dental plan, or a more comprehensive premium dental option.
These more comprehensive dental plans provide preventative coverage as well as more major restorative services, such as:
- Fillings
- Root canals
- Crowns
- And more
Dental coverage provided by Medicare Advantage plans may come in HMO or PPO plans.
In an HMO plan, you’ll need to use the plan’s network of providers; you’ll likely receive no coverage for dental work done by an out-of-network provider. With a PPO plan, you’ll pay lower prices if you use a network dentist, but the plan will still provide some coverage if you go out of network.
Private Dental Insurance
If you don’t want a Medicare Advantage plan, perhaps because you already have a Medicare Supplement insurance policy, another option for dental coverage is standalone dental insurance. You can purchase dental insurance from a private insurer.
Private dental insurance for individuals and families is available from a wide range of insurance companies. When shopping for dental insurance, you’ll want to consider:
- The monthly premium
- The deductible, if any
- The plan maximum coverage
- The network of dental providers
- The waiting period for major services, if any
The monthly premium is a fairly basic item that’s easy to grasp, but pay close attention to the maximum coverage amounts. Many dental insurance plans limit payments to between $1,000 and $2,000 per person, per year. It won’t take many procedures to reach this cap, after which you’ll pay the full cost.
Also check to see if a waiting period applies to any dental plan you’re considering. For major services like root canals, and crowns, you may have to pay premiums for six months or more before you’ll be covered. This can be an unpleasant surprise, so make a point to find out before you enroll.
When you go to a dentist, make sure they accept your plan. If your dental plan is HMO-based, you may not receive any coverage if you see an out-of-network dental professional.
Dental Discount Plans
As the cost of dental services has gone up and dental insurance plan maximums have stayed stagnant, dental discount plans have become more and more popular.
Dental discount plans are not insurance at all. You don’t pay a premium for them and they don’t provide coverage like insurance does. Instead, you pay a fee in return for access to discounted dental services and procedures.
Most dental discount plans have an annual fee and a monthly payment amount. They are less expensive than almost all other forms of non-Medicare Advantage dental insurance. There are no waiting periods, plan maximums, or deductibles.
For any type of service, from cleanings and X-rays to repairing major decay with root canals and crowns, you can save by using a discount card.
Providers of dental discount cards are often insurance companies. The discount cards work with a select group of providers. The dental providers agree to charge discount plan members less than their normal prices. Frequently advertised discount plans mention discounts of 10% to 30%. Just like with dental insurance, be sure to find a discount plan that your preferred dentist participates in.
Pay Cash for Dental Services
If you can’t afford the premiums for dental insurance, and you’re not interested in a dental discount plan, you’ll have to pay cash for dental services.
Properly taking care of your teeth with frequent brushings and flossing can go a long way to preventing poor oral health. Call your dentist and ask how much a cleaning would cost if you paid cash. If it’s beyond your budget, you can always save for it over several months, if need be.
You can utilize the same strategy for repair work; ask how much you would pay if you paid cash. You may receive a discount for paying in cash, even without paying for a discount card.
If you’ve experienced severe dental pain before, you know it’s better to cut back on your budget for a few months than to ignore a tooth problem. Plus, if you ignore it long enough, the cost when you finally address your dental issues can be far worse than if you’d taken care of it earlier.
Choosing Your Medicare Dental Coverage
Many people are concerned about the lack of Medicare dental plans. With enough research and planning, you can get the right coverage. Get a Medicare Advantage quote if you’re interested in the dental insurance options provided by these plans.
Beyond Medicare Advantage, look for a combination of affordable premiums, and a plan that your dentist accepts. If your dentist accepts a dental discount plan and dental insurance, compare the discounted prices to the premium for the insurance to see which is best for you.