Medicare Dental Coverage Options for Seniors - Jason Rubin Insurance
Many Medicare beneficiaries are often surprised that Original Medicare doesn’t include dental insurance. Instead, 65+ clients need to sift through options for dental coverage. These options include a Medicare Advantage plan with dental coverage, a stand-alone dental plan for seniors, or other choices.
With over 20 stand-alone dental plans in the Los Angeles area, choosing the best option can be challenging. In the city of Los Angeles alone, there are 67 Medicare Advantage plans with dental coverage.
Dental treatments are necessary as you age. While you may want to invest your money in other aspects of your health instead of your mouth, your mouth plays a key role in your overall health. Mounting research shows that oral issues like tooth decay and gum disease influence other chronic diseases.
Dental insurance motivates and reassures you to visit the dentist regularly. It helps you get into the dentist’s chair, even if you’d rather be elsewhere.
What are the Different Medicare Dental Coverage Options?
Once enrolled in Medicare, you typically have four main options for dental coverage. Finding the best fit depends on your budget, coverage preferences, and long-term dental needs.
- Medicare Advantage: Your Medicare Advantage plan can include dental coverage in addition to your Part A, Part B, and Part D coverage.
- Stand-alone Plan: Original Medicare doesn’t offer dental coverage. So, you can buy an annual stand-alone plan that helps with your year’s dental services.
- Employer Coverage: Some employers allow retirees to keep their dental coverage even after no longer working for the company. Group dental insurance often provides the most coverage and highest limits. This can make it the best dental option for Medicare beneficiaries.
- Self-Insure: You don’t have dental coverage and save money on premiums; you have a stockpile of savings to pay for any necessary dental work.
Dental care is important, so if clients don’t bring it up, an advisor will ask what they want to use. Dental coverage can save clients money overall, even on a fixed budget. For example, they will pay only an in-network negotiated rate for a root canal without haggling alone.
Choosing the Best Medicare Dental Plan for 65+
When comparing plans, consider the following big-picture details of each plan.
Type of Medicare Dental Plan
Dental plans are usually PPOs or HMOs.
PPOs give you the most choices for dentists, including excellent Los Angeles dentists. Your care will be covered up to a specific limit. You’ll typically pay a percentage of the costs for a root canal or other dental procedure. Alternatively, you may pay the remainder of the expenses up to a negotiated amount.
Some more expensive PPOs resemble a premier credit card. They work only with dentists they’ve invited into the group. These dentists might work only with one dental insurance company. If you’re already seeing a dentist you love before you enroll in Medicare, you might ask which insurance companies they accept.
On the other hand, HMOs can restrict you to just a few dentists on the list of approved providers. You won’t have as much choice, but you’ll probably just pay a copay for procedures.
If you choose a dental HMO, you’ll need to review the list of available dentists carefully. Also, learn about their wait times for service.
Dental Service Waiting periods
Most plans impose a 12-month waiting period for “major” services. These services include dental procedures other than preventive treatments (like cleanings) or cavity fillings. These waiting limits prevent people from signing up for a plan, getting expensive work done, and quitting coverage.
Some plans waive the waiting period for in-network doctors and specific services. Other plans don’t have a waiting period but might pay lower coverage percentages (see below).
Deductibles and Coverage Percentages
Most plans have a deductible of $50 or $100 for non-preventive care or only charge the deductible for some care, such as anything beyond an exam and routine cleaning.
Medicare Advantage and standalone dental plans typically cover most preventive care costs. These expenses include twice-yearly exams, cleanings, fluoride, and X-rays.
Most Medicare Advantage plans cover preventive care. However, some may not cover other dental services at all. You must carefully review the plan’s details.
After you pay the deductible, standalone plans may further cover dental treatments. They reward your continued loyalty by offering better coverage for ongoing treatments. The insurance company pays 10% or 20% in the first year, and you must cover the rest.
The company pays 20% in the second year; the best dental insurance companies pay 50% to 60% of a treatment in the third year and beyond. Like fine wine, the longer your insurance is in effect, the better it gets.
Dentists may treat cavities and fillings differently and pay them at higher rates.
Dental Benefit Limits
The benefit limit in dental is the maximum your insurer pays for your treatment over the year.
When you see a plan that covers $2,000 annually, it refers to the maximum amount the plan will pay. This is the total for all of your dental work throughout the year. You’ll pay that last dollar if you have $2,001.000 in dental expenses.
In Los Angeles, standalone plans typically offer higher benefit limits than Medicare Advantage plans. Stand-alone plans usually cover up to $2,000, $5,000, or even $10,000.
Dental Care Restrictions
Every insurance plan contains restrictions to try to contain costs. If everyone could get routine teeth-whitening, orthodontia, and other great (but expensive) extras on demand, dental insurance would cost even more.
Medicare Advantage plans are typically the most restrictive regarding options.
Stand-alone dental plans address these restrictions in different ways. They may not pay for treatment, limit treatment frequency to every few years, or severely limit percentages. Most plans restrict you to two dental cleanings yearly. Yet, some allow you to visit more often.
Review the plan to look for the gotchas. These could include exclusions for more expensive services that Medicare beneficiaries typically desire, such as:
- Implants
- Metal braces
- Invisalign
- Bridges
- Dentures
- Gum treatment
- Cosmetic procedures
However, at least one company offers teeth whitening. So, if you value one of the services above, it pays to compare dental plans for seniors.
Dental Out-of-Pocket Costs
With any dental plan, you should look at how much you pay every year in premiums, deductibles, copays, and coinsurance. Compare that to what you’d pay out of pocket without the negotiated rate. Consider both a good year (no dental treatments) and a bad year (costly dental treatments).
A primary benefit of Medicare Advantage plans with dental coverage is that you won’t pay extra premiums. This could be a real cost-saver if you’re only concerned about cleaning. However, if the Medicare Advantage plan only covers dental cleanings, you could pay a lot out of pocket directly to the dentist for an implant, root canal, or bridge.
You will pay a premium for stand-alone dental plans, typically every month. Most plan premiums increase yearly as you age, as older adults tend to have more expensive dental needs. Because of the graduated percentage payments, you may pay out of pocket between premiums and 90% of a procedure’s cost. This is especially true if you have an expensive procedure in the first year.
Making the Right Choice for Your Medicare Dental Coverage
Your decision should balance affordability with the level of care you expect to need. Medicare Advantage plans with dental benefits can be cost-effective for basic preventive care. In contrast, stand-alone dental plans often provide broader coverage and higher limits for more extensive procedures.
At Jason Rubin Insurance Services, we specialize in helping Medicare beneficiaries handle their dental coverage options. We offer guidance on Medicare Advantage plans and supplemental policies to help you make informed decisions. Contact us today to explore coverage that keeps your smile healthy without breaking your budget.