Medicare provides health insurance to seniors and people with specific disabilities, but it’s important to note that dental coverage is not included in this plan. This can surprise new enrollees, who may assume that Medicare covers dental services. In reality, Medicare only covers dental treatment that is medically necessary.
This implies that Medicare generally does not cover routine cleanings, yearly exams, extractions, and root canals. If you are looking for coverage, you will need to find it elsewhere. The number of people with dental coverage drops significantly at age 65 after they retire and lose dental insurance from their employers.
Let’s break down what you need to know about dental coverage and Medicare and explore your options for maintaining a healthy smile in retirement.
What Does Medicare Cover in Terms of Dental Care?
Medicare offers limited coverage for dental care. Original Medicare (Part A and Part B) does not usually cover routine dental services such as cleanings, fillings, extractions, crowns, or dentures. Medicare can only cover dental procedures if they are an integral part of a larger medical treatment.
In 2023, Medicare expanded its coverage to include dental exams and necessary treatments required before organ transplant surgery, including cardiac valve replacement, not just kidney transplants. In 2024, Medicare will cover a dental exam as part of a comprehensive workup at the same time as Medicare-covered treatments for head and neck cancer.
Why Doesn’t Medicare Include Routine Dental Care?
Medicare focuses primarily on hospital and medical insurance, leaving out routine dental care, typically considered a separate domain. This omission has been a point of contention and discussion, given the importance of dental health to overall well-being. One reason for this exclusion is that Medicare’s design in the 1960s reflected a different understanding of health needs, and dental care was not as integrated into overall healthcare as it is today.
What Are the Options for Medicare Beneficiaries Seeking Dental Coverage?
While Original Medicare doesn’t cover dental care, you still have several options:
Medicare Advantage Plans with Dental Coverage
Private insurance companies provide Medicare Advantage plans, also known as Part C. These plans offer additional benefits beyond what Original Medicare covers, including dental, vision, and hearing coverage. However, the extent of dental coverage these plans provide varies widely as some plans offer only basic preventive services, while others provide comprehensive coverage for more extensive dental work.
If you are considering a Medicare Advantage plan for dental coverage, please contact Skyline Benefit. Our team of experts can provide you with a proper overview of Medicare Advantage plans and help you select the best one that fits your budget.
Standalone Dental Insurance
Standalone dental insurance can be a viable option for those who prefer Original Medicare or find their Medicare Advantage plan’s dental coverage lacking. These policies are designed specifically for dental care and can offer a broader range of benefits.
Key considerations for standalone dental insurance include:
- Coverage Limits: Some policies cap the annual amount they will pay for dental care.
- Waiting Periods: Be aware of waiting periods for major dental work to avoid surprises.
- Premium Costs: Consider the monthly premiums and other out-of-pocket costs to determine if the plan fits your budget.
Takeaway
Dental coverage is not in Original Medicare plans, and beneficiaries seeking dental care will have to explore other options. While Medicare Advantage plans with dental coverage or standalone dental insurance can offer additional benefits, it’s essential to consider the coverage limits, waiting periods, and premium costs before selecting a plan. Investing in dental health is crucial to overall well-being and confidence, and it’s never too late to explore your options and make the best choice for you and your smile. At Skyline Benefit, our team of experts can guide you through the process and help you select the plan that fits your budget and needs. Remember, a healthy smile is a happy smile!
Do you need a consultation for Medicare in 2024?
Skyline Benefit is an independent Medicare insurance broker that offers affordable and flexible Medicare options. Selecting the best Medicare insurance plans can be overwhelming; our mission is to simplify the process and help our clients every step of the way.
Schedule a consultation today. Call us at: (714) 888-5112