Dental Insurance for Medicare Beneficiaries
One of the most common questions that I get is “what does Medicare cover for dental?” Well, unfortunatley, nothing.
That’s right, the Federal entity of Medicare has ZERO coverage for dental. Oddly, the folks who design Medicare decided that dental coverage is not a priority or even a secondary health concern. If you have only Original Medicare, either with or without a Medicare Supplement Plan, there is no dental coverage that comes standard.
So, what can you do about this? What are your options? Is there actually “good” dental insurance out there? I will go over these questions and and more in hopes of shedding some light on this important aspect of health.
Medicare Advantage Plans
First up on our breakdown of coverage options is the dental coverage that is sometimes included in some Medicare Advantage Plans available in San Diego.
There are a few plans that offer dental coverage included in the plan at no extra cost. Most of the plans like this are going to be a DHMO meaning that you must see their network dentists to have any coverage at all. There are also a few Medicare Advantage Plans that have in them a PPO dental plan. With this plan, you can see any dentist and if they’re not in the network, you will submit reciepts to the insurance company and they will reimburse accordingly.
A few of the carriers will also offer “Add-On” dental coverage. Meaning that it does not come standard with the plan and you have to pay extra for the coverage, these add on plans are also DHMO & PPO plans.
In looking at dental coverage, it’s good to know your options and this type of set up is one. With a Medicare Advantage Plan, there are quite a few varialbles to think about in picking the “best” plan for you and dental coverage might be included in that list. In my opionion, the first things to be sure of is how well your presciptions are covered and if your Doctors will accept that insurance. All of the plans in San Diego have co-pays for services and a Maximum out of pocket amount. Making sure all of these issues are covered and understood shoule prioritize dental coverage or any of the other “sprinkles on top” the insurance companies advertise to pique your interest!
You can read more about Medicare Advantage Plans HERE.
What about Medicare Supplement Plans?
By design, the basic benefits of a Medicare Supplement Plan do not include and dental coverage. Medicare, the Federal entity is who designs all Medicare Supplements meaning that in general, the only difference between the companies that off these plans is the monthly premium you pay. The Medical coverage, the freedom to choose your providers, the fact of having no network to contend with, these are all the same.
Some Medicare Supplement companies do offer “extra” benefits, whether built into the policies or as an optional “add-on” for an extra cost. Dental coverage is one of the options and at time of writing, these are all “add-on” benefits which you pay extra for. There are both PPO and DHMO options for this coverage and premiums for the dental coverage range from $25-$60 extra per month. Benefit amounts range also, from $500-$1500 annual max benefit. Which I will go into more detail below what that means. If you want to read more about Medicare Supplements in general, go HERE.
Stand Alone Dental Insurance
Stand alone Dental Insurance means that is a completely separate policy apart form your Medicare insurance, whether Medicare Advantage Plan or Medicare Supplement.
The benefits of having this type of coverage are many. These plans generally offer higher benefits, a wider network of participating Dentists and because they’re not tied to your Medicare insurance, they can be added or dropped at any time of year.
There are three different types of coverage in a stand alone dental insurance policy. There are the traditional DHMO, PPO and also there are dental discount plans. Let’s talk about each one and their respective pro’s and con’s.
DHMO-
Pros-
- Affordable premiums
- Know exactly what you pay for each service
- Generally no max benefit or cap
- Generally no waiting period for major services
PPO-
Pros-
- Larger networks of participating Dentists
- Higher benefit amounts as high as $5K annual max
- Some services have no waiting period
Dental Discount Plans-
- Very affordable premiums or free
- No waiting periods
- No max benefit
Cons-
- Network only coverage
- Can be hard to find a provider in network
- Could still be high costs for major services
- 12 month waiting period for major services
- Higher monthly premiums
- Non network providers can be more expensive
- Limited networks
- Costs can still be high after discounts
What are Annual Max Benefits? What about waiting periods?
These are two main components of many plans, specifically PPO plans. An annual Max benefit means that it is the most the plan will pay out in a given year. This amount resets every year and is usually based on when you signed up for the plan, not the calendar year. These amounts range from $1,000 all the way to $5,000. How it effects your plan depends on what kind of services you have rendered. For example, if you have a teeth cleaning and that is $100 and is covered at 100%, and your annual max benefit is $2,000, you now have $1900 in benefits left for the year. Let’s say you go in 6 months later and have a simple extraction that costs $200 and is covered at 80%, you would now have $1,740 left in coverage for the year and so on. It is important to be aware of what services are covered and at what percent. Coverage amounts change depending on type of service and commonly the higher cost services offer lower coverage, meaning you pay more percentage wise.
Most plans have waiting periods for major services and some have waiting periods for basic services. Major services are going to be things like bridges, root canals, crowns, implants and more. Basic services are things like full mouth x-rays, restorative amalgams, composites, simple extractions and more. Major service waiting periods are generally 12 months from the start of your plan and some plans will waive this waiting period if you had prior coverage that meets their criteria, generally they want you to have had a plan that offers at least $1,000 annual benefits in order to waive the waiting period for the new plan.
In summation..
To wrap up, although Medicare itself does not have dental coverage, there are many options to choose from to make sure that you have this important coverage. We have access to many different plans and coverage types so if dental insurance have been on your mind like many of our clients, don’t hesitate to reach out for some free guidance! Thanks for reading and good luck to you in all you do!
Best regards,
Steve Korts