Understand which dental services are covered by Medicare
Generally speaking, Original Medicare does not cover dental services. Many Medicare Advantage plans offer dental coverage alongside other benefits like vision coverage and fitness programs. Another option (for those on Original Medicare) is stand-alone dental insurance.
So, what’s the best way to get dental coverage through Medicare? It depends. Let’s look at what dental coverage can look like under Original Medicare vs. Medicare Advantage.
Dental Care Under Original Medicare
Original Medicare does not cover most dental services, including regular cleanings, tooth extractions, and fillings. Medicare also doesn’t cover dentures, dental plates, or other dental devices. In rare circumstances, when patients receive dental care in a hospital, Medicare may provide coverage for some services.
So, what are your options if you’re on Original Medicare?
A few Medigap plans offer discounts and add-ons
Most Medigap (Medicare Supplement) plans do not cover dental services. This is because Medigap plans help to fill the gaps in costs not covered by Original Medicare, but they do not cover additional services.
However, a small number of Medigap plans may offer pre-negotiated dental discounts that can provide significant savings. Some Medigap carriers also allow you to tack on dental coverage for an added premium.
Should you consider a stand-alone dental plan?
Many Original Medicare + Medigap beneficiaries consider stand-alone dental plans to minimize dental costs. We generally recommend paying for minor dental items out of pocket rather than purchasing a stand-alone plan.
Why? The costs and coverage of a stand-alone plan are generally unfavorable to beneficiaries. Low annual caps, paired with premiums and copays, often result in costs just as high—or sometimes higher than—what you would pay out of pocket. Additionally, network restrictions can prevent you from being able to see the dentists and specialists you want to see. Finally, many plans have waiting periods in place that limit your coverage for the first year you’re enrolled in the plan.
Dental Care Under Medicare Advantage
Many Medicare Advantage plans provide coverage for not only preventative dental services but also comprehensive and even some restorative services. These plans typically offer the most robust coverage when you use an in-network dentist. Many plans cover up to $1,500 - $2,500 of dental expenses per year, although you will pay co-insurance for part of most services.
If you’re already on a Medicare Advantage plan, there’s a good chance you have a plan with dental coverage. If not, there are plenty of options. During the next Open Enrollment Period, speak with a Chapter Medicare Advisor to see if there’s a plan that fits your needs better than your current one.
If you’re considering switching to Medicare Advantage because you want the dental coverage they provide, make sure you’re aware of the enrollment periods and drawbacks of switching.
From having helped thousands of seniors enroll in Medicare, we know that the lack of affordable, comprehensive dental coverage is a significant void. Many of our clients see the dentist at least twice a year and want an affordable way to get these appointments covered. For someone who needs a crown, a root canal, or a new set of dentures, coverage is even more important.
Lawmakers have not yet agreed on a solution to provide Medicare beneficiaries with better dental coverage, but we’re here to help! If you have any questions about the best way to save on dental, get in touch with a Chapter Medicare Advisor, who will walk you through your options.
