You brush your teeth twice a day and floss once in a while. That’s all you need to do to keep up with your oral hygiene, right? Wrong.
Good oral hygiene remains an essential component of your health as you get older, as dental checkups can sometimes be an early indicator of underlining conditions, such as HIV, nutritional deficiencies and some cancers.
Unfortunately, many Medicare enrollees don’t have dental insurance. According to the Kaiser Family Foundation, 37 million Medicare recipients in 2016, or 65 percent, did not have dental insurance.i By adding a private, stand-alone dental insurance plan or switching to a Medicare Advantage Plan with dental insurance, you may be able to improve or more easily maintain your oral health.
With that in mind, let’s break down why dental insurance is important, what kind of coverage is included with standard Medicare coverage and how to get dental coverage as a Medicare enrollee.
Why You Shouldn’t Skip Dental Insurance
As stated above, going to the dentist is more than just a teeth cleaning. It’s an opportunity for a dental specialist to look at your overall oral health, which is vital if you’re over the age of 65.
According to the Centers for Disease Control and Prevention (CDC), older adults (age 65) are more prone to have oral health problems: ii
- 1 in 5 adults has untreated tooth decay.
- About 2 in 3 adults (68 percent) have gum disease.
- Nearly 1 in 5 have lost all their teeth.
- Cancers of the mouth (oral and pharyngeal) are primarily diagnosed in older adults, median age 62.
Hopefully, you can see why going to the dentist from a health perspective is essential, but does that mean you need to sign up for an actual dental insurance plan? That all depends on how comfortable you are paying for everything out of pocket. Even a simple cleaning can be costly.
According to Cost Helper Health, a standard dental cleaning by a dental hygienist can cost anywhere between $75 to $200 depending on the dentist’s office and local rates. If you add an exam and dental X-rays to that cleaning, your price can jump to anywhere between $100 and $300.iii
What Dental Coverage is Included with Original Medicare
If you’re a Medicare enrollee, then you’ll be happy to know that “some” dental coverage is included, but not much. Dental coverage, as we commonly know it – with cleanings, extractions, etc. – was excluded when Medicare was originally conceived. However, your Medicare Part A (hospital insurance) will cover some procedures that require you to be hospitalized.iv
Dental Coverage Under Medicare:
- Dental services that are an integral part of a covered procedure (ex. Jaw reconstruction following an injury).
- Extractions done in preparation for radiation treatment for neoplastic disease involving the jaw.
- Oral examinations, but not treatment, preceding kidney transplantation or heart valve replacement, under certain circumstances.
- Inpatient hospital services when the medical condition requires hospitalization.
What’s Not Covered by Original Medicare: v
- Tooth extractions
- Dental plates
- Most dental care
If you do choose to get a non-covered dental procedure, then you’ll be required to pay 100 percent of the cost out-of-pocket.
How Do I Get Dental Insurance with My Medicare Plan?
Now that you know what Medicare Part A covers and, more importantly, doesn’t cover, you have options on how you can get dental insurance while on Medicare.
Medicare Advantage Plan
Often known as an “all-in-one” plan, Medicare Advantage Plans combine your Medicare Part A (hospital insurance) and Part B (medical insurance), and often also include prescription drug coverage (Medicare Part D). Many Medicare Advantage Plans also include extra benefits – such as hearing, vision and dental insurance.
Medicare Advantage Plans are private insurance plans approved by the U.S. government, which may lower your out-of-pocket costs and may offer $0 monthly premiums as well as $0 copays.
Most plans will help cover routine dental services with in-network dentists including preventative and diagnostic services, like:
- Dental exams
- Routine cleanings
Some may also provide more comprehensive coverage for services like:
- Crowns and bridges
- Root canals
- Dentures and implants
Stand-Alone Dental Insurance Plan
If you are content with your Medicare Part A and Part B plans and still want dental insurance, you can get a stand-alone plan. Many well-known insurance providers offer these stand-alone dental insurance plans. Benefit details on items such as premiums, deductibles, annual plan maximums and coverage areas will vary depending on which insurance provider you choose.
Ready to Enroll?
If you’re a Medicare enrollee interested in enrolling in a stand-alone dental insurance plan or a Medicare Advantage Plan with dental coverage, then please call Ensurem.
Ensurem partners with some of the most well-known insurance companies in the U.S. to offer plans with the lowest costs and the most benefits. Our team of licensed insurance agents gets to know your needs to help you find the health care plan that fits your needs.
Give Ensurem a call to help take your oral health to the next level.0123BGDVGN2020M_V1.0
i “Drilling Down the Dental Coverage and Costs for Medicare Beneficiaries,” Kaiser Family Foundation, March 13, 2019, https://www.kff.org/medicare/issue-brief/drilling-down-on-dental-coverage-and-costs-for-medicare-beneficiaries/
ii “Oral Health for Older Americans,” Centers for Disease Control and Prevention, https://www.cdc.gov/oralhealth/basics/adult-oral-health/adult_older.htm
iii “How Much Does Teeth Cleaning Cost,” Cost Help Health, https://health.costhelper.com/teeth-cleaning.html
iv “Medicare Dental Coverage,” Centers for Medicare & Medicaid Services (CMS), https://www.cms.gov/Medicare/Coverage/MedicareDentalCoverage/index
v “Dental Services,” Medicare.gov, https://www.medicare.gov/coverage/dental-services