Does Medicare Advantage Cover Dental Care?
Does Medicare Advantage Cover Dental Care? For seniors who have Medicare Part A hospital insurance and Part B medical insurance as their main healthcare coverage, there are some limitations to your benefits. Unfortunately, routine dental care is not included in Part A and Part B, but you may be able to get access to coverage through a Medicare Advantage plan.
Medicare Benefits Solutions
Aug 16, 2021
Proper dental care is vital for healthy teeth, mouth, and gums for everyone, but it’s even more important as we get older. As we age, their teeth become more vulnerable to wearing, cracking, and decay. Gums can become inflamed, infected, and recede to the point of tooth loss.
Without routine care, overall dental health can suffer. And unfortunately, Original Medicare doesn’t offer coverage for the routine dental services that you may really need. Procedures like cleanings, extractions, filling cavities, periodontal care, and dentures aren’t part of Original Medicare insurance.
Medicare Part A does cover emergency dental care, but if you want the assurance of having routine care as part of your benefits, you may have to sign up for a Medicare Advantage policy.
Does Medicare Advantage cover dental care?
Medicare Advantage (Medicare Part C) plans, which are sold by private insurance companies, provide all the benefits that both Parts A and B of Original Medicare. Most MA plans also include extra benefits and additional coverage for services that Medicare doesn’t cover.
Many MA plans cover routine dental care procedures, although they vary from plan to plan. The following list gives you an idea of what the most common dental services that Medicare Advantage plans cover are:
- Oral examinations
- Teeth cleaning
- Dental X-rays
- Diagnostic services
- Some restorative services
- Root canal
- Treatments for gum disease and other types of oral inflammation
- Tooth extraction
- Possibly: crowns, bridges, implants, and dentures
Most MA dental benefits are limited to a specific number of annual visits for each procedure.
If you choose an HMO Medicare Advantage plan, it may require that you use dentists and medical facilities that are within a specific network of providers. If you go outside the network, you may not have coverage.
How much do Medicare Advantage plans with dental care cost?
All Medicare Advantage plans cover dental services that are included in Medicare insurance. Most MA plans charge a copayment for these services.
The amount of your monthly premium for Medicare Advantage coverage including dental care depends on where you live, what type of plan you choose, who the insurance provider is, and your personal demographics i.e. age, gender, and health condition.
Medicare Advantage HMO plans typically have $0 to $30.00 monthly premiums. The low monthly cost is due to the fact that HMOs require enrollees to use network healthcare providers. HMOs also generally charge a higher copay and deductible.
On the other hand, Medicare Advantage PPO plans with dental care have higher monthly costs. Depending on the demographics, the average monthly premium is between $40.00 and $200.00. PPOs have an average copay of around $50.00.
How much do seniors spend on dental care without Medicare coverage?
Again, final costs depend on where you live, what procedures you have done, and who does them. But for simple, routine services like cleaning, examinations, and some less complicated procedures, the average amount is over $1,000.00 per year. For those who need dentures, partials, or more complicated procedures, the average can rise to $2,000.00 annually.
If you are concerned about having to cover large dental care costs on a limited income, a Medicare Advantage plan with dental care can be worthwhile. Before enrolling in a Part C plan, you should have all the information about what deductibles, copayments, coinsurance, and limitations the plan carries.
It’s also essential that you make sure your dentist accepts your Medicare coverage, or whether your plan requires that you use another dentist. In many cases, if you use a provider who is not in the network, you lose your benefit and end up paying all costs for the service.