How to Get Dental Benefits on Medicare

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What is Medicare: A Quick Overview

Medicare is federally managed health insurance for people 65 years or older or people with certain disabilities. It is divided into four parts. Part A covers hospital expenses and nursing care. Part B covers other medical expenses like tests, doctor’s visits, outpatient care, and medical equipment. Part A and B are also known as “Original Medicare.”

Part C is also known as “Medicare Advantage.” This is an option that allows for more choice and flexibility on what is insurance covers. Medicare Advantage plans vary by region and provider. Part D pertains to the coverage of drugs and vaccines. Original Medicare offers this coverage, however, you can also get it via a Medicare Advantage Plan.

Original Medicare Dental Coverage


Original Medicare is limited in its coverage of dental procedures. It does not cover most dental care such as cleanings, fillings, dentures, root canals, X-rays, or extractions. Any covered dental care will be part of other approved and necessary procedures. Examples may include tooth extraction for the purposes of cancer treatment, jaw reconstruction in the case of injury, or treatment required by doctors before heart procedures. This is not an inclusive list. Any covered dental procedure will likely be narrow in scope and specifically required by a medical doctor.

Medicare Advantage Dental Coverage

These kinds of plans are highly variable and offer a wide scope of coverage. All Medicare Advantage plans must abide by Medicare mandated regulations, but there is no requirement for dental coverage. You will need to read through what each option offers to determine if they provide adequate dental care for your needs. Before looking for a plan, it would be wise to first compare Original Medicare to Medicare Advantage.

If you decide to look further into purchasing Medicare Advantage, you’ll need to look up what is offered in your region to compare plans, and you will still need to enroll in Original Medicare. Be mindful of any existing coverage you may have through an employer or union. Enrolling in Medicare or Medicare Advantage can affect that coverage.

Other Dental Coverage Options

If you prefer to keep Original Medicare or don’t find that your needs are met by any of the Medicare Advantage plans offered in your area, there are other dental coverage options. It is important to consider your individual needs as well as the availability of each option. How much dental care do you need? Someone needing only routine cleaning may want a different option than someone needing dentures. Additionally, if you live in an area with a wide range of dentists and oral practitioners available, you will be able to consider different options than someone living in a rural area with only a few practitioners nearby.

Medicaid


Medicaid and Medicare are two different programs. Medicaid is state sponsored. Coverage and eligibility will vary by factors like income, age, and ability. The amount of coverage you receive may also vary. Learn more about Medicaid and see if you qualify.

Private Dental Insurance


You can purchase separate dental insurance alongside your Original Medicare. There are hundreds of different dental plans available from just about every major insurance company. The main aspects include: services covered, participating practitioners, premium costs (how much you pay each month), deductibles (how much you may need to pay before insurance begins to pay), co-pays (how much you pay out of pocket for services), maximum coverage, and maximum out of pocket.

Many people have a general idea of their dental needs or what their dental needs might entail in the near future. Keep these in mind when comparing plans. If you are particular about dentists, make sure to call them and verify that they participate in the insurance plan you are considering.

Dental Discount Programs

Discount programs are available either through a company or directly through a practitioner. Some discount programs cost a fee each month or year to join and allow the subscriber to take advantage of discounts offered by participating care providers. You will need to factor in the available practitioners, discounts on each service offered, and the cost of joining the program.

Some dental care practitioners may offer discounts to patients who pay in cash, discounts for seniors, discounts for veterans, or offer discounts for lower income patients. You will need to contact providers individually to learn who offers what discounts. Making arrangements directly with your service provider can be simpler to manage than working through insurance.

Dental Schools

Many schools of dentistry offer discounted services in exchange for allowing supervised students to perform those services. You will need to find your local dental school and either browse their website or contact them directly to see what is offered.

Find What Works for You

Original Medicare doesn’t offer dental services needed by most patients, but there are plenty of options for finding a dentist, oral surgeon, or other dental provider. Make a list of your needs to include your budget. If the process seems daunting, ask a friend or family member to help you find the best solution. Adequate dental care is within your reach, and these options will help you find it.

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