Does Medicare offer Dental coverage?

This is one of the most common questions we receive. When referring to routine dental and vision care, the answer is ‘no.’ Routine procedures like cleanings, fillings. dentures, and extractions are not covered under Original Medicare. Likewise, routine eye exams, glasses, and contacts are not covered either. Medicare will cover eye diseases and conditions, like glaucoma or cataracts, when considered medically necessary. While there is technically no dental or vision coverage under Original Medicare there are options to add dental and vision coverage through a stand alone plan or with Medicare Advantage plans.

The importance of Oral Health

It’s no secret that oral health is linked to overall health. Our mouths are home to millions of bacteria. That’s true with many areas of our body, but our mouth is a gateway to digestive and respiratory tracts. Improper oral hygiene can lead to gum disease and tooth decay and infections. Some medications effect the saliva which is essential in neutralizing some bacterias. Studies have shown links between oral health and diabetes, Alzheimer’s, cardiovascular health, and other conditions. It is no doubt that oral health is important and needs the proper attention. Unfortunately, many people place their al health on the back burner.

Studies have shown that the number one reason people do not go to a dentist as often as they should is because of the perceived high cost of dental care. Yes, dental services can be expensive. I will not deny that; that is why picking the right dental plan is so important!

Check out our favorite Dental Plans

Ameritas Dental Plans Click for a Quick Quote and Plan Comparison!

Ameritas is one of our trusted providers for a great classic dental plan. With no waiting periods and annually increasing max benefit amounts, our client’s satisfaction rates with these plans are off the charts.

Allstate Health Solutions Dental Plans Click for a Quick Quote and Plan Comparison!

Allstate dental plans have a wide variety like a classic value plan to keep up with preventive care. Our most popular plan with Allstate is the copay plans. From day 1 no waiting periods, beyond that each service has a copay. Which means you know exactly what you will pay with a contracted provider. You are not left guessing what your percentages total will be. The Copay Plan 2 is the Cadillac of dental policies.

Delta Dental Plans Click for a Quick Quote and Plan Comparison!

When you think of dental insurance what name comes to mind? Delta Dental!

What is a Standalone Dental plan?

A standalone dental plan is just that. An insurance policy to cover dental care, from routine to major services, completely independent from your medical insurance or any other insurance policies. Optimal standalone dental insurance plans provide comprehensive coverage, encompassing preventive care, basic, and major dental services. Medicare beneficiaries have the flexibility to add or discontinue dental policies at their discretion. Since these dental services operate independently of Medicare, they do not impact your medical benefits and are not bound to any particular enrollment window.

In contrast to dental coverage within Medicare Advantage plans, standalone dental plans grant policy ownership to the individual. This means that the benefits remain consistent from year to year, immune to external alterations. Your standalone dental policy is yours to keep, and its benefits remain unchanged, contingent on your regular payment of the monthly premium. The most effective dental coverage is achieved through a personalized standalone dental plan tailored to your specific needs, providing the dental benefits that you find most valuable.

Medicare Advantage and Dental Coverage

As per data from the Kaiser Family Foundation (KFF.org), around 94% of folks enrolled in a Medicare Advantage plan enjoy some level of dental coverage, making it a prevalent feature in these plans.

However, it's worth noting that roughly 60% of these individuals face a coverage limit set at just $1,000. Many are limited to dental coverage for basic services, such as tooth extractions, with little or no support for more extensive procedures like root canals. While any effort to lower dental costs for Medicare Advantage enrollees is a positive step, it's essential to recognize the limitations of Medicare Advantage dental benefits when compared to standalone dental plans.

The downside of Medicare Advantage Plans' dental coverage lies in its annual variability. The dental benefits you find beneficial this year may either disappear or become significantly restricted in the following year. These plans are administered by private insurance companies, and their primary obligation is to align benefits with those offered by Original Medicare.

It's crucial for individuals to review their Medicare Advantage plans' annual Summary of Benefits. Take a closer look to ascertain if dental benefits are included, and if so, whether they cover major dental care, oral surgery, tooth extractions, or if the focus is mainly on preventive coverage. This proactive approach ensures individuals are well-informed about the scope and potential changes in their dental benefits.

Read more about Medicare Advantage plans here.

Will Insurance Pay For My Dental Implants?

The short answer is, 'yes.’ There are various dental insurance plans that will offer coverage for dental implants.

Not 100%, but a portion of the cost would be covered, typically 20-50%. This coverage would be outlined in the brochure

or summary of benefits, but there are ways the insurance companies can deny the claim. Unless you require dental

implants due to an accident, your plan may categorize dental implants as a cosmetic procedure and deny coverage.

Adult braces are also considered a cosmetic procedure. If the implant is not considered cosmetic you may be able to use HSA funds to pay for the cost. Alternatively, We offer HMA, Health Matching Accounts, which do cover cosmetic procedures about 50%.

Components of Dental Insurance

There are a few features of a dental policy you need to look out for: Network, Max Annual Benefit, Waiting Periods, and Coverage of Major Services. One thing to note, many policies cover child orthodontia, but adult orthodontics is considered cosmetic and not typically covered by insurance.

Network: When reviewing your quotes, confirm that your dentist or desired provider is contracted with the plan. While the majority of the plans we offer have both in and out of network coverage, the highest benefits are provided for the policy holder when seeing a contracted in network provider.

Max Annual Benefit: This maximum benefit limit is most the plan will pay for covered services in a year

Waiting Period: This is the amount of time one must be enrolled in the plan before the plan contributes to the cost sharing. Typically, the preventive/routine care is covered day one, but the major services may have a wait. We often see 3, 6, or 9, months, even up to 1 year before the plan will pay for major services. The plans that we recommend do not have waiting periods, that being said, often times benefits do increase over the lifetime of the policy.

Major Services: We mentioned above the waiting periods that may apply to major services, but it is also important to consider how the services are covered. Will there be a copay or coinsurance? Is a root canal covered as major type one or two? If you know you may need a crown, root canal, or other non-routine service, it is important to verify in the plan documents how and when that service will be covered.

Does Medicare offer Vision coverage?

This is one of the most common questions we receive. When referring to routine dental and vision care, the answer is ‘no.’ Routine procedures like cleanings, fillings. dentures, and extractions are not covered under Original Medicare. Likewise, routine eye exams, glasses, and contacts are not covered either. Medicare will cover eye diseases and conditions, like glaucoma or cataracts, when considered medically necessary. While there is technically no dental or vision coverage under Original Medicare there are options to add dental and vision coverage through a stand alone plan or with Medicare Advantage plans.

Is Vision Insurance worth it?

Plans can be affordable, so if you have regular vision care costs, vision insurance might be worth it. Add up your average annual out-of-pocket costs for eye doctor visits, glasses, and contacts, and compare that with quotes for vision insurance. Remember to factor in the potential deductible, copays, and co-insurance when you compare plans. If you have good vision and don't need regular eye care, vision insurance may not be worth it right now. There are many reputable online eyewear providers that offer a variety of styles of frames at affordable prices, some even work with insurance plans to bill out of network.

Vision Insurance and Medicare Advantage

According to the Kaiser Family Foundation, 99% of Medicare Advantage plans offer some kind of routine vision coverage. Benefits could include routine vision exams and an allowance for contacts and/or glasses. It is important to check the plans in your area to see what is available.

Vision Plans We Love

Ameritas Vision Insurance EyeMed and VSP Network

No waiting periods, enrollment fees, or age limits.

UHC Vision Insurance UnitedHealthCare Vision Network

No waiting periods, enrollment fees, or age limits.

Almost all of the facilities that offer eye exams now also have some selection of eyewear. This is very convenient for the consumer to have there eye exam and glasses selection all taken care of in one place. However, many vision plans give an eyewear allowance for frames that doesn’t fully cover many of the name brands offered by the doctors offices. Luckily, you can take your prescription anywhere you like to make sure you get the glasses of your dreams at a great price!

One of our favorite online retailers for eyewear is DiscountGlasses.com. There is a huge selection of glasses at very affordable rates. I always like to look i the clearance section to try out a new color/style along with my everyday glasses. The best part is that they are an out of network provider with several major vision insurance plans. Their website features easy instructions and links to submitting your order for plan reimbursement. They offer free returns, virtual try-on as well as student and military discounts!

These are not the only plans we work with. To take a closer look at the options available to you give us a call today!