If you are approaching retirement age, you may be wondering, does Medicare cover dental? The answer isn’t one you are hoping for—original Medicare does not cover the vast majority of dental care.
Then you may wonder, how do seniors pay for dental care? Some receive coverage through retiree benefits packages provided by former employers…those with very low income and assets could qualify for Medicaid dental coverage…and veterans with service-related disabilities might qualify for VA dental benefits. But the rest of us either pay dental bills out of pocket or seek other forms of dental coverage, each of which has limitations.
Bottom Line Personal asked insurance specialist Lauren Bigham Steele to explain the dental-coverage options available to Medicare-age patients…
Medicare Advantage plans
These often include some dental coverage—but it is far from comprehensive. Many Medicare Advantage plans cap dental benefits at $1,000 or $1,500 per year and/or cover only basic preventive services, such as cleanings and X-rays. Patients who require extensive dental work, such as multiple implants, are likely to face big out-of-pocket bills. There are Medicare Advantage plans with more generous dental benefits in some regions, but those are becoming rare.
Cost: Many Medicare Advantage plans charge no premiums, but selecting one means that you will receive Medicare coverage through a private insurance company instead of the government, as you would with original Medicare. Read more about Medicare Advantage versus original Medicare here.
Bigham Steele’s advice: Do not select a Medicare Advantage plan based primarily on its dental benefits. More important factors for determining whether a particular Advantage plan is appropriate for you include whether your preferred doctors and hospitals are in the plan’s network…and whether the plan provides strong coverage for any expensive pharmaceutical that you take. If you conclude that Medicare Advantage is appropriate for you and there are multiple Advantage plans that serve your medical needs well, then differences in dental benefits could be a tie breaker.
Stand-alone dental insurance
This insurance is sold by companies including Aetna, Cigna, Delta Dental, Humana, Manhattan Life and Mutual of Omaha, among others. Some of these policies require policyholders to see “in-network” dentists and/or offer less impressive terms when policyholders see out-of-network providers…but others cover bills from any dentist. As with the Medicare Advantage plan dental coverage discussed above, these policies often cap coverage at $1,000 or $1,500 per year. It’s possible to find policies that provide up to $5,000 in annual coverage, but even these generally have lower caps on specific high-cost procedures, such as implants. Stand-alone dental policies often have long waiting periods—in other words, you may have to wait a full year before they’ll cover pricey procedures such as implants, crowns and periodontal work. Medicare Advantage plans tend to have fewer waiting periods.
Cost: There’s no simple answer to the question, “how much is dental insurance?” Prices vary depending on the applicant and coverage. You can find dental policies for less than $20 a month, but a retirement-age applicant seeking around $1,500 in coverage that doesn’t restrict him/her to a restrictive provider network is more likely to pay perhaps $50 to $60 per month.
Bigham Steele’s advice: Stand-alone dental policies make sense mainly for people who require significant dental work in most or all years or who expect to in the coming years. This type of coverage is less likely to justify its cost if you often need only a cleaning and x-rays.
If you decide stand-alone dental insurance is for you: Compare rates and terms available to you from multiple insurers, either by visiting their websites directly or through an insurance broker who works with multiple dental insurance providers. Chances are, the insurance agent who you are already working with sells these plans.
Compare not only the premiums and coverage caps but also policy waiting periods and whether treatment is restricted to only in-network providers. If you’re loyal to a particular dental practice, confirm that it accepts the dental insurance you’re considering. If a policy promises to cover any dentist’s bills but the dental practice doesn’t specifically accept that insurer’s coverage, you likely will have to pay bills out of pocket, then file claims with the insurance company to recoup the covered portion of bills.
Discount or membership plans
These are available from some dental practices. Patients who participate in these plans typically pay a monthly or annual fee and in exchange receive routine preventive services such as cleanings and X-rays at no or low cost and discounts on other services.
Cost: Prices vary but expect the annual cost of these plans to represent a modest savings compared with the price of paying for routine preventive services a la carte.
Bigham Steele’s advice: If you have a dentist you like, it’s worth asking whether he/she offers a program along these lines.
Similar: Some insurance companies, including Aetna and Humana, offer dental discount plans, too. These provide savings off dentists’ normal rates for relatively modest monthly premiums, often $10 to $20 per month. But: These savings are available only from participating dental practices—confirm that there’s a participating dentist in your area who you feel comfortable seeing before signing up.
