Medicare does not cover most routine dental care. Dental procedures like cleanings, fillings, tooth extractions, dentures, implants, and x-rays are not covered by Original Medicare.
In this post, we’ll go through four different ways to save money on your routine dental care when you’re on Medicare.
Confused about your Medicare coverage options? Watch our free video: How to Find the Best Medicare Coverage Without Paying More Than You Need To…
Why Doesn’t Medicare Cover Dental?
When Medicare began in the 1960s, most health insurance didn’t include dental coverage. The American Dental Association, the dentists, opposed including dental coverage in Medicare. This wasn’t seen as strange at the time since it was standard for medical insurance to not include dental.
Now, dental coverage is pretty standard in employer group health plans and individual health plans, but Original Medicare still doesn’t include it.
Over the years, Congress has tried to increase Original Medicare coverage, but due to the increases in costs to Medicare beneficiaries associated with added coverage, voters have rejected increasing levels of coverage to Medicare Parts A and B.
If you are turning 65 or are over age 65 and leaving employer health insurance for Medicare, what options do you have for dental coverage?
1. Standalone Dental Plans
Standalone dental insurance plan premiums can be as low as $10 a month up to over $80 a month, depending on the plan. Benefits and networks also vary widely.
At the lower monthly costs, you can expect things like oral surgery, dentures, root canals, crowns, and orthodontia to not be covered at all.
Standalone dental insurance plans have a maximum limit on how much they will pay for your dental care in a calendar year. With most plans, this limit is somewhere between $1000 and $5000.
Many of these plans will not pay for major dental procedures, like implants, until you’ve been on the plan for 12 months, unless you are coming from prior dental insurance.
Some dental plans also have graduated benefits. For example: plans pay for 60% of a service in your first year on the plan, then 80% the second year, and 90% the third year and following.
Most standalone dental plans do use networks of dental providers, though some allow you to use any provider and reimburse you when you turn in a dentist’s bill.
All the details of each dental plan are important to look at before enrolling so you can make sure you’re really getting a plan that will be valuable for you. If you would like assistance with plan comparisons, we can help.
The annual maximum and the likely amount of benefits you’ll use are important considerations when comparing standalone dental plans.
If you are going to be paying, say $50/month ($600/year), for an annual maximum benefit of $1000 or $1500, is that a good use of your hard-earned money?
Or if you’re paying $80/month for a plan with an annual maximum benefit limit of $5,000, and realistically you’ll only need $750 a year in benefits, does it make sense to spend that $960 in premiums?
Fortunately, standalone dental plans are month to month contracts that you can change, drop, or add anytime. You are not locked into a plan, so if what you have now isn’t serving you well, you can find something better and change.
Cash Option
Another option may be to put money in a savings account every year and use it to pay for dental expenses when they occur.
Some dental offices offer discounts to patients who have no dental insurance but pay cash for services, so it’s a good idea to speak with your dentist’s office as part of your dental coverage decision making process.
2. Combination Dental Plans
Some insurance companies offer combination plans that include dental and vision, or dental, vision, and hearing coverage all in one plan.
If you are looking for benefits for routine vision care and hearing exams and hearing aids, combining everything with your dental insurance in one insurance policy can make sense.
These plans do have annual maximum benefit limits for each type of coverage, so you’ll want to find a plan that has enough coverage for your needs in dental, vision, and hearing care.
The combination plans usually also use networks of providers, so check the associated network for your dentist, eye doctor, and audiologist before enrolling.
The costs for the combination plans are higher than standalone dental insurance, so again, it makes sense to estimate how much you are likely to use in benefits to see if what you’ll spend in monthly premiums for the insurance is worthwhile.
3. Dental Discount Programs
These programs are not dental insurance, but they can lower your costs significantly.
If you have a Medicare Supplement plan, you may already have a dental discount program included with that policy.
There are also independent dental discount programs you can enroll in. These programs do have an annual cost to be in the plan. You can expect to pay about $120 for the year to be in the discount program.
You will need to use dentists who contract with the discount plan for dental services. Those dentists have agreed to discount their rates by 15-60% for discount plan members.
Because these are not insurance policies, the discount company doesn’t pay anything for your dental care. The company negotiated discounts with dentists, and you pay your membership fee to access those discounts.
The discount programs have no waiting periods for major services like crowns or implants and no annual maximum benefit limits, since the discount company isn’t paying out any benefits.
What’s the best dental coverage solution?
That answer is unique to you.
If you prefer a Medicare plan that doesn’t have a dental discount program, then we can look at the options for dental coverage available in your area, including possible discounts for cash payment with your current dentist, compare the pros and cons of every option, and then you choose the one that will work best for you.
And, because most standalone dental insurance and discount plans are month to month contracts, you are free to change your mind anytime during the year.
Curious about the dental options to you?
Give us a call at 877-312-1414 or schedule a free, no obligation Medicare plan consultation. We’re happy to help you find the best value for your premium dollar!
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