Most dental care is not covered by Original Medicare (Part A and Part B). Therefore, routine checkups, fillings, cleanings, dental implants, dentures and tooth extractions are all 100% out-of-pocket if you are enrolled in only Medicare Parts A and B. Although Medicare doesn’t cover dental care, maintaining good oral health improves your overall health. It can help prevent gum disease, cavities, tooth decay, bad breath and more. Fortunately, you have several options for finding dental coverage and decreasing the cost of your dental care while enrolled in Medicare.
Medicare Dental Coverage Options
Choose a Medicare Advantage Plan
Medicare Advantage Plans (Part C) are offered by private insurance carriers and include all the same coverage as Parts A and B. They also may include additional benefits such as dental, vision and prescription drug coverage. Depending on where you live, you will likely have many plan choices from multiple insurance carriers. Explore plan quotes to find the combination of services and costs that works well for you. Don’t forget to check whether your dental care providers are included in the plan’s network!
In some areas, Medicare Advantage Plans are available with $0 premiums. These areas allow some people to be able to receive additional benefits without paying additional premiums. Each plan will have varying levels of dental coverage, from no additional dental benefits to much more comprehensive coverage.
Enroll in Your Spouse’s Dental Plan
If your spouse is still working and covered by a group plan through their employer, you may be eligible for coverage through their dental plan.
Find a Stand-Alone Dental Plan
You could also purchase a dental-only insurance plan in addition to your coverage through Original Medicare. You must pay a monthly premium; however, you will have lower out-of-pocket fees. Most of these dental plans will recommend that you see a dentist who is in your network as opposed to out-of-network because there may be lower rates. Some plans may give you the opportunity to go to any dentist, but there will likely be higher prices for services under those plans.
Use Medicaid’s Limited Coverage
If you are eligible for both Medicare and Medicaid, you may be able to have some of your dental care covered by Medicaid. Your coverage options will vary by state, since each state has a slightly different Medicaid program. You can also consider a Dual Special Needs Plan, a type of Medicare Advantage Plan designed specifically for people who are enrolled in both programs. There may be a Dual Special Needs Plan in your area that includes dental coverage.
Medicare Dental Exceptions
Although Original Medicare will not pay for routine or emergency dental care, it does offer limited coverage for specific dental procedures, typically if necessary to treat other health issues. For example, Medicare Part A may cover an oral exam in the hospital before a heart or kidney transplant, surgery to treat jaw or face fractures, dental splints and more.
What About Medicare Supplement Plans?
Medicare Supplement plans assist with your copays, deductibles, and coinsurance under Original Medicare but generally do not offer additional coverage beyond Parts A and B.
Annual Enrollment Period (AEP)
Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?
Initial Enrollment Period (IEP)
Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.
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