According to the Centers for Disease Control and Prevention (CDC), seniors have special dental needs as they age. Nearly one third of Americans 65 and older have untreated dental cavities. Over 70 % of adults ages 65 and older have s periodontal disease, a dental condition where the teeth loosen and separate from the gums. In addition, older adults take more prescription and over-the-counter medications that may harm dental health. The CDC says that over 400 medications cause dry mouth, which can increase the risk for dental disease. Poor dental health is also linked to other serious conditions and diseases, according to the Mayo Clinic. Poor oral health may contribute to heart disease, diabetes, osteoporosis, and even Alzheimer’s disease.
If you’re eligible for Medicare, here’s what you should know about your dental benefits under Medicare Advantage and Original Medicare.
What dental benefits are available with Medicare Advantage?
It’s helpful to understand how the Medicare Advantage program works before discussing dental benefits. Medicare Advantage (also called Medicare Part C), is an alternative way to get your Medicare benefits. Unlike Original Medicare, which is administered by the federal government, Medicare Advantage plans are offered by private insurance companies operating under guidelines established by the Centers for Medicare and Medicaid Services (CMS).
Medicare Advantage plans must provide, at a minimum, all the benefits you’re entitled to under Original Medicare (Part A and Part B). However, because they are private companies, they have more flexibility to structure their plans in ways that benefit their members. For example, Medicare Advantage plans typically offer extra perks, called supplemental benefits, to help offset healthcare costs. These supplemental benefits typically include routine dental and vision care, and occasionally even hearing care benefits.
Why is this important? Original Medicare generally doesn’t cover dental services such as cleanings, extractions, fillings, root canals, or dental restorations, except under very narrow and specific circumstances. A Medicare Advantage plan is one way to get coverage for most types of dental care if you’re a Medicare beneficiary.
Are all dental services covered by Medicare Advantage?
Because Medicare Advantage plans are private health insurance plans, there is no standard for dental benefits; each company decides what services it will cover and what amount it will pay. According to CMS, most Medicare Advantage plans with supplemental dental benefits will pay some or all of the costs for preventive and diagnostic care such as
- Annual exams.
Many Medicare Advantage plans also include some benefits for treatments such as
- Root canals
- Periodontics (treatment of gum disease)
- Prosthodontics (crowns, bridges, dentures).
Keep in mind, however, that your plan may require you to use dental providers within the plan’s network. Your plan may also pay a set amount toward certain services regardless of actual cost, and there may be an annual limit on dental benefits.
Finally, it’s important to remember that not all Medicare Advantage plans offer dental benefits, and that there may be big differences in the amount and type of benefits among those that do. Monthly plan premiums, which you pay in addition to your normal Part B premium every month, may also vary from plan to plan. If you are considering a Medicare Advantage plan because you want dental coverage, make sure you consider all the costs and benefits so you know you’re getting the best plan for your situation.
Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.
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