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Medicare and Dental Insurance

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    Medicare and Dental Insurance

    Medicare and Dental Insurance

    By Ed Crowe | | 0 comment | 13 January, 2022 | 0

    Medicare and Dental Insurance

    Knowing how Medicare and Dental Insurance work is important. While Medicare does not cover dental work, some MAPD plans do.   In addition, standalone plans add additional coverage.

    Original Medicare

    Medicare doesn’t cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices.  

    Medicare Part A (Hospital Insurance)  will pay for certain dental services that performed while a beneficiary is in a hospital. Part A can pay for inpatient hospital care if you need to have emergency or complicated dental procedures, even though it doesn’t cover dental care.   Beneficiaries pay 100% for non-covered services, including most dental care.

    Medicare Advantage

    Some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare doesn’t cover – like vision, hearing, or dental.  The amount of dental benefit one gets through an advantage plan varies greatly from plan to plan.  The geographic location of plans will influence the amount of dental benefits offered.  Some dental benefits are included in the base Medicare Advantage plan.  Other plans may also give the members the option of purchasing a dental rider for a monthly premium amount.

    Dental benefits through an Advantage plan do NOT have waiting periods. This is regardless of if the member had previous dental coverage or not. Dental benefits inherient in the Advantage plan range from preventitive only coverage to coverage for major servies ranging from $1,000 to $5,000 per year.  A number of plans offer an HMO style plan bu this has been changing lately with more plans using a PPO platform.   Other companies offer the benefits on an indemnity basis which allows the member to use any dentist.  The flexibility of the indemnity benefit is nice but provider costs are not negotiated which is a negative.

    Medicare and Dental Insurance: Standalone Dental Plans

    Standalone dental plans can be good options for individuals on Original Medicare/Medicare supplements.   Keep in mind, Medicare supplements do not cover dental expenses beyond the earlier mentioned emergent care covered by Original Medicare.  Stand alone plans are independent policies which are not part of the Advantage plan.   If a member changes Advantage plans they can still keep the stand alone plan.   Premiums on stand alone options range a lot depending on the benefits being offered.  Examples of Stand alone plans are Nationwide NationalCare dental and Cigna Dental plans. 

    Unlike Medicare Advantage dental benefits, standalone plans can have waiting periods.  Some companies will waive the waiting periods if the member had continuous previous coverage however.  Waiting periods are usually 6 months on basic services and 1 year on major services.

    Dental Discount Plans

    Discount plans do not pay out a benefit like traditional dental plans.  They simply pass on the negotiated savings through the plans network. When the member uses an in network dentist, the provider can only charge them the rate that has been negotiated.   Discount amounts depend on the plan and service but can range from 5% to 70% off of standard charges.  The monthly premium of discount plans is usually very reasonable which can make them a good option.  Discount plans do not have benefit maximums so the member can continue to get the discounted rate even if they have a lot of dental work.   The plans only give the negotiated rate when you use a dentist in the network.

    Looking for help with Medicare lead and marketing costs?  Learn about our Free Medicare lead and marketing program

    dental for seniors ,dental insurance ,medicare dental ,medicare dental insurance ,over 65 dental

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