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Medicare and Dental Coverage: What You Need to Know

When people think of Medicare, they often assume it covers all their healthcare need; including dental. Unfortunately, that’s not the case. Original Medicare (Parts A and B) does not cover most routine dental care. This can come as a surprise to new Medicare beneficiaries, and as an agent, it’s important to help clients understand Medicare and dental coverage.

What Original Medicare Covers

Original Medicare only covers dental care in very limited situations; usually when it is part of a hospital stay or a medically necessary procedure. For example:

• Jaw reconstruction after an accident.
• Tooth extractions needed before certain surgeries, such as heart valve replacement.
• Oral exams done in the hospital before a covered procedure.

Routine services like cleanings, fillings, dentures, or root canals are not covered.

Why Dental Coverage Matters

Oral health is closely tied to overall health. Poor dental health can contribute to heart disease, diabetes complications, and infections; all of which are major concerns for Medicare-aged clients. Helping your clients plan for dental costs can protect both their health and their wallets.

Options for Dental Coverage

Here are the most common ways beneficiaries can get dental coverage:

1. Medicare Advantage Plans (Part C)
   Many Medicare Advantage plans include dental benefits. Coverage can range from basic preventive care (cleanings, x-rays) to more comprehensive services like crowns, root canals, and dentures. Make sure to compare networks, coverage limits, and annual maximums.
2. Stand-Alone Dental Insurance Plans
   These plans are separate from Medicare and can offer flexible options. Beneficiaries can choose plans based on coverage needs and budget.
3. Discount Dental Plans
   Not insurance, but these plans provide negotiated discounts with participating dentists. They can be a low-cost option for those who only need occasional care.
4. Paying Out-of-Pocket
   Some clients may choose to budget for routine care rather than purchase coverage. This may work for those with minimal dental needs, but it carries financial risk if major dental work is required.

Watch a YouTube video on Individual Dental Plan Sales

Tips for Agents

• Ask about oral health needs during your fact-finding process. This helps you recommend plans that fit your clients’ situation.
• Compare annual maximums carefully — dental coverage is often capped between $1,000–$2,000 per year.
• Educate clients about timing — enrolling in dental coverage early can help them avoid waiting periods for major services.

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Medicare beneficiaries need to know that Original Medicare will not take care of their routine dental needs. By helping them understand their options Medicare Advantage plans, stand-alone dental insurance, or discount plans; you position yourself as a trusted advisor and help them maintain both their oral and overall health.

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Ancillary Health Insurance

Ancillary health insurance coverage can provide an additional layer of protection for those who need it.  Unfortunately, most health care plans do not cover every need a client has. Ancillary health products address gaps in coverage and offer additional benefits not included in a primary insurance policy.

Ancillary products include things such as, dental and vision, home health care as well as life products.  These plans provide a diverse array of coverage options.  Beneficiaries can find coverage options tailored to meet their healthcare needs.  In this post we will go over some ancillary health coverage options and why it is a good idea to contract to offer them.

See why ancillary products are a great addition to your business, watch our YouTube video

Dental & Vision Insurance

One of the most requested ancillary health products is dental insurance. Regular dental care, including check-ups, cleanings, fillings, and major procedures such as; root canals and crowns, are not usually covered by standard health plans. In most cases, when these benefits are are included in a Medicare Advantage plan, the coverage is minimum at best.  This leaves the client with a huge bill if they require dental care beyond cleanings. Dental insurance can offset the cost of these services, especially when beneficiaries use an in-network provider. Dental coverage makes it possible for individuals to maintain good oral health without financial burdens.

Vision insurance works similar to dental insurance. It covers routine eye care services such as, routine exams, prescription glasses, and contact lenses. Because many individuals need vision correction and regular eye exams to maintain good vision health. Vision insurance makes these services more accessible and affordable.

Long-Term & Short -Term Care Insurance

Long-term care insurance helps cover the costs associated with extended care services, such as nursing home care, assisted living facilities, and in-home healthcare. Medicare Supplement and Medicare Advantage plans provide limited coverage for long-term care, making long-term care insurance essential for individuals concerned about potential future care needs. Long-term care insurance policies vary in coverage options, benefit amounts, and eligibility criteria.

Learn more about short-term vs long-term care coverage

Short-term care insurance is very similar to long-term care in what it covers.  The real differences are in the amount of time the policies cover.  These policies cover care for a period of 1 year or less depending on the coverage option each beneficiary chooses.  It is also much easier to qualify for coverage, there are no waiting periods, and the cost is much more affordable than a long-term care policy.

Cancer, Heart Attack & Stroke Insurance

If an individual is diagnosed with cancer or had a heart attack or a stroke, they already have enough to worry about, they do not need to add paying bills to that list.   When it comes to the costs associated with Cancer, Heart Attack and Stroke, insurance that provides coverage for these conditions takes that concern away so beneficiaries can focus on recovery.

Once a beneficiary is diagnosed with any of these conditions, this coverage provides a lump-sum benefit amount. Beneficiaries receive payment in addition to other health coverage you already have.  The amount of the benefit depends on the plan purchased and provides a benefit of up to $50,000.  More than half the costs incurred with cancer can be non-medical.  Patients may need help paying bills if they or a spouse is unable to work.  The coverage may also provide financial assistance to receive out of network care with other providers.

Critical Illness Insurance

Critical illness insurance provides a lump-sum payment in the event of a serious illness or medical condition covered by the policy. This coverage helps individuals manage expenses not covered by their primary health insurance, such as lost income, medical bills, and additional caregiving costs. Critical illness insurance offers financial protection and peace of mind during challenging times, allowing individuals to focus on their recovery without financial strain.

If you want to add any of these products to your offerings, click here for online Crowe contract

Crowe agents who want to add a carrier, click here

Accident Insurance

Because accidents are unpredictable, it is not easy to guess if or when you need the coverage. Accident insurance is beneficial for anyone who lives an active lifestyle which can increase the possibility of an accident.  When this happens, you may lose pay due to injury especially if you are not eligible for workers compensation.  Accident insurance can help cover costs beneficiaries incur from medical treatments, injuries, hospitalizations, accidental death, dismemberment, or other loss.

Hospital Indemnity

Although accident insurance is a good choice to cover an emergency room visit, hospital indemnity insurance provides another option to cover costs if the beneficiary requires an extended hospital stay or several visits for rehabilitation or other care.  Once the beneficiary receives acre, they can submit a claim and, if it is valid, they receive a payment.

Click here to learn more about hospital indemnity plans

Disability Insurance

If a beneficiary is injured and it results in a covered disability, this insurance provides either short-term or long-term protection.  The amount of coverage, like other plans depends on what the beneficiary chooses.  This coverage gives the beneficiary a way to avoid the financial stress that comes from not being able to work. Beneficiaries may receive weekly payments for three months up to a year, depending on the policy. Get more information on disability insurance and what it covers.

Final Expense Insurance

Due to the high cost of funerals, many people choose to purchase a Final expense plan.  This can alleviate at least some of the stress that comes from losing a loved one.  A Final Expense plan can provide financial relief for your client’s family. Crowe and Associates’ agents have access to contracts with several top final expense carriers who offer level, graded and guaranteed issue types of plans. in all 50 states.  A few of the carriers we are contracted with are: AIG, Foresters, Mutual of Omaha, TransAmerica, Cigna, Baltimore Life, Columbian Life, Royal Neighbors, and Gerber.  Learn more about Final Expense plans.

Life Insurance

Although some employers offer life insurance coverage, the benefits usually rely on your employment.  In the event a beneficiary loses a job or stops working, they may opt to add a supplemental life plan.  There are many choices of life insurance, including term life insurance, whole life insurance and universal life insurance.

There are a wide variety of ancillary coverage options.  Each individual has their own needs.  A professional insurance agent can provide several options within a client’s budget tailored to supplement primary healthcare coverage.  Adding ancillary products is a great way agents can add a steady stream of revenue to their business.  Agents can add these products to their existing client’s coverage and both agent and client benefits.

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Medicare dental benefits

Most people have heard about the additional benefits offered on some Medicare plans.  One of the most asked about benefits are Medicare dental benefits.  Although dental care is an integral part of overall health, in the vast landscape of healthcare, dental benefits are often overlooked.

The state of Dental coverage in Medicare:

Medicare plays a crucial role in ensuring individuals over the age of 65 and qualifying individuals with disabilities.  Unfortunately, the comprehensive healthcare coverage Medicare provides is definitely lacking when it comes to dental coverage.

As we have already mentioned, Medicare provides a great deal of coverage for various health services, yet dental care has traditionally held a separate status.  Neither Part A nor Part B (Original Medicare) cover routine dental care.  This includes things like check-ups, cleanings, fillings, and extractions.  These services can be quite expensive and many people on fixed incomes simply do not have the resources to afford the costly dental care they require.  This lack of coverage frequently leaves beneficiaries looking for supplemental options that will cover their oral health needs.

Medicare Advantage Plans with dental benefits:

These days, many people look to Medicare Advantage plans (Part C) to provide some relief from the high cost of dental work.  Medicare Advantage plans are offered by private insurers and often provide additional benefits beyond Original Medicare. Many Medicare Advantage plans include dental coverage.  This coverage usually includes preventive and a few additional services.  In some rare instances, more extensive treatments like root canals or dentures are also covered to some extent.

Learn about some of the plan comparison tools that help clients sort out their options

Stand-alone Dental Coverage:

Many Medicare beneficiaries ask about dental coverage because they understand the importance of dental health.  This is where you need to explain that supplementary (stand-alone) plans cater specifically to dental care needs.  There are many different options available and many dental insurance carriers. Each carrier provides a few different coverage options that include things like checkups, cleanings, fillings and various other dental procedures. It is imperative that beneficiaries understand dental plans only work well if they use an in-network provider for dental care. As an agent, you need to check that their dentist is in network with any plan they are considering.

click here to learn about the NCD metlife dental plans

The Importance of Routine Dental Care:

While navigating Medicare and dental benefits, it’s imperative to understand how important routine dental care is. Oral health can significantly impact overall well-being.  There are several studies that link poor oral health to various systemic conditions. Maintaining regular dental visits preserves a healthy smile and also contributes to overall health and quality of life.

Advocating for Future Changes:

Because of the critical role oral health plays in overall well-being, there’s an ongoing call for expanding Medicare to include comprehensive dental coverage.  Both advocates and policymakers continue to push for changes within the program to include preventive and restorative dental services.  The goal is to provide better access to essential oral healthcare for Medicare beneficiaries.

As the healthcare landscape continues to evolve, understanding the importance of Medicare dental benefits remains pivotal for individuals seeking comprehensive healthcare coverage.  Although the current scope of dental coverage in Medicare has many gaps, exploring supplemental options like Medicare Advantage plans or standalone dental coverage offer some help addressing oral health needs.

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MetLife dental NCD

National Care Dental is offering dental coverage in the MetLife dental network.  MetLife dental NCD is available is several states including CT, NY and MA!  If you already know the details abou the product and simply want to contract, use the link below.

CONTRACTING

CLICK HERE TO CONTRACT  

How much money can you make selling dental?  Click here for an example

The Metlife dental NCD product offers three levels of coverage.

Clients will like these plans because; they have great plan options with extremely high coverage amounts.
The levels of coverage with this plan start out at $750 of basic coverage on the NCD Value by MetLife plan.  The next level of coverage is the NCD Essentials by MetLife which offers $2,000 of coverage per calendar year. The Third and most impressive plan is the NCD Complete by MetLife; this plan offers an unheard of $10,000 worth of coverage per year!

MetLife NationalCare Dental plans are now available in the following states:

AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MI, MN, MO, MS, ND, NE, NJ, NV, NY, OH, OK, PA, RI, SC, TN, TX, VA, WI, WV, WY

Click here to view Metlife Plan availability

Click here to see how easy it is to run a quote

Find a provider – Click here to access the directory

The three plan options

1.  Value by MetLife benefits:

Annual maximum benefit $750 (a $50 deductible applies annually per member)

The Value plan covers dental exams at 100%  (2 exams per 12 month period).  Clients also receive 100% coverage for bitewing x-rays (1 per 12 month period), 2 cleanings per year as well as fluoride for children under 16 years old.

This plan provides coverage for basic care starting at 50% for year 1 and going up to 80% for the third year of coverage.

Major dental care is not covered for the first year on this plan.  Although year 2 provides 10% coverage and the third year provides 25% coverage for these services.

Value plan details; click here

2.  Essentials by MetLife benefits:

For this plan, the annual maximum benefit is $2,000 (a $50 deductible applies annually per member)

Members receive 100% coverage for preventative care including; dental exams (3 per 12 month period).  Other services covered at 100% on this plan are; bitewing x-rays (1 per year), 3 cleanings per year and fluoride for children under 16.

Basic care coverage starts at 65% for the first year and goes up to 80% for the second year.  Third year coverage is 90% on this plan.

Major dental services are covered at 10% for the first year, 50% for the second year and 60% for the third year.

Essentials plan details; click here

3.  Complete by MetLife benefits:

The NCD Complete plan is a complete coverage option with the annual maximum benefit of $10,000 (there is a $100 lifetime deductible for this plan)

The Complete plan covers preventative care at 100%.  This includes three routine exams and cleanings per year.  This plan also covers 1 set of bitewing x-rays as well as fluoride treatments for children under 16 at 100%.

Basic care is covered the first year at 65%.  The second year at 80% and the third year at 90%.

Major dental care is covered at 10% the first year, 50% the second year, and 60% the third year.

Complete plan details; click here

As you can see, these plans offer the comprehensive benefit packages that your clients are looking for.

If you want to offer these products to your clients; contact lisa@croweandassociates for contracting.

Learn more about what we have to offer our agents

UnitedHealthOne Dental Plans

Crowe and Associates is offering it’s clients the opportunity to purchase Dental insurance with UnitedHealthOne Dental Plans, so you will have one less thing to worry about.  The dental plans we are offering are either a PPO or an EPO.  When it comes to finding dental coverage that fits your unique needs and budget the UnitedHealthOne Dental Plan gives you the coverage you need at a price you can afford.  The newly expanded dental products have many features that will keep you smiling.

There are 4 new plan types to choose from.

UnitedHealthOne provides coverage for preventative and basic as well as major services.

Vision benefits are also available, if you want to add that option.

Additionally, you will have access to an extensive dental network.

The PPO plan is in the Solstice PPO Network and is available in all 50 states.

The EPO plan is the S500A network and is only available in NY, NY, CT and FL.

Please click on the links below for more information on the dental plans we are offering.

 Brochure CT Dental for Individuals and families UnitedHealthOne

Dental Application Individuals and Families CT UnitedHealthOne

Brochure for 50 and over- CT UnitedHealthOne

Dental 50+ Application CT UnitedHealthOne

If you have any questions or would like to enroll in one of these plans, please either call us at (203)796-5403 or email us at Edward@croweand associates.com.