This article has been updated from a post originally published on 11/18/18.
Access to Medicare coverage is a helpful benefit for those aged 65 and older in the United States. Medicare medical insurance offers comprehensive coverage and goes a long way in making it possible for older Americans to afford quality healthcare as illness and injury become more common.
However, Medicare isn’t a perfect shield against all the medical issues a senior may face and the program’s limitations are not as widely understood as they could be. Here are five things all seniors who rely on Medicare should know, specifically when it comes to dental care.
You’re probably not covered for dental care
As noted by “Medicare Maven” journalist Phil Moeller, “the failure of Medicare to cover most dental, hearing and vision expenses is perhaps its greatest failing.” Specifically, “original Medicare,” or Medicare Parts A and B, do not cover standard dental procedures like routine cleanings, examinations, fillings, and crowns. So, if you are looking to these programs to help with the cost of maintaining your oral health, you will not find it here.
It should be noted there are some exceptions to keep in mind:
- The plan does offer dental services that are directly tied to a covered medical procedure, such as an oral exam that must be done in preparation for heart valve replacement or oral cancer treatments.
- It may also be able to help with emergency dental care required to treat an injury.
But, there are Medicare plans that DO cover dental care
Medicare Advantage plans (Parts C and D) offer everything covered through the original Parts A and B, plus additional coverage toward dental care and prescription drugs. However, they cost more to enroll in, as they’re not provided automatically through the standard Medicare program.
As a result, many seniors on a fixed income must be selective with what Medicare Advantage plan options they want and need. And when it comes down to getting your semi-annual dental cleaning or the four different prescriptions you need to take every single day, dental care, unfortunately, loses this hard choice.
“Medigap” plans are designed to fill the gap
Supplemental insurance plans have been designed specifically for Medicare recipients to fill the gap between what Medicare covers and what care the average patient over 65 should be receiving. This the name “Medigap Plans.”
Like the Medicare Advantage plans, Medigap programs have a cost associated with them, as well as the standard limitations and details that go with nearly all insurance plans: deductibles, copays, waiting periods, coverage maximums and exclusions. Therefore, the cost of the monthly premiums needs to be carefully weighed against the value you expect to get out of the program if you want to select the best option for your unique circumstances.
Private insurance plans are also an option
It’s important to recognize that being a Medicare recipient doesn’t preclude seniors from purchasing private dental insurance. In fact, hundreds of different plans are available with a wide range of services and coverage amounts.
This could be a good option, but you will need to weigh the costs and benefits and do some thorough research to find the program that is best for you. (Note that you cannot utilize both Medicare and the Marketplace.)
Finally, there are plenty of alternatives to traditional dental insurance
The last item on our list may be the most important, as dental insurance alternatives don’t receive nearly the media coverage that Medicare and all its connected plans do. That is why many seniors and their families don’t realize there are legitimate ways to obtain quality, affordable dental care without insurance.
These include:
- Low- and no-cost clinics
- Dental discount programs
- Negotiating discounts with your dentist
- Dental credit cards or financing plans
The bottom line: Just because you are on Medicare doesn’t mean you don’t have options of dental. Take a look at your budget and unique health needs when researching the best path for you.