As of January 1, 2023, patients will begin to see more Medicare Advantage plans available with improved network access. For example, Associated Dentists will be included in the network of dental providers accessible by Cigna Dental Medicare Advantage plan customers. We currently are in-network with some United Healthcare and Humana Medicare Advantage plans and we are sure there will be more in the future.
Medicare is the federal government’s national health insurance program that primarily covers Americans aged 65 and older. It is divided into four parts – A, B, C, and D.
Medicare Part A and Part B (often referred to as Original Medicare) cover a broad range of health benefits, however, routine dental coverage is not included in the benefit plan. Medicare Part D is for prescription drug coverage.
Medicare Part C is an alternative to Original Medicare, known as Medicare Advantage that allows individuals to choose health plans that provide the same services as Parts A and B, but with additional benefits that can include dental, hearing, vision, and prescription drug coverage.
Dental coverage provided by Medicare Advantage plans can provide patients with benefits that include access to networks of qualified dentists, while offering price protection in the form of in- network discounts. Prior to January 1, 2022, patients with Medicare Advantage plans with dental benefits had to visit practices that had opted in to Medicare parts A and B to receive full benefits. This is no longer the case. Before the change, patients with Medicare Advantage plans who visited practices that had opted out of Medicare parts A and B may not have received any benefits at all for their dental care. Others received only partial reimbursement. Now, patients who visit in-network providers will receive applicable in-network discounts as well as full plan benefits for covered services, regardless of whether or not the office participates with Medicare. This provides patients with more choice.
Aside from Medicare Advantage, those who qualify for Medicare have few other options. They can choose to pay for dental services out-of-pocket, meaning they have no dental insurance coverage at all, or they can buy an individual insurance plan from a private insurer. In addition, some offices, including Associated Dentists, offer in-house membership plans for those with no traditional dental insurance coverage. It is important to compare all options to find the best fit for your dental care needs.
If you qualify for Medicare and need dental insurance, a Medicare Advantage plan with dental benefits may be an option worth considering. Be sure to ask about annual maximums, waiting periods, and deductibles when choosing a plan. For example, it is important to note that a dental insurance plan deductible does not work the same as a health or auto insurance deductible. The dental plan deductible, typically anywhere from $25 to $100, must be paid out
of pocket by the patient before the annual maximum available will be applied to treatment costs. It is also helpful to know the difference between preventative and comprehensive dental coverage. Some plans may only offer coverage for routine exams and cleanings, which would be considered preventive only. Comprehensive coverage may include a combination of services such as fillings, extractions, root canals, crown, bridges, and dentures.
Like private and commercial dental plans, a typical Medicare Advantage plan with comprehensive coverage may operate on a “100-80-50” coverage agreement, which means the plan will cover 100% of routine dental costs, 80% basic dental costs, and 50% major dental costs. These percentages are paid up to the plan’s available annual maximum. This means that a plan with a $1500 annual maximum will only pay $1500 in a given benefit year. Some plans may deduct routine visits from this maximum and some may not. Depending on your Medicare Advantage plan, waiting periods can also apply. This means that certain benefits will not apply until after the waiting period has been met, which can range from 6 to 12 months.
According to new research produced by the Kaiser Family Foundation, 47% of Medicare beneficiaries (nearly 24 million people) do not have any dental coverage. The research also indicates that almost half of Medicare beneficiaries did not visit a dentist in the past year.
Our mouths are full of bacteria, most of which are harmless with proper dental care. However, poor oral hygiene carries the potential for more serious health complications, not to mention pain and discomfort associated with decay and infection.
Throughout one’s life, dental health is important to maintain. Many studies have found direct connections between oral health and one’s overall health. Routinely visiting the dentist can help avoid complications found to be associated with poor dental hygiene such as:
● heart disease,
● respiratory disease,
● chronic pain,
● infections, and
To learn more about Medicare Advantage, visit medicare.gov. You can enter your zipcode to find plans in your area and filter the insurance plan to your specific needs. You can also get an idea of your monthly premium and compare plans. If you need any assistance understanding your current dental insurance benefits, or have questions about plans available through Medicare Advantage, reach out to our in-house insurance department at our Madison and Verona locations..