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Dental Coverage

Can I Get Dental Coverage through Medicare?

According to the CDC, around a quarter of all Americans over the age of 60 no longer have any of their natural teeth. Your odds of losing your teeth are higher if you live in a rural area, don’t have insurance, or live at or near the poverty line. Having dental insurance – and regularly seeing your dentist – greatly improves oral health, and your chances of keeping your teeth.

Even though tooth loss happens naturally with age, Original Medicare does not cover dental care. It will cover care for certain related conditions, such as oral cancers. However, you do have options when it comes to dental insurance.

Medicare Advantage and Dental Coverage

Although Medicare Advantage (MA) plans must provide the same benefits as Original Medicare, most of them also offer additional coverage. This makes sense, since beneficiaries would likely not pay for an MA plan otherwise. One service many Medicare Advantage plans offer is dental care. If you aren’t sure whether yours offers dental coverage, talk to your plan provider. If you’re interested in changing plans to find one that includes dental, call us toll-free at 855-350-8101. One of our licensed agents can work with you to find the best MA plan that includes dental.

Medicaid and Dental Coverage

Medicaid is similar to Medicare in that it is a government-sponsored health insurance program. It differs by the fact that it is a joint venture of the state and federal government. That difference is important, though, as each state sets its own parameters over what its Medicaid program will and will not cover (although it must meet federally-mandated minimums).

The federal government requires state Medicaid programs to provide dental care for children. Unfortunately, it leaves the choice of covering adults up to each state. Most states offer emergency dental coverage, but the majority do not offer comprehensive care.

Standalone Dental Insurance

If you’re happy with your MA plan, or prefer to stay with Original Medicare, you can also buy standalone dental insurance. When comparing plans, look for one that covers routine exams and cleanings every six months with no out-of-pocket cost to you.

Expect to pay a monthly premium for your dental insurance. You’ll also likely have co-pays and possibly a deductible.

Most dental plans are similar to Medicare in that they cover services at a certain percentage of a pre-approved cost. For example, your plan may set the approved cost for fillings at $75 per tooth. Your co-pay may be a flat rate or a percentage of that approved amount.

Dental Coverage

Common covered dental procedures include:

  • Exams and cleanings
  • Fillings
  • X-rays
  • Tooth extractions

Other common services include root canals, bridges, and crowns. If your plan covers these, you likely have a 50 percent co-pay. Most plans do not cover cosmetic items such as braces.

Many dental providers also have network requirements similar to those in an HMO or PPO plan. The Affordable Care Act also provides dental coverage through the Marketplace (as of July 2018).

Dental Savings or Discount Plans

Dental savings plans are not insurance. Instead, they’re more like a co-op, where a large group of people pay a monthly fee and their plan negotiates rates with participating dentists. Costs vary, in terms of both your premium and the discount offered by the dentists. Review plans carefully before choosing one – including which dentists participate. If no dentists in your area accept that plan, there’s no point in joining.

Alternative Dental Care

If cost is an issue (as it is for most of us), you may find discounted dental care through a number of sources. One popular option is going to a dental school. The students gain valuable experience and their patients get significantly reduced prices. Plus, a licensed dentist is on-site to supervise the work.

Every state also provides dental clinics at a reduced rate (and sometimes for free). Rates are typically based on income level. Check this map from the American Dental Association to find coverage in your area.

Do You Really Need Dental Insurance?

In a word, yes. We already told you that around 25 percent of all seniors lose their natural teeth. Typically, this is due to gum disease (periodontitis) and tooth decay. Receding gums is common and often leads to decay at the tooth’s root.

One issue for older people is that common medications cause dry mouth, which raises your risk of oral disease. This is because saliva contains antimicrobial properties that kill the bacteria that cause tooth decay.

Routine dental exams are also how oral cancers are detected early. Survival rates decline dramatically for those not receiving routine care – around 56 percent for Caucasian patients and 34 percent for African Americans.

dental coverage

How Can You Protect Your Teeth?

You can help protect your oral health with preventive maintenance. It starts with good oral hygiene, aka brushing and flossing your teeth regularly. Use a fluoride toothpaste. Also, don’t reject fluoridated water – it helps protect your teeth against decay.

See your dentist every six months, even if you don’t have any teeth. Remember, this ensures oral cancers are discovered early.

If you smoke, quit. If you use smokeless tobacco, quit. Your risk of periodontal disease skyrockets with tobacco use. Heavy drinkers also raise their risk for oral cancers, so drink moderately.

Finally, if your medications cause dry mouth, talk to your doctor about a substitute. If there isn’t one, or if your insurance doesn’t cover it, make sure you drink plenty of water. Also try chewing a sugar-free gum, which helps your body create saliva.

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