Tammy Burns is an experienced health insurance advisor specializing in Medicare and senior health issues, including Medicare Advantage Plans and prescription drug plans, as well as ACA certified for health insurance and other ancillary, life and annuity products.
What you should know:
- Original Medicare does not provide dental coverage except for certain services received while in the hospital.
- Medicare Advantage Plans can cover additional services not provided for by Original Medicare, such as dental coverage.
- Most Medicare Advantage Plans provide dental coverage but some may require an additional premium.
- The amount of dental coverage offered by Medicare Advantage Plans and the cost of services varies based on plan and location.
Medicare Advantage Plans, which are offered by private insurance companies, can cover services not covered by Original Medicare, including dental services, but not all plans provide the same coverage or at the same cost. For instance, one plan may cover cleanings only while others can provide more comprehensive benefits. Some may charge an additional premium for dental benefits.
“The plans vary based on the state and county you live in and the benefits change each year,” says Cynthia Pruemm, Investment Advisor, Founder and CEO of SIS Financial Group in Hoffman Estates, Illinois. “It is important to not only compare benefits of the plan but also the value-added services that they offer, such as dental coverage.”
Since most individuals can only change their Medicare Advantage Plan during the Annual Election Period from October 15 to December 7 each year, it’s worth doing the research to make sure you get the best plan for you from the start.
Do Medicare Advantage Plans Cover Dental?
“Whether Medicare Advantage plans cover dental or not depends on the plan you have,” says John Hill, president of Gateway Retirement in Rock Hill, South Carolina.
Over 90% of Medicare Advantage Plans provide dental coverage in 2021, according to the Kaiser Family Foundation. The available plans vary by location, but according to KFF, 98% of Medicare beneficiaries have access to at least one Medicare Advantage Plan that offers dental coverage in 2021.
When Medicare Advantage plans do offer dental coverage, Hill says it’s often limited and with network restrictions. “If you want dental coverage, ask your dentist what plans they accept and then see which is best for you.”
What Does Medicare Advantage Dental Cover?
Medicare Advantage Plan dental coverage varies by plan. It can be anywhere from as little as two cleanings per year to an annual allowance of up to $2,000, Pruemm says. Medicare Advantage dental coverage usually includes cleanings, routine x-rays, extractions and fillings. However, a prior authorization or advance approval is usually required. Other services may also be covered, but often for an additional premium.
Plans will also often limit the number of services covered. For example, you may be eligible for only one periodontal exam every three years, according to KFF.
“Some plans will let you go to your own dental provider, but others may have a network of dental providers you must stay within in order to receive their benefits,” Pruemm says.
You can read the Explanation of Benefits included in the plan documents to see what benefits a specific plan offers.
What Are The Costs Associated With Medicare Advantage Plans Dental Coverage?
The costs for dental coverage with Medicare Advantage plans vary depending on the plan and level of coverage. Some plans require beneficiaries to pay an additional premium for dental coverage, but usually these plans offer more extensive dental benefits as well. These additional premiums averaged $264 in 2016, but ranged from $72 to $720 per year, according to KFF.
Plans also vary widely in the level of cost sharing provided for dental benefits. For instance, some plans may cover all costs for preventative care while others may charge a small fee per visit, such as $5 for each service. Some plans may charge a flat coinsurance rate for more extensive services, but these can range from 20% to 70%, while other plans charge flat copayments instead.
Which Medicare Advantage Plans Offer Dental Coverage?
Not all Medicare Advantage Plans offer dental coverage. When they do, the services can vary greatly, even within companies. “A company may offer dental in one state, but not another,” Hill says. “If you’re looking for dental, you can look up a specific company you’re interested in and check with their network of dentists to see which one you like best.”
Some samples of available Medicare Advantage Plan dental coverage in 2021 include:
- Aetna: Dental coverage for as low as $0 monthly premium but with a cap of $750. Coverage up to $3,000 is available but for an additional monthly premium.
- Cigna: Available to beneficiaries in 23 states and the District of Columbia, dental coverage is offered for as low as $0 monthly premiums in some plans but the coverage limits vary.
- Humana: Dental coverage for as low as $0 monthly premium with most preventative services costing $35 per service and other services requiring copays of 50% to 70%.
- Kaiser: Dental coverage is available for an additional premium, but only when grouped with hearing and vision.
- United Healthcare: Dental coverage premiums range from $0 to over $100 per month, with coverage generally up to $2,000.
Since coverage costs and availability can vary based on location, it’s important to review each plan’s documents before deciding. To compare plan coverage and costs, Pruemm goes to www.Medicare.gov. “On this site you can enter your zip code, county, doctors’ names and medications to get a customized list of plan information,” she says. “You can also talk to a licensed professional that is certified to compare these plans for you.”
These experts were consulted for insight into Medicare Advantage dental coverage.
- Cynthia Pruemm, Investment Advisor, Founder and CEO of SIS Financial Group in Hoffman Estates, Illinois
- John Hill, president of Gateway Retirement in Rock Hill, South Carolina
- Kaiser Family Foundation: Drilling Down on Dental Coverage and Costs for Medicare Beneficiaries | Last accessed May 2021
- Medicare: Dental Services | Last accessed May 2021
- Kaiser Family Foundation: Medicare Advantage 2021 Spotlight: First Look | Last accessed May 2021
- Cigna: Does Medicare Cover Dental? | Last accessed May 2021