Medicare is a vital healthcare program for millions of seniors in the United States, providing essential medical coverage for those aged 65 and older, and also those younger on disability. However, there is a significant gap in this program - dental care. Dental benefits are not generally covered by Medicare, except under limited circumstances, and many Medicare beneficiaries do not have any dental coverage at all. This gap in coverage has spurred policy discussions and proposals aimed at making dental care more affordable and accessible for those on Medicare
Understanding how the coverage for dental services varies significantly between both Original Medicare and Medicare Advantage plans is crucial for making informed decisions about your oral health.
Dental health is a critical aspect of overall well-being. However, as of 2019, nearly half of all Medicare beneficiaries (47%), totaling approximately 24 million individuals, lack dental coverage and did not have a dental visit within the past year. This rate is even higher among Black (68%) and Hispanic (61%) beneficiaries, low-income individuals (73%), and those in fair or poor health (63%).
Through Medicare Advantage plans, 29% of beneficiaries had access to some dental coverage. Another 16% had coverage through private stand alone plans. About 11% of Medicare beneficiaries had access to dental coverage through Medicaid (including the aforementioned who also have coverage through Medicare Advantage plans).
What Original Medicare Does/Doesn’t Cover
Original Medicare, consisting of Part A (hospital insurance) and Part B (medical services), does not cover most routine dental care, like checkups and cleanings, or comprehensive work, such as fillings and dentures.
There are exceptions. Medicare Part A may pay for certain dental services when they are closely related to other covered medical services. For example, it may include services like surgery to treat jaw fractures, limited dental services before radiation treatment of oral cancer, or an oral exam in a hospital before a kidney transplant.
This lack of coverage has led many Medicare beneficiaries to seek alternative solutions for their dental health.
Alternative Options for Dental Coverage
Some standalone dental insurance policies are available. These plans offer coverage for various dental services, from routine checkups to more extensive procedures like extractions, root canals, dentures, and oral surgery. Premiums for standalone dental policies may vary based on your location and the specific coverage you choose. There may also be wait times between when you start making premium payments and when you are allowed to schedule comprehensive work to be completed.
Exploring Dental Coverage with Medicare Advantage Plans
One of the ways to secure dental coverage as a Medicare beneficiary is by opting for a Medicare Advantage plan (Medicare Part C) that includes preventive and comprehensive care. In 2021, 94% of Medicare Advantage enrollees in individual plans had access to some dental coverage, including preventive dental exams, teeth cleanings, X-rays, dental fillings, anesthesia, and even dentures.
The Future of Dental Coverage in Medicare
While Original Medicare doesn't currently cover routine dental care comprehensively, there are proposed changes on the horizon. Lawmakers are considering adding dental coverage to Medicare, a development that would greatly benefit the millions of Medicare beneficiaries.
The Medicare and Medicaid Dental, Vision and Hearing Benefit Act (S. 1423) was introduced in 2021 and reintroduced in 2023 to attempt to strengthen Medicare by providing coverage for vision, dental, and hearing services and care under Medicare. The legislation would expand Part B benefits to include coverage of oral, vision, and hearing care, while providing for reasonable measures to facilitate implementation and contain costs.
The ongoing debate highlights the importance of improving dental coverage for Medicare beneficiaries, addressing health disparities, and managing the potential costs associated with adding dental benefits to the Medicare program. Balancing the interests of lawmakers, the dental industry, and the wellbeing of older adults just north of 65 remains a complex challenge in the ever-evolving landscape of healthcare policy.
As you navigate your Medicare path, remember that maintaining good dental health is crucial for your overall well-being. Explore your dental coverage options, weigh the costs, and choose a plan that best aligns with your oral health needs.
Embark on the journey to better dental health, and make informed decisions about your Medicare coverage. Your smile is worth it!
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