More and more people are beginning to understand the impact of our oral health on the overall health of our bodies. Having poor oral health can impact our hearts and minds and even cause us to have an increased risk for certain cancers.
With all these facts, it’s surprising that Original Medicare does not offer any coverage for dental treatment. How can Medicare beneficiaries get dental insurance in Arizona? We’ve got two options to choose from.
Many Medicare Advantage plans include extra benefits not found in Original Medicare - like dental coverage. Each plan is different, so you’ll need to understand the dental network and how your coverage works.
Medicare Advantage plans have provider networks their members need to use. The two most common networks are PPOs (Preferred Provider Organizations) and HMOs (Health Maintenance Organizations). PPO plans allow you to receive care outside the network and still have some coverage, though you’ll pay more to use it. HMO plans do not cover any services received from non-HMO providers.
Some HMO plans now include a POS (Point of Service) option, which allows certain services to be covered outside of the HMO network. Most often, this is directed at the dental portion of the plan.
Once you figure out what kind of network the plan has, you should also learn how your dental coverage works. Each plan will have an annual maximum, which is the most the plan will pay for benefits. Any costs above that maximum are the beneficiary’s responsibility.
Some plans cover 100% of costs up to the maximum, while others have cost-sharing amounts. For example, you may have 100% coverage on preventive services like cleanings but pay 50% of the cost for a dental crown. If you go outside the plan’s network, your portion could be higher.
Next, look at what types of dental treatment are covered by the plan. Some plans are starting to include coverage for dental implants, while others only offer limited benefits. Most do not pay for whitening or any other esthetic services.
Lastly, many plans are now included flex cards in their benefits. These flex cards are typically used for dental, vision, or hearing services. If your plan contains a flex card, be sure to know how much of the card’s amount can be used for dental treatment.
As we mentioned, Original Medicare (Parts A and B) does not include any dental benefits. There are two very rare instances when dental treatment is covered, but it involves jaw reconstruction and radiation treatment. Since Original Medicare does not offer dental benefits, neither does a Medicare Supplement (Medigap) plan.
If you’ve decided not to enroll in Medicare Advantage, you can choose to enroll in a stand-alone dental insurance plan. (You can even add one to your Medicare Advantage plan if you’d like secondary coverage.)
Stand-alone dental plans work just like they would if they were part of a Medicare Advantage plan. You’ll have provider networks, maximum benefits, and cost-sharing amounts. You should consider enrolling in a plan that also includes vision and hearing benefits since those are also not covered by Original Medicare. Insurance carriers often offer Dental/Vision/Hearing plans that are an all-in-one solution to this problem.
Not sure if you have dental insurance? Talk to an agent at Local Medicare Specialists. We can help you understand your current coverage and help you look for a dental insurance plan that would fit your needs.
Schedule a FREE Medicare consultation with an agent in your neighborhood.