Best National Coverage: Aetna
Not all plans offered in all areas
Not all plans come with dental coverage
We chose Aetna as best for national coverage for its operations in all 50 states plus the District of Columbia and Puerto Rico. Aetna has approximately 12.7 million dental members, and their network includes about 1.2 million health care professionals, with over 700,000 primary care doctors and specialists and over 5,700 hospitals.
With many of their Medicare Advantage plans, Aetna offers home delivery of most prescription drugs through their mail-order pharmacy: CVS Caremark. Aetna also offers a concierge program with many of its Medicare Advantage plans. An Aetna concierge can help you manage your health care expenses, understand your benefits, locate providers near you, and help plan for treatments.
Founded in 1853, Aetna, has a full range of plans with premiums ranging from $0 to over $100 each month, depending on your needs and location.
Does Medicare Cover Dental Services
If youre wondering whether Medicare offers dental coverage, the answer is, It depends. Dental coverage is limited under Original Medicare, and you wont be covered for most routine dental services. However, routine dental coverage may be available as part of a Medicare Advantage plan. Because Medicare Advantage plans are available through Medicare-contracted private insurance companies, benefits may vary by plan.
Find affordable Medicare plans in your area
Heres an overview of how Medicare dental coverage works and the situations where you may be able to get help with dental costs.
See If You Can Enroll In Your Spouse’s Dental Plan
If your spouse is covered by a group plan through his or her employer, you may also qualify for coverage.
While routine dental services are not covered by Medicare, dental coverage is still an important part of protecting your overall health. Thankfully, there are a number of options for finding the coverage you need.
Whether you choose a Medicare Advantage plan, a stand-alone dental plan or one of the discount plans available in your area, please take the time to find a plan that fits your needs and protects your dental health.
This material is provided for informational use only and should not be construed as medical advice or used in place of consulting a licensed medical professional. You should consult your doctor to determine what is right for you.
Humana is the brand name for plans, products and services provided by one or more of the subsidiaries and affiliate companies of Humana Inc. . Plans, products, and services are solely and only provided by one or more Humana Entities specified on the plan, product, or service contract, not Humana Inc. Not all plans, products, and services are available in each state.
Go365® is not an insurance product. Not available with all Humana health plans.
A minimum one-year, initial contract period may be required for some dental plans, excluding Dental Savings Plus.
A minimum one-year, initial contract period may be required for some vision plans.
Life Insurance Plans
Research Finds Cost A Barrier To Dental Care
Unlike the ADA, the National Dental Association is pushing for a universal Medicare dental benefit. The group, which “promotes oral health equity among people of color,” was formed in 1913, in part, because the ADA did not eliminate discriminatory membership rules for its affiliates until 1965. Dr. Nathan Fletcher, chairman of NDA’s board of trustees, says he was unsurprised to find his organization at odds with the ADA over Medicare coverage.
“The face and demographic of the ADA is a white male, 65 years old. Understand that those who make decisions for the ADA are usually the ones who have been in practice for 25 to 30 years, doing well, ready to retire,” Fletcher says. “It looks nothing like the we’re talking about.”
Research from the ADA’s Health Policy Institute found cost as a barrier to dental care “regardless of age, income level, or type of insurance,” but low-income older adults were more likely to report it as a barrier.
Why Some Oppose A Universal Medicare Dental Benefit
“It would be tragic if we didn’t do something for those low-income seniors,” says Michael Graham, senior vice president of government and public affairs for the ADA.
Graham is critical of the design of the proposals in Congress for a universal Medicare dental benefit, noting that one includes a 20% copay for preventive services that could block low-income patients from getting access to the care they would otherwise be gaining.
“Something is better than nothing, but the something almost equals nothing for many seniors,” Graham says.
The ADA backs covering 100% of preventive services for low-income Medicare recipients, he says.
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The Lifecycle Of A Tooth
The ADA-backed Medicare proposal would cover only seniors who earn up to three times the poverty level. That currently translates to $38,640 a year for an individual and would the number of potential recipients from more than 60 million people to roughly half that number.
Medicare has never required means testing, but in a world where Congress is looking to trim the social-spending package from $3.5 trillion over 10 years to $1.85 trillion, the ADA presents its alternative as a way to save money while covering those who need a dental benefit the most. A Congressional Budget Office analysis estimated the plan to provide dental coverage to all Medicare recipients would cost $238 billion across 10 years.
What Dental Care Does Medicare Advantage Cover
Medicare Advantage dental coverage may be as basic as annual cleanings and X-rays, or a plan may cover more comprehensive services like extractions and dentures. Many plans have an annual dollar limit on coverage, so although a plan may cover comprehensive services, if you need significant work done in one year, you may still spend a good amount out of pocket.
A plan may also require prior authorization for more expensive services.
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Medicare Advantage Dental Policies
One exception to the dental exclusions under Original Medicares parts A and B is Medicare Advantage. Commonly referred to as Part C, these types of policies are offered by private insurance companies and are intended to cover all of the same basic expenses participants receive under the Original Medicare plan.
Many Medicare Advantage plans do offer dental coverage, according to Medicare.gov, though the exact benefits provided varies based on the plan chosen.
Additionally, these plans can be:
- PFFS Plans
The type of plan chosen depends on what benefits youd like to receive, the cost of the plan, and any coinsurance or copayments that would apply.
Best For Special Needs: Cigna
Only available in 23 states
Dental coverage only available with some plans
We chose Cigna as best for special needs because of their personalized plan offerings. While other Medicare Advantage Plans limit coverage to individuals with special health conditions or care needs, Cigna offers special needs plans that include access to a wider range of specialists, along with regular health assessment .
Depending on your health care needs, Cigna offers an increased range of services, whether that is more intensive treatments, personalized care treatments, or more individual specialist attention.
Based on a review of Cignas Model of Care, the National Committee for Quality Assurance has approved Cigna to operate as a Special Needs Plan through 2021.
Cigna offers a health risk assessment that can be used to develop personalized care plans with Cigna Medicare Advantage Plan enrollees and their primary care doctor. The HRA also helps match each enrollee with the health and wellness services that best fit their needs.
Originally founded in 1792 as the Insurance Company of North America, Cigna is now an American worldwide health services organization. They have a full range of plans with premiums ranging from $0 to over $100 each month, depending on your needs and location.
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Dental Benefits Through A Clover Health Medicare Advantage Plan
Clover Health Medicare Advantage plans include all the benefits of Original Medicare , but we dont stop there. Clover Health plans include other benefits and services like prescription drug coverage, vision, hearing, wellness, over-the-counter items, and dentalall with a zero or low monthly premium. Unlike Original Medicare, Clover Health plans have low copays and an out-of-pocket maximum, so your costs are predictable.
Many of our plans include coverage for both preventive and comprehensive dental care. With these Clover Health plans, you get:
2 oral exams per year with $0 copay
2 cleanings per year with $0 copay
1 set of dental X-rays per year with $0 copay
Benefits may vary based on your service area, so enter your zip code on our plans page to see the Clover Health plans and benefits available in your area.
Medicare Advantage Plans With Dental Care Benefits
Another option for Medicare beneficiaries is to enroll in a Medicare Advantage plan that offers routine dental care coverage.
A Medicare Advantage plan provides all the same coverage as Original Medicare .
In addition to covering the same benefits as Original Medicare, some Medicare Advantage plans may offer additional benefits such as:
- Prescription drug coverage
The dental coverage afforded by some Medicare Advantage plans can provide patients with benefits such as access to networks of qualified dentists while offering price protection in the form of deductibles, cost-sharing measures and out-of-pocket spending limits.
Plus, many Medicare Advantage plans also offer coverage for prescription drugs, so some of the medications needed for oral care may be covered under the plan as well.
In 2018, the average premium paid for a Medicare Advantage plan was around $35 per month, or roughly $420 per year.4 When you consider the annual costs of receiving dental care without insurance, you may find that a Medicare Advantage plan with dental benefits could fit your situation and health care needs.
Find a Medicare Advantage plan with dental coverage
Or call 1-800-557-6059TTY Users: 711 24/7 to speak with a licensed insurance agent.
Is Dental Insurance Via Medicare Advantage Worth The Money
Depending on the plan, yes. If you dont foresee yourself needing much in the way of dental care except maybe the occasional cleaning or X-ray, then a simple plan that covers preventative dental care may be right for you. If you know youll have certain dental needs , its worth shopping for different Medicare Advantage plans and exploring exactly what each plan covers because all Medicare Advantage plans that offer comprehensive dental care do not cover every single aspect of dental care. Some plans do, though, and its worth looking into the comparative costs of these plans, especially in the case of surgery and similar big-ticket expenses. However, most of these plans have a yearly maximum coverage amount, so if you know you have some big dental bills ahead of you, it might be worth it to look for a plan thats built specifically for dental care. Prices may be more affordable for more detailed care.
Why Dental Health Is Important For Seniors
Dental health is connected to whole-body health and should not be forgotten as we get older. Taking care of your teeth and gums is just as important as caring for your digestive and heart health.
Research has shown that poor dental health, especially if you have gum disease, may increase your risk of serious health problems, such as heart attack, stroke, and poorly controlled diabetes. Poor oral health can also affect a seniors ability to chew and eat certain foods, causing poor dietary intake and weight loss. Discomfort from poor oral health can also disrupt sleep and the ability to relax. This is why its important to take care of your teeth and see a dentist twice a year.
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Coverage Of Routine Dental Care Wasnt Built Into Medicare
Medicare was never designed to include routine dental care Medicares coverage of dental expenses is limited to situations where the dental treatment is integral to other medical treatment . Although, as noted in this brief from the Center for Medicare Advocacy, CMS has some flexibility when it comes to how the rules are interpreted.
While health insurance plans generally pick up the tab for large medical bills, its rare to find dental coverage that doesnt leave enrollees on the hook for significant bills if they need extensive dental work. This is generally true across a wide range of plan types, including Medicare Advantage dental coverage, stand-alone dental plans, and group dental plans for employees and retirees. Dental plans commonly have benefit maximums of $1,000 or $2,000 per year, and a single root canal can cost upwards of $1,500, while an implant can be as much as $7,500 per tooth.
But some coverage is better than nothing. Even with low benefit maximums, people who have dental insurance are more likely to receive routine preventive dental care, and are less likely to have untreated dental problems that get worse over time.
What Can People Aged 65 And Over Do About Dental Coverage
If a person wishes to have Medicare-associated dental cover, they should select a Medicare Advantage plan that offers these benefits.
To enroll in Medicare Advantage, a person must first enroll in Medicare during their Initial Enrollment Period, which starts 3 months before their 65th birthday, includes their birth month, and extends to 3 months after their birthday.
If a person misses this enrollment period, they can enroll in Medicare during the General Enrollment Period, which starts in January and finishes at the end of March.
After this time, a person can sign up for a Medicare Advantage plan from April through June. They must be enrolled in Medicare parts A and B in order to select a Medicare Advantage plan. They will likely have to pay a copayment or deductible to cover some dental costs.
If a person does not want a Medicare Advantage plan, or if there are no suitable plans available in their area, they can choose to purchase a separate dental insurance policy.
Private health insurance companies offer plans that include dental cover. Before purchasing one, a person may wish to research the different plans available to them and select one that best suits their needs.
Other options for dental care include:
Community organizations, such as the United Way, may also help a person find free or low cost dental services.
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Which Parts Of Medicare Cover Dental Care
|No, except for extremely limited situations when dental services require hospitalization|
Medicare Part B
|Yes, included in 94% of plans, but sometimes there’s an extra fee for dental coverage|
Medicare Part D
|Medicaid||Yes, if you are eligible for dual enrollment in Medicare and Medicaid, you could have access to dental care. Coverage varies by state.|
Medicare Dental Coverage Under Medicare Advantage
If youd like to get more comprehensive dental coverage under Medicare, you might want to consider a Medicare Advantage plan, available under the Medicare Part C program. Offered through Medicare-contracted private insurance companies, these plans are required to offer at least the same coverage as Original Medicare in other words, a Medicare Advantage plan would cover dental care under the same situations as Original Medicare. In addition, many Medicare Advantage plans offer additional benefits such as routine dental or vision care, wellness programs, and prescription drug coverage.
While Medicare dental benefits may vary by plan, some of the services you may be covered under a Medicare Advantage plan may include routine dental exams, cleanings, X-rays, fillings, crowns, root canals, and more. Some Medicare Advantage plans may require you to use dentists in provider networks when receiving care, or you may have the option to use non-network dentists but at a higher cost-sharing level you can check with the specific plan youre considering for more details.
Keep in mind that there may be certain costs related to your dental coverage, including deductibles, copayments, and or/coinsurance. In addition, youll need to keep paying your Part B premium if you enroll in a Medicare Advantage plan, along with any monthly premium required for your plan.
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Medicare Advantage Plans & Dental Coverage
At Clover Health, we know how important dental care is to our members overall health. So we want to let you know which types of Medicare plans include preventive and comprehensive dental coverage. This page gives you an overview of the dental coverage offered with different types of Medicare plans and how Clover Health can expand your coverage to provide this essential benefit.
Original Medicare And Dental Coverage
Original Medicare does not provide coverage for most dental care. Part A will cover certain dental services that are administered in a hospital and may provide some coverage for emergency dental care or complicated dental procedures.
Routine care like cleanings, extractions and fillings, however, are not covered.
For example, Medicare may cover the cost of an oral examination that is necessary to prepare a patient for a kidney transplant. But a routine dental examination, checkup or cleaning would not be covered.
Without much help from Original Medicare, Medicare beneficiaries are essentially left with three options for paying for their dental care:
- Paying out of pocket
- Buying a dental insurance plan
- Buying a Medicare Advantage that offers dental care benefits
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Compare Dental Private Health Insurance
Extras cover can be a great way to cover your dental expenses and can help you skip the Medicare queue if you’re in a little pain.
We’ve rounded up a few of the basic level dental policies from Finder partners. They all have a general dental limit which includes annual check-ups, minor extractions, dental X-rays, minor fillings and teeth cleaning. All these options have a 2-month waiting period.
Where can I access public dental services in NT?
You can find a list of dental clinics here.