Seniors & Dental Insurance Coverage
Plan Options to Fill Original Medicare’s Gap in Coverage
For many Americans aging into the Medicare system, they are surprised to learn that Original Medicare (Parts A and B) does not cover dental care. Part A covers hospitalization and related services, Part B, in contrast, covers routine medical services such as doctor and specialist visits and other outpatient care. Dental care, unfortunately, does not fall in either category. This means that an enrollee in Original Medicare is responsible for 100 percent of dental expenses without help from Medicare.
However, there are some cases of inpatient care, such as emergencies, where Medicare Part A will pay for certain types of dental care. It is important to remember that this is the exception, rather than the rule, with respect to Medicare and dental care. Care such as teeth cleanings, x-rays, fillings, and dentures are not covered.
Medicare Supplement plans, also known as Medigap, address out-of-pocket costs associated with Medicare and, in some cases, extend benefits. Nevertheless, standard Medigap plans do not supply dental benefits just as they do not supply prescription drug coverage.
For beneficiaries under the age of 21, Medicaid often provides dental coverage. However, for seniors who are simultaneously enrolled in Medicare and Medicaid (known as “dual eligibles”), Medicaid provides no benefit for routine dental care.
Dental Options Available to Seniors
Even though both Original Medicare and traditional Medigap lack dental benefits, there are still other options available for seniors. These options include:
- Private dental insurance
- Dental benefits included in Medicare Advantage
- Reduced cost, or free, dental care from dental schools
- Dental discount plan
So what’s the best dental insurance for seniors? The answer lies in understanding your options.
Private dental insurance is a simple way to obtain dental coverage. These plans charge a monthly premium in exchange for sharing the costs of covered dental services. The monthly cost of these plans are normally much less than their private health insurance counterparts. Plans differ in their covered services and do not have a common benefit design. Private dental insurance plans can be compared on exchange websites such as DentalInsurance.com. These plans differ based on:
- The dental services they cover
- The dentists who accept the insurance coverage
- The maximum dental costs the insurance will pay within a year
- The out-of-pocket costs charged for different dental services
For more information on private dental insurance, see our guide Dental Insurance 101.
Most Medicare Advantage plans do offer some level of dental coverage as an extra benefit beyond Original Medicare. These dental benefits are not standardized and some can be quite modest (see the following section, “Do I Still Need Dental Insurance if I have Medicare Advantage?”).
There are dental schools that offer dental services to the public for reduced costs or, in some cases, for free. Dental care received at a dental school would normally be performed by a student under the guidance of an experienced and licensed dentist. Seniors wishing to use such services must wait for clinic hours and all dental services might not be provided. Additionally, many seniors live in regions that do not have a nearby dental school.
Dental discount plans are not dental insurance. They are products where a consumer pays an annual fee for the discount card and, in exchange, there is some level of discount off of retail price for services provided by participating dentists. Care received by nonparticipating dentists is paid at full price with no discounts. Dental discount cards do not have a maximum savings amount, after which discounts discontinue.
Do I Still Need Dental Insurance if I have Medicare Advantage?
Medicare Advantage is an insurance product that delivers the benefits of Original Medicare through a healthcare provider network. Given the way the government reimburses Medicare Advantage insurers, these plans often offer additional benefits that are not part of Original Medicare. With respect to dental benefits, 92 percent of 2021 Medicare Advantage plans offer some form of dental benefits according to a Kaiser Family Foundation study.
If you are enrolled in a Medicare Advantage plan, you may be wondering if you still need a dental plan in addition to the Medicare Advantage dental benefits you already have. There is no standard response to this question because the answer depends on a senior’s circumstances. The most important of these circumstances are:
- What dental services are covered by the Medicare Advantage plan and what dental services are uncovered?
- What are the dental services most likely to be used in the coming year?
- What dentists are in-network for the Medicare Advantage plan?
The answers to these questions aid a senior in deciding whether or not their existing Medicare Advantage dental benefits are adequate.
Why Dental Care Is So Important to Seniors
As people age, they are more likely to develop medical conditions requiring ongoing medication. These medications can sometimes come with side effects including “dry mouth.” Dry mouth is a particular worry with respect to dental health since saliva helps protect teeth against cavities. When the mouth is dry, this protection is gone. Aside from regular dental check-ups, a senior suffering from dry mouth can keep a humidifier running while they sleep and drink more water during the day.
Ideally, proper dental care helps to prevent the prospect of tooth loss. When seniors lose teeth, eating can become more difficult. As a consequence of problems with eating, nutritional problems may develop. Proper dental care can also spot problems early. For example, among seniors who smoke, regular dental visits can spot signs of an emergent oral cancer.