By Kev Coleman Insurance
Industry Expert & Author
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,
contrast, covers routine medical services such as doctor and specialist visits and other outpatient
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
rule, with respect to Medicare and dental care. Care such as teeth cleanings, x-rays, fillings, and
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
benefit for routine dental care.
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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
normally much less than their private health insurance counterparts. Plans differ in their covered
and do not have a common benefit design. Private dental insurance plans can be compared on exchange
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
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
guidance of an experienced and licensed dentist. Seniors wishing to use such services must wait for
hours and all dental services might not be provided. Additionally, many seniors live in regions that do
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
discounts. Dental discount cards do not have a maximum savings amount, after which discounts
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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
to this question because the answer depends on a senior’s circumstances. The most important of these
What dental services are covered by the Medicare Advantage plan and what dental services are
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.
We can help you find the plan that best suits YOUR needs.
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.
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Our knowledgeable customer service team will assist you with any questions you may have
prior to enrolling in a dental plan. They can guide you through the process of choosing
coverage that matches your needs as well as your budget.