Medicare and Dental Coverage for Seniors
Does a Medicare supplement plan include dental care? It does not. While Original Medicare Part A and Part B do shoulder some dental procedures that are necessary when you are in the hospital as an in-patient, it does not cover any procedure or consultation outside of a hospital stay. Seniors who would like to expand their insurance coverage to include dental care will have to purchase private dental insurance.
The types of procedures that Medicare will cover when you are in the hospital are those that are necessary to protect your overall health, or are prerequisites to another procedure that Medicare actually shoulders. Here are some instances where Medicare does provide dental coverage.
When Medicare DOES Cover Dental
There are specific instances when you will need to undergo a dental procedure so the doctors can proceed to another treatment that is covered by Medicare. For example, it may shoulder:
– Dental services necessary for certain jaw-related ailments prior to radiation treatment, such as oral cancer
– Oral exams prior to a kidney transplant
– Surgical procedures to rectify fractures on the face or the jaw
– Oral exams in a Federally Qualified Health Center or rural clinic before a heart valve replacement surgery
– Dental wirings and splints necessary post jaw surgery
– Surgeries that involve ridge reconstruction during a facial tumor removal procedure
– Dental-related hospitalizations where you require observation due to a health-threatening situation
In the case of hospitalizations that are dental-related, Medicare may cover the likes of x-rays, anesthesia, and even room and board, depending on the condition. However, it will not shoulder the expenses related to dentist fees and the charges for other attending physicians, such as anesthesiologists and radiologists.
Options for Senior Citizens to Acquire Dental Coverage
If you need a dental care plan in your senior years, you will need to be prepared to have it as an out-of-pocket expense because it will not be covered by Medicare. While there are specific inclusions, mostly related to hospitalization, it’s better to count it as an additional coverage that you must pay for.
So how can a senior citizen obtain a dental plan? There are several options.
- Enrol in a Medicare Advantage (Part C) plan
Medicare Advantage plans are another way to access Medicare benefits and may include dental care. While Medicare is administered by the U.S. government, Medicare Advantage is offered via private insurance agencies that are working under the rules set by the CMS (Centers for Medicare and Medicaid Services). Medicare Advantage are required to offer the minimum benefits under Original Medicare Part A and Part B, they have greater leeway when it comes to what more they can offer because they are private agencies. Typically, the extra benefits included are vision and dental care, as well as hearing care.
Generally, Medicare Advantage plans that offer dental benefits will cover preventive and diagnostic procedures such as x-rays, cleanings, and annual exams. Many Medicare Advantage providers can also include fillings, extractions, root canals, crowns, dentures, bridges, and treatment of gum diseases. Take note, however, that these plans might require to seek dental care only from a pre-selected list of dental clinics. You can also expect to pay a certain set amount for these services regardless of how much they really cost, while some might put a cap on the dental benefits that you can avail in a year.
- Check if your spouse has an existing dental plan and if you can enroll in it
If your spouse is currently employed and is enjoying a group plan that includes dental coverage, you might also qualify for this coverage. Ask your partner to inquire with his company on extended coverage for family members.
- Join a club that offers discounts on routine dental procedures
There are organizations where you pay a fee to become a member and then be entitled to a range of services on discount. Look for those clubs that offer special rates for dental procedures or are partnered with clinics that offer cheaper rates, in addition to other healthcare and lifestyle perks.
- Sign up for a stand-alone dental insurance policy
Most private insurance agencies offer dental coverage as an independent plan and you can certainly subscribe to a dental only policy. You will be asked to pay a monthly or quarterly premium, but the cost will generally be offset by lower out-of-pocket expenses. Many of the dental plans will require that you work only within a pre-listed network of clinics and healthcare professionals—and this list will vary depending on the private insurer you sign up with. Some plans will allow you to go outside of their network, although be prepared to pay a little more for their consultation fees and services.
What We Offer
At SecureCare65, we offer four types of dental care plans with features that range from routine checkups to the more advanced orthodontic care procedures. The maximum benefit of each also varies depending on the type of plan you sign up for and every package will have varying degrees of coverage for Preventive, Basic, Major, and Orthodontia procedures.
Plans
(For Year 1 only*) |
Preventive |
Basic |
Major |
Orthodontia |
Spirit Choice 3500 |
100% |
65% |
25% |
10% |
Spirit Choice 1200/2500/5000 |
100% |
50% |
10% |
10% |
Spirit Choice 1200 |
100% |
50% |
25% |
10% |
Spirit Choice 750/1000/1250 |
100% |
50% |
10% |
none |
*The percentage of coverage increases as your subscription extends from year 1 to year 2 and to year 3.
For Spirit Choice 1200/2500/5000 and Spirit Choice 750/1000/1250, here is the distribution of benefits.
Spirit Choice 1200/2500/5000 |
Preventive |
Basic |
Major |
Orthodontia |
Year 1 (max. benefit $1,200) |
100% |
50% |
10% |
10% |
Year 2 (max. benefit $2,500) |
100% |
60% |
30% |
25% |
Year 3 (max. benefit $5,000) |
100% |
80% |
50% |
50% |
Spirit Choice 750/1000/1250 |
Preventive |
Basic |
Major |
Orthodontia |
Year 1 (max. benefit $750) |
100% |
50% |
10% |
n/a |
Year 2 (max. benefit $1,000) |
100% |
60% |
30% |
n/a |
Year 3 (max. benefit $1,250) |
100% |
80% |
50% |
n/a |
Preventive: 3 cleanings and 2 exams per calendar year
Basic: Sealants for 16 years old and below, 1 topical fluoride annually for 16 years old and below, basic fillings, 1 series of bitewing x-rays annually, and space maintainers
Major: Includes implants, simple extractions, oral surgery and restoration services, endodontic and periodontics’ treatments, 1 diagnostic x-ray in panoramic or full in any 3-year period, and prosthetic services such as dentures and bridges
Orthodontia: orthodontic care of proper teeth alignment for dependents under the age of 19 years; has a $1,200 lifetime maximum per child
Note: These rates are guaranteed for your first 12 months and may change in the succeeding years.
Some Reminders About Senior Dental Care
Dental coverage acquired as a stand-alone policy gives you the freedom to avail of any service you want at a price that it lower than the usual market rates. While you are paying a premium for these services, you will find that the healthcare providers included in the private company’s network will be more affordable, if not free. Should you want to obtain services of a dentists who is not part of the network, you will have to be ready to pay larger out-of-pocket fees.
To further illustrate the difference, let’s say you are having a crown installed. This is considered a Major procedure. Here is a sample of your possible fees.
Network |
Usual Dentist’s Fee |
Reduced Network Fee |
Your Plan’s 50% coverage |
Your out-of-pocket expense |
Within the network |
$985 |
$685 |
$342.50 |
$342.50 |
Outside the network |
$985 |
$750 |
$375 |
$610 |
Before deciding on any dental care policy, talk to your preferred insurance agency about their inclusions and exclusions. For example, you might think that you can get veneers for aesthetic purposes and be able to get it for free because you have a dental plan, and then find out later that your policy does not cover it.
Be upfront with your queries and plans when it comes your oral healthcare, whether it’s for practical healthcare or aesthetic reasons. Better yet, talk to our team of healthcare plan experts so we can help you find the best and most cost effective policy that matches your and your family’s needs and budget.
Let us help you get an accurate quote before enrolling in any dental insurance plan by visiting us at https://securecare65.com/. You can also give us a call at 1-800-354-1078 so our customer service team can assist you immediately and answer any questions you might have
