It’s easy to forget that dental health is important for whole-body health. Did you know that poor oral hygiene is linked to pneumonia? Gum disease is a contributing factor to diabetes and puts you at higher risk for heart attack, stroke, and coronary artery disease.
The evidence is pretty clear that daily brushing and flossing, along with regular dental care, is a major factor in protecting your health. Given all its benefits, it’s logical to conclude that Medicare would cover routine dental care—but the fact is, it generally doesn’t.
If you’re nearing Medicare enrollment, here’s what you need to know about Medicare and dental care.
Does Medicare cover routine dental exams?
If you have Original Medicare (Part A and Part B), you’re on your own for routine annual x-rays, cleanings, and dental exams. There are one or two exceptions, however. If you’re a candidate for organ transplant or have certain heart conditions, your doctor may order a dental exam prior to surgery. In those cases, Part B would cover 80% of allowable charges.
Even if you combine Original Medicare with a Medigap plan, you still won’t have coverage for routine dental care. Medigap only pays your out-of-pocket costs for covered expenses under Part A and Part B; since routine dental isn’t covered by Medicare, your Medigap plan won’t pay.
If you choose a Medicare Advantage plan, you may have coverage for routine dental visits. Depending on your plan, you may need to see a network provider, or your plan may pay a set amount per year for you to use on the dental provider of your choice.
Does Medicare cover any dental services?
While Original Medicare doesn’t cover routine dental services—or restorative services such as fillings, crowns, or implants—it does cover medically necessary dental services related to an illness or injury.
If you have oral cancer and need care from an oral surgeon to treat your cancer, Part B pays 80% of allowable charges. If you fall and injure your jaw, Part B would cover medically necessary dental services to treat your injuries and help you recover.
Medicare Advantage plans also cover all medically necessary dental services; when you choose Medicare Advantage, you don’t lose any benefits under Original Medicare. Many Medicare Advantage plans also include benefits for restorative care such as fillings, crowns, and even dentures.
How can I get dental coverage if I’m on Medicare?
If you’re one of the 60% of Texas retirees who choose Original Medicare, you’ll need a separate dental plan if you want routine dental coverage. Depending on where you live, you may be able to buy a stand-alone dental-only plan or a plan that covers both dental and vision care.
You can also look into dental discount cards. These discount plans aren’t actually insurance plans—you pay an annual fee to have access to a network of dental providers who discount their usual fees for cardholders.
If routine dental coverage is important to you (and it should be), your best bet may be a Medicare Advantage plan. Medicare Advantage plans are private plans offered by major insurers in Texas such as Aetna, UnitedHealthcare, and Cigna.
When you join a Medicare Advantage plan, a portion of your Medicare premiums goes to the insurance company to cover your health care. These companies compete for your Medicare dollars by adding extra benefits such as routine dental and vision coverage. Medicare Advantage plans are all-in-one plans, which means one plan covers your inpatient and outpatient care as well as your prescription drugs. In other words, if you see the dentist with a toothache and he prescribes an antibiotic and refers you to an ENT doctor for a possible infection, your Medicare Advantage plan covers it all—dentist, specialist, and medication.
If you’re not sure which Medicare path is right for you, or you need help finding dental insurance to supplement Original Medicare, talk to a Texas Medicare insurance broker. They’ll explain your options, help you compare prices, and find the right coverage for your health and financial situation.