Dental Care and Your Medicare Options

Shifting from employer-sponsored health insurance to Medicare involves planning. While you can only enroll in Original Medicare without incurring a financial penalty three months before (or after) your 65th birthday, Original Medicare does not cover dentistry. Meanwhile, some Medicare Advantage plans include dental care as a benefit, but limit your dental and medical care to “in-network” providers.

If you do not have dental coverage and unexpectedly need a crown or implant, paying the entire dental care bill “out-of-pocket” can drain your savings. The National Institute of Dental and Craniofacial Research (NIDCR) notes that adults aged 65 and older have 43 decayed or missing tooth surfaces on average (and around 18 percent have untreated tooth decay).

Although your employer may require you to switch to Medicare (with their group insurance plan as the secondary payer after Medicare), considering your dental care needs is an important aspect of your overall Medicare decision-making process.

Do You Need Dental Insurance?

Fillings as a result of cavities in adolescence often require replacement in later life. Untreated decay can lead to the need for a root canal or gum surgery, so preventive dental care is necessary if you have a history of cavities or periodontal disease. Nineteen percent of all Medicare beneficiaries spent more than $1,000 in “out-of-pocket” for dental expenses in 2016 (per a Kaiser Family Foundation report).

Therefore, anticipating your probable dental care needs can enable you to determine whether the cost of dental insurance is less (or more) than the cost of your likely dentist visits. In particular, the Centers for Medicare Services (CMS) lists the following as non-covered services under Original Medicare:

• Tooth cleanings (e.g., dental hygienist visits);
• Tooth fillings;
• Dentures

You may be able to purchase group dental insurance at a lower cost than an individual dental plan. However, it is crucial to check whether the chosen dental insurance limits you to “in-network” providers, so that you can ascertain whether your dentist is included in their provider list.

Since most dental insurance plans limit dental hygienist visits to twice each year, you may still need to pay for additional tooth-cleanings despite coverage under a dental insurance plan.

Why Plaque Build-Up is Harmful to Teeth and Gums

Some people have a genetic disposition toward plaque build-up under the gum-line. This can cause periodontal disease (leading to gum recession), and result in experiencing loose teeth.

In turn, loose teeth are more likely to fall out upon biting into an apple or other hard food item. For people who skip flossing or have a tendency toward plaque build-up, visiting the dentist’s office for tooth-cleanings at three-month intervals may be necessary to reduce the likelihood of worsening periodontal disease and/or loss of teeth.

Differences in Dental Insurance Coverage within Medicare Advantage Plans

The annual dental care expenditure “cap” can differ between Medicare Advantage plans that include a dental care benefit. Likewise, the percentage of the cost that a beneficiary has to pay for a specific dental service (e.g., bonding of a tooth) can vary between Medicare Advantage plans.

Furthermore, the dental coverage “cap” and cost-sharing percentage can change every year. For these reasons, it is advisable for anyone covered by a Medicare Advantage plan to review its coverage terms prior to each Medicare open enrollment period. The agents at UrHealth Benefits recognize that coping with the costs of dental care can be frustrating as a Medicare enrollee, and our aim is to aid you in choosing the options that will best meet your needs.

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