A blog about Medicare. What you and your employees need to know
Sinking Our Teeth Into Dental Plan Options
Author: Lora Drummond
Medicare Transition Specialist
When employees transition to Medicare from an employer plan, one of the conversations that commonly comes up is whether or not Medicare provides the coverage for dental that they previously enjoyed while on the group plan. Dental and vision care are important to maintaining a complete wellness plan and here are some solutions to replacing those benefits with Medicare.
Original Medicare Parts A and B and Medicare Supplements do not cover routine dental. Emergencies resulting from trauma to face, jaw, or teeth are sometimes covered under Original Medicare depending on the extent of the injury. Certain medical conditions and eye surgery for glaucoma and cataracts may be covered but routine eye exams unless you are deemed high risk, are not covered. Do not worry though, you do have ways to fill this gap! The rest of this article will cover potential solutions for your dental and vision needs while on Medicare.
We are going to cover every way we can imagine for you to obtain dental coverage on your own outside of Original Medicare.
Stand Alone Insurance Carriers
The first and simplest option would be to just get a stand-alone dental plan through a third party… However, we must warn and advise you to do your research first. In our experience, most folks will pay more in premiums than they will receive in care over the course of their policy term, as well as waiting periods before the plan will even pay for anything! Regardless of what we say, we know you need to see for yourself what a stand-alone dental plan would cost you. That is why we developed www.123EasyDental.com. This site provides the opportunity to shop the dental exchange, or simply shop with a company well known across the country (Delta Dental). You will be able to find premiums, deductibles, as well as coverage limits all within a few clicks.
Again, be advised that we do not currently recommend any dental coverage from the dental exchange, or even delta dental, simply because the math does not make sense.
Don’t fret though, there are more options!
Dental Discount Plans
Here is one that we recommend to thousands of clients each and every year… Ask your dentist about a cash plan! Usually, dentists have some sort of program established for cash-paying patients that covers annual x-rays, and routine visits for a discounted price, often much cheaper than even dental insurance premiums from the exchange. In many cases there are even dentists that will offer significant discounts on more extensive dental work as well, you just have to ask as every dental practice is different.
Dental Pricing Membership Clubs
Yes, this is actually ‘a thing’ and similar in concept to other clubs you join. Well, we did say we’d give you all the options we could think of… Dental pricing/membership clubs were created to provide discounted fees on care. Instead of a monthly premium for dental insurance, you pay a membership fee to join the club and that membership entitles you to discounted services from participating dentists. You pay the dentist directly, there is no claim routed to insurance. Members pay only for the services they receive, rather than monthly premiums for services they never use. The coverage is limited to a network of dentists but some clubs are large enough that they are nationwide. We have not referred clients to this utilize this care option, but it is care that is available to you if a club concept interests you.
Don’t forget! You still have your HSA that you can apply to your dental expenses. While you cannot contribute any new funds to your HSA after you turn on any part of Medicare, the money in that account is still yours to use!
Affordable Walk-in Dental Clinics or Dental Schools
If you are just looking for dental care on an as-needed basis, you might consider using a low-cost fee-for-service clinic in your area to avoid monthly premium payments. Web searches for free dental care bring up a host of free and sliding-scale clinics specific to your area. Also, there are coupons through various online sites for free dental cleaning and exams.
Dental schools are another great option for routine services, preventive care, and other dental services performed by dental students for free or lower costs. All treatment is supervised by licensed dentists.
But wait! There’s more…
Medicare Advantage Plans
Lastly, this is a new option that has been emerging over the past two years or so…
Folks with a Medicare Advantage plan, may-in-fact have dental benefits built-in. If you have one of these plans, or even if you don’t, I am sure you have all seen the commercials boasting free dental, so they are pretty hard to ignore.
First things first, you need to know if you have a Medicare Advantage plan or not. The easiest way to tell is to ask yourself the following:
–When you go to the doctor’s office, what card do you give them?
Your Medicare card, or your Insurance Card with an insurance company’s name on it?
- If you answered “Your Medicare Card…” you very likely have a Medicare supplement and will need to refer to the previous sections for solutions to cover your dental expenses.
- If you answered “Your Insurance Card…” then you likely do have a Medicare Advantage plan, also known as an all-in-one plan.
So, for folks with a Medicare Advantage plan this section is for you.
How to find out if your plan has Dental
Since Medicare does not require these benefits, not all Medicare Advantage plans offer extras like Dental coverage. So how would you know if you do have a dental benefit on your plan?
The quickest way would be to take a look at your Summary of Benefits (the book you get when you leave our office for the plan you enrolled in, or in the pile of papers that came from the insurance company with your card). If you are a client of ours, you can give our office a call and we can look up your policy.
Different Types of Coverage
Since this is not a standardized benefit, what is included and what is not varies widely across the thousands of Medicare Advantage plans offered across the county.
Some offer dental benefits with only a very select few providers, with many restrictions, including but not limited to, waiting periods, max-coverage-amounts, etc.
Other plans offer more simplistic coverage in the form of a discount program. With this model, you receive a book of dental codes that you refer to under a network of participating providers to see what portion of the procedures cost you would be responsible for. Others still make it even easier. Some plans have dental benefits in the form of a simple reimbursement program… you go to whatever dentist you want, simply submit your receipt to the Medicare Advantage Company, and you get a reimbursement up to a certain amount for the calendar year.
It is extremely important to be sure you understand how your built-in dental benefit works before attempting to utilize it. These programs are so new, the dental benefits are still very coverage-limited, but they are getting better!
If finding dental coverage is important to you, it would be important to address those interests in the discussion with your Certified Medicare Planners® when reviewing Medicare coverage options.
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