Photo by Mohamed Hassan on Pixabay
A healthy mouth is half the battle when it comes to smiling. With healthy teeth, you can show them off with a confident smile. In the United States, 50.2% of adults have dental coverage that includes a Medicare benefit. But almost half of them had not visited a dentist in the previous 12 months.
Medicare beneficiaries spend an average of $874 per year on dental care. This is a large amount that’s usually more than what people spend on other health services. So, you can imagine why many seniors opt to skip the dentist.
But that doesn’t have to be the case. If you are eligible for a Medicare benefit, there is great news for you! Medicare Advantage plans in some states, like Texas, cover dental care services. This article lists the important things to know about dental care in Medicare, before signing up for one.
Do Medicare Benefits Cover Dental Care?
Before we answer that question, let’s take a closer look at the five different parts of the Medicare program.
In general, all these parts help provide coverage for certain treatments. Most beneficiaries choose Original Medicare, the fee-for-service program provided by the federal government. Under Original Medicare, you can get your medical treatments covered in full. That means you can consult any physician and get admitted to hospitals anywhere in the US.
But Original Medicare has its limitations, particularly with dental care treatments. But don’t worry. You have the option to choose a Medicare Advantage Plan.
If you sign up for a Medicare Advantage Plan, keep in mind that you still have Medicare. This means that you should pay your Part B monthly fee and your Part A premium if you have one.
The best Medicare Advantage plan will cover all Original Medicare treatments. Still, there are different rules, fees, and limits that determine how and when you receive care. And these factors depend on which state you’re residing in.
The average monthly premium cost of Medicare in Texas is just $11.42. This is among the lowest premium costs you can get compared to that in other states. Applying for Medicare Advantage plans in Texas means you get to choose from 337 plans. And that is more than what other states offer.
The eligibility requirements for Medicare across states also vary. To be qualified for Part A Medicare plans in Texas, you need to have a monthly income limit of $1,063 or below (single). Meanwhile, in Connecticut, you need to have a $1,133 monthly income limit.
Part D is prescription medication coverage. If you choose to keep your Original Medicare, you can supplement your coverage with a separate drug plan. You should have already enrolled in Part A and B to get prescription drug coverage. Medicare eligibility in Texas means you’re entitled to financial help with prescription drug costs.
Lastly, the Medigap plan will help you pay for out-of-pocket expenses. It includes things such as deductibles, copays, and coinsurance. Many policies also include foreign travel emergency coverage. New beneficiaries in Texas can choose from eight standard Medicare Supplement plans.
Now, let’s go back to the question. Can you get dental care coverage under Medicare benefits?
The answer is, yes and no! Original Medicare doesn’t cover most treatments for dental care. This includes dental procedures like:
- Preventive cleanings and exams
- Fillings, crowns, and root canals
- Periodontal scaling, dentures, or implants
But if you need dental procedures when you’re in the hospital, your Medicare Part A plan will cover the expenses. Even though it doesn’t cover dental treatment, it can help fund hospital stays for urgent or difficult dental operations.
Medicare Part B also has a few exceptions when it comes to dental care and services. It covers dental procedures that are necessary for another qualified operation. This can include:
- Oral examinations before a kidney transplant
- Extractions carried out before radiation treatments that target the jaw
- Recovery from an injury requiring jaw reconstruction
- Outpatient checkups before having oral surgery
But if you need preventive or common dental treatments, you should consider other Medicare plans. This way, you can get the dental care coverage that you need.
Which Medicare Plan Covers Dental Care and Services?
- Medicare Advantage Plan Dental Coverage:
Different Medicare Advantage plans offer different levels of dental coverage. The dental benefits of each plan differ from one another. Some Medicare plans in Texas offer both preventive and comprehensive dental treatments.
Before you enroll in one, do a little research to determine what your plan covers. Check out the advantages your plan provides as well as the states that accept those benefits.
Never enter Medicare Advantage with no knowledge of it. When signing up for a Medicare Advantage plan, knowledge is essential.
- Medigap Dental Coverage:
You can also get access to dental care with Medicare supplemental insurance. But to do so, you should buy a separate dental plan or make use of dental discount options.
Your insurance will only pay the medical expenses that Original Medicare doesn’t cover. That’s because Medigap policies are extensions of Original Medicare coverage. Dental insurance is not included in this.
There are plenty of Medicare Supplement plans with dental coverage to choose from. Make sure you check out some of them and don’t forget to compare each plan with one another.
What Dental Services Does Medicare Advantage Plan Cover?
The dental coverage you get from different Medicare Advantage plans can vary. In general, dental services that Medicare Advantage plans may cover include:
- Oral tests
- Dental X-rays
- Diagnostic help
- Reconstructive treatments
- Root canal treatment
- Gum disease and oral inflammation treatment
It’s important to note that your coverage may be limited to a fixed number of services per period. For example, you can have only one x-ray per year or one cleaning every six months
How Do You Get Dental Coverage if Medicare Does not Cover it?
Sometimes, the Medicare Advantage plan that works for you doesn’t have the dental coverage you need. If you’re enrolled in one, you have other options to consider:
Medicaid offers dental care for members who are 65 years or older, pregnant, crippled, and blind. You’re also eligible if you have met the criteria for Early Periodic Screening, Diagnostic, and Treatment (EPSDT). So if Texas doesn’t have the right Medicare dental plan for you, it’s time you search for a Texas Medicaid application guide.
- Dental Insurance
You can buy a separate dental plan from a private insurance company. Basic dental plans can give coverage for preventive dental care at a lower monthly cost. Other plans may offer more dental coverage in exchange for a higher premium.
- Local Dental Clinic
Find a low-cost walk-in dental clinic in your area. Some provide financing and payment plan alternatives for different dental operations. You can get these dental care treatment plans at a low price.
- Health Savings Account
You can also open a Health Savings Account (HSA) to get dental coverage. This applies if you have a high-deductible health plan and are under the age of 65. Take note that you can no longer contribute to the fund once you enroll in Medicare. But you can use what you’ve saved to help pay for covered expenses, including eligible dental services.
Dental Care is Essential for You
Keep up the sparkle in your teeth. Whatever you do, make dental care a priority, both at home and at the dentist. Taking good care of your teeth as you age can help you avoid tooth problems.
In the end, there’s no denying the importance of oral health. So you should enroll in the best Medicare advantage plans. It can cover a lot of important dental procedures and treatments. Be sure to check what it covers for you and what it doesn’t. Get help from Medicare advisors to understand more about your Medicare plan.