One of the most frustrating aspects of Medicare is figuring out what’s covered and what isn’t. Today, we’re going to address the issue of dental care and other oral health coverage. Is it available or not?
Seniors, it isn’t good news!
When trying to understand your Original Medicare benefits, that’s Part A (hospital) and Part B (medical), it’s important to understand that it’s for your major medical only. That means it covers anything about your overall health condition. And, as far as the government is concerned, that does not include your teeth or any other aspect of oral health.
There is an exception to the hard-and-fast, no dental coverage rule. Medicare will pay when your primary care physician or specialist determine that oral surgery, or another dental procedure, is “medically necessary”. This only happens in the treatment of another health condition, such as oral cancer. Curiously, Medicare may pay to have all of your teeth pulled, but they won’t pay for your dentures or implants.
How-to Get Coverage?
We all have a different situation, so, thank goodness, there are different solutions. For some luck people, Medicare Advantage is a solution. But, it’s a real crap shoot, because so many things need to match up (primary care doctor, specialists, prescription coverage, etc). Good luck finding the right plan that also offers dental.
The next option is an individual dental plan. Here’s where you’d think the government could have done some good, because dental plans are available through the federal healthcare exchange, but only if you’re enrolled in a health plan on the exchange. Where was Obama on that one? Okay, gripe over.
If you want traditional dental insurance, you’ll have to go to a private health exchange or an individual plan o get it. Plans start at about $25 per month, but be careful. These cheap-o dental plans are just that, and they come with a long list of caveats, like a 6+ month waiting period, annual limits or a lifetime limit. If you want a plan that does not have these limitations, then you’re looking at more money, on up to $60 to $70 per month. And, you still have deductibles and co-pays, driving the cost up even more.
The third option is to pay out of pocket and find the discounts. Hey, we’re seniors, right? We know how to get discounts! And, as far as I can see, there’s none better than the discount dental cards available from a wide variety of players, including CVS, Aetna, Cigna and man more.
If you’re not familiar with these cards, it’s a really simple concept. For a flat fee each year you get 40% to 60% off standard dental rates. I guess the dentists and specialists can afford to give these discounts because it reduces their advertising costs, or something like that. Whatever it is, it’s a great deal for us. Click here for a list of all savings plans.