Most routine dental care, like exams, cleanings, and procedures, isn’t covered by Original Medicare. However, specific dental services related to surgeries or general health may qualify under Medicare Part A. Explore additional dental coverage options with Medicare Advantage, certain Medigap plans, or stand alone dental insurance.

Does Original Medicare include dental coverage? 

Unfortunately, Original Medicare (Parts A and B) generally excludes most dental care. In 2019, almost half of Medicare beneficiaries lacked dental coverage. Medicare Part A, however, does cover specific dental services related to inpatient hospital stays, including jaw reconstruction post-accident, necessary tooth extractions before jaw-involved radiation, and oral exams preceding specific procedures like kidney transplants or heart valve replacements. Although Part A covers the hospital stay for emergency or complex dental treatments, the dental care itself is not included.

Does Medicare Advantage include dental care? 

Unlike Original Medicare, the majority of Medicare Advantage plans do provide dental coverage. In 2023, 97% of individual plans offer dental benefits. These plans, also known as Medicare Part C, are offered by private health insurance companies approved by Medicare. Dental benefits in individual Medicare Advantage plans may encompass discounted fees or percentage coverage for cleanings, fillings, routine X-rays, and extractions. However, coverage, provider networks, and out-of-pocket costs can vary among plans, with many having an annual cap on dental care expenses. Ensure that the Medicare Advantage plan you’re considering aligns with your specific dental needs.

Does Medigap provide dental coverage?

Medigap, or Medicare Supplement Insurance, is an additional option for Original Medicare users, covering out-of-pocket costs for services under Parts A and B. While the majority of Medigap plans don’t include routine dental care, a small percentage may offer added benefits like vision, hearing, and dental coverage as an optional add-on. 

Options for Dental Coverage Outside of Medicare:

You’re not limited to Medicare for dental coverage. Enroll in standalone dental insurance from major insurers. These plans function similarly to traditional insurance, requiring a monthly premium for access to a network of in-network dentists. Depending on the plan, out-of-network options may be available with higher fees or limited coverage.

Additional coverage alternatives include:

• Dental Discount Plan: Similar to joining a discount club, such as Costco, this plan involves paying a fee for access to a group of dentists offering discounted rates.
• Partner’s Dental Coverage: If your spouse or partner has dental benefits through their employer, union, or veteran’s plan, you may qualify for enrollment.
• Employer’s Dental Coverage: If still employed and your employer provides dental benefits, enroll in that plan to benefit from group rates.

How to Choose the Right Dental Coverage Plan?

Navigating the process of finding the ideal dental coverage plan involves thorough research and comparison of options tailored to your specific needs. Here are steps to guide your search:

• Assess Your Dental Needs: Understand your requirements, whether routine check-ups, cleanings, or extensive treatments, to determine the necessary coverage level.
• Explore Available Options: Investigate various plans, including stand alone dental insurance, Medicare Advantage plans with dental benefits, or employer-sponsored options, considering the unique benefits and limitations of each.
• Coverage Details: Scrutinize the coverage details of each plan, checking services like preventive care, major treatments, orthodontics, and oral surgeries. Be aware of waiting periods, exclusions, or limitations on specific procedures.
• Dentist Network: Verify if your preferred dentist is part of the plan’s network, prioritizing convenience and accessibility, especially if you have specific dental professionals in mind.
• Cost Considerations: Compare associated costs, evaluating premiums, deductibles, copayments, and coinsurance. Ensure the overall cost aligns with your budget and expected dental care expenses.
• Additional Benefits: Assess extra benefits offered by plans, such as orthodontics, cosmetic dentistry, or coverage for specific conditions, considering their relevance to your needs.
• Read Reviews and Seek Recommendations: Review ratings and feedback for considered plans, focusing on customer satisfaction, claims processing ease, and overall reputation. Seek recommendations from trusted sources like friends, family, or healthcare professionals.
• Seek Assistance: For guidance or specific queries, reach out to insurance representatives, licensed brokers, or dental care professionals. Their insights can aid in making an informed decision.

Need help? Call Health Plans in Oregon: 503-928-6918. Our assistance is at no cost to you.