5 things to know about dental health and Medicare (2023)

5 things to know about dental health and Medicare (1)

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Except in very limited cases, original Medicare does not cover dental care.

Surgery to treat jaw fractures, some dental work to prepare for radiation treatment for oral cancer, or an oral exam at a hospital before a kidney transplant are among the few instances where Medicare says it's okay. But Original Medicaredoes not cover routine dental careNursing care or procedures that many people don't realize until they retire.

The percentage of people with dental insurance drops dramatically at age 65, after they retire and lose their employer's insurance.

Just over a quarter of adults ages 50 to 64 do not have dental insurance, according to the University of Michigan.National Healthy Aging Survey, sponsored in part by the AARP, which surveys approximately 2,000 people twice a year. as intervieweereach 65 and beyondAt Medicare age, the percentage of people without insurance almost halves, to 47 percent.

One in five seniors surveyed said they had delayed or avoided dental care in the past two years. Most said cost or lack of coverage played a role in that decision.

“The elderly have complex oral health needs. And they don't get the care they need or face high costs trying to get the care they need," said Meredith Freed, senior policy analyst for the Kaiser Family Foundation's Medicare Program.Medicare and Dental Carein July 2021. The Foundation found that one in five Medicare beneficiaries who used dental services in 2018, the most recent year for which information is available, spent more than $1,000 out of pocket; 11% spent $2,000 or more.

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A private Medicare Advantage plan or standalone dental insurance can cover some of your dental needs, but the details can vary greatly. Some plans only pay half the cost of extractions, fillings, root canals and major surgery.

Here are five things you should know about Medicare and dental insurance and ways to cover the costs.

1. Medicare Advantage plans do not have standardized dental coverage

In 2021, 94% of Medicare Advantage members in individual plans had access to some dental coverage, according to the Kaiser Family Foundation. Only 10% of Medicare Advantage members need to pay a separate premium to receive dental benefits.

"Most plans cover preventative services like cleaning and X-rays, but coverage for more comprehensive services definitely varies," says Freed. The Kaiser study found that nearly two-thirds of those enrolled in plans with access to oral exams, cleanings and x-rays are not charged for these services.

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In addition to preventive services, members typically have to pay a larger share of the cost of crowns, dentures, extractions, implants, root canals and gum disease treatments. Kaiser found that the most common co-insurance sum for longer benefits is 50 percent. The cost share for the examined plans was between 20 and 70 percent.

Coverage limits averaged $1,300 in 2021, but varied widely. You can find higher limits if you search, but expect to pay higher premiums than lower limit plans, says Freed.

The study found that less than a quarter of people who had dental insurance were enrolled in a plan with $2,000 annual coverage. About 1 in 12 had a plan with an annual limit of $2,000 to $5,000.

Learn more about Medicare Advantage plans in your area by entering your zip code in the fieldMedicare Plan Finder. You will see a green tick ✓ next to Zahn if a plan includes dental insurance. tightenplan detailsbutton |Additional benefitsTab to view summaries of preventive and comprehensive dental care.

"If dental care is important to you, you need to refer to the plan's summary of benefits or insurance statement to see what the plan covers as part of its dental package," says Freed. Typically, this information can be found on a plan's website.

a link tosite do planois on top ofplan detailsbook page. Some websites have phone numbers and chat features so you can speak with a customer service representative.

This is where you can switch Medicare Advantage plansevery year during open enrollmentFrom October 15th through December 7th, with coverage beginning January 1st, check the fine print of plans even more closely if you anticipate major dental procedures in the next calendar year. Consider this a factor in yourMedicare Advantage Decision, along with coverage for your doctors, prescription drugs, and healthcare. Some plans have networks of dentists, so make sure your dentist is present.

2. Standalone Dental Policies Vary Widely in Details

While Medicare Advantage is the most common way for Medicare beneficiaries to obtain dental coverage after retirement, you do have other options. If you want to keep your original Medicare or get mid-year dental coverage, you can purchase separate insurance.

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"Costs, benefit coverage, deductibles, waiting times and annual maximums vary between different types of dental plans, depending on the insurer or provider and the state," said André Richards, spokesman for Delta Dental. The largest all-ages dental insurer in the United States sells individual and group dental plans, including an AARP-branded plan.

Self-employed dental insurance premiums vary by coverage level and location. Policies generally don't have exclusions for pre-existing conditions, but they may require a waiting period before some expensive procedures are covered, says Gregg Ratkovic, Medicare president for eHealth insurance broker. They also usually have an annual coverage cap.

Self-employed dental insurance for people age 65 and older typically costs $20 to $50 a month, says Ratkovic. These plans usually cover exams and cleanings, but you'll usually pay 20 to 50 percent plus a $50 to $100 annual deductible for dental restoration work.

Take care:Some plans, standalone and part of a Medicare Advantage plan, may not pay to replace a tooth that was missing before coverage began, according to the American Dental Association. Other dental problems you had before you signed up may also not be covered. Therefore, it is important to look at the details of a plan before purchasing it.

Find out if a plan you're considering has a network of providers, if your current dentist is included, or if other network dentists are available in your area. Some plans cover out-of-network dentists, but you pay more out of pocket.

3. Other options or discounts on dental care

First,Contact your or your spouse's employer if either of you is still working. According to the National Survey on Healthy Aging, half of people age 65 and older who had dental insurance were employees, employees' spouses, or retirees. In some cases, employers may offer retirees access to a dental benefit plan or refer them to a company that offers benefits, says Richards of Delta Dental.

Second,You can get dental insurance or a dental discount program through a Medigap policy. In 2020, nearly 1 in 8 Medicare beneficiaries were enrolled in Medigap plans with supplemental dental, vision or hearing benefits, according to the Commonwealth Fund, a century-old foundation focused on better health care. Some dental programs offer 30-40% discounts for services such as cleanings, crowns, exams and fillings at licensed dentists and have no copayments, coverage limits or waiting periods.


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  • You can enroll in a stand-alone dental discount program, usually with an annual upfront payment.
  • Ask your dentist if he participates in other plans, such as internal B.dental membership programsor discounts for early payments.
  • Medicaid provides dental coverage in some states for individuals who meet income and wealth requirements. According to the Kaiser Study, approximately 1 in 9 Medicare beneficiaries had Medicaid dental coverage in 2019. Less than half of states offer adult care in addition to emergency dental services.Contact your state Medicaid officefor details.

4. Your dentist can be an ally in controlling expenses

Before you retire, talk to your dentist about the care that will be important in the coming years, says Leonard Brennan, a retired dentist and co-director of the Geriatric Fellowship Program at the Harvard School of Dental Medicine. If you need some expensive services, consider scheduling them while you still have dental insurance from your employer, which may be better than your future coverage.

Don't skip preventative dentist visits like teeth cleaning because you're worried about the cost. Short-term savings can lead to bigger health problems, says Brennan.

Your dentist can extend your cost of coverage. As you approach your policy's annual coverage limit, your dentist may distribute some of the services you need in the next calendar year. To get an idea of ​​how much different procedures cost in your area, Delta Dental has aCalculator.

5. HSA tax-free money can help with direct dentist costs

Even if you have dental insurance, you may still have a lot of expenses to cover. If you already have oneHealth Savings Account (HSA)Because you got your health insurance through a high-deductible plan, you can withdraw tax-free cash for reimbursable medical expenses, including dental expenses.

You cannot make new contributions to an HSA after you enroll in Medicare. However, you can withdraw cash for eligible expenses at any age.

If you haven't enrolledMedicareHowever, the tax-free savings for medical and dental expenses is a good reason to start an HSA. To be eligible to pay HSA contributions in 2022, you must have HSA-qualified health insurance with a minimum deductible of $1,400 for individual coverage or $2,800 for family coverage. You can pay up to $3,650 for individual insurance or $7,300 for family insurance in 2022, plus $1,000 in upgrade premiums if you are age 55 or older.

HSA offers a triple tax break: Your contributions are deducted from your paycheck before tax is calculated, or are deductible if not paid through your employer. Money grows tax-deferred. And you can withdraw it tax-free on eligible expenses each year.

Kimberly Lankford is a contributing author covering personal finance and Medicare. She previously wrote toKiplinger's Personal FinanceMagazine, and his articles also appeared inUS news and world report,Washington Postit's atBoston-Globus. She received the Best in Business in Personal Finance award from the Society of American Business Editors and Writers.

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