Does Medicare Cover Dental Care? | Understanding Medicare Dental Coverage - YouTube

Welcome to Medicare School Daily where we help you understand Medicare, save money,

avoid mistakes, and above all else, get the most out of your Medicare benefits.

One of the most common questions we get as people go on Medicare: Is Medicare going

to cover my dental?

And so that's the topic I want to address in this particular video today, how to get

dental benefits on Medicare.

Now, the first thing you need to realize that as you enroll into Medicare, and you enroll

into Medicare A and B, Medicare A and B is rarely going to pay for any dental expenses.

Now, on a rare occasion, they will; it's going to have to be some extreme situation, such

as someone has jaw cancer and maybe part of their jaw is removed.

Well, it will be medically necessary to reconstruct their teeth after that jaw surgery, so Medicare

would participate in the cost of that.

Again, that's a rare, rare situation.

So when we talk about fillings and extractions and root canals and crowns and those types

of things, original Medicare A and B is not going to cover those expenses.

And so you have to decide a couple of things.

Number one, are you going to go without dental insurance or do you want to have dental insurance?

And so there's a couple of different ways in which you can get dental insurance.

All right?

And so I want to show you those ways today.

Number one, about half of you that are viewing this video statistically are going to get

an advantage plan, and with advantage plans almost always those plans are going to include

some kind of dental benefit.

All right?

So I want to talk about the different aspects of an included dental plan within an advantage

plan.

First off, most of the advantage plans are going to have a network of dentists.

And so you have to make sure that your dentist is in that network.

If not, that dental benefit is not going to do you any good.

But as long as that dentist is in the network or you're willing to go to a dentist within

that network, then this embedded plan may work for you.

Now, the benefits on the plan and the amounts are certainly going to vary plan to plan.

And so what do you mean by benefits is this: some of the advantage plans are going to cover

preventive benefits only.

Meaning your cleanings and your X-rays probably two times a year.

And that's all they're going to cover.

Others are going to add some comprehensive benefit to that, which could be some fillings,

extractions, maybe root canals.

But always these plans are going to stop somewhere.

All right?

So normally the embedded plans are going to have about $1,000 worth of dental benefit

that's included.

Now, that $1,000 could be first dollar coverage, which means the very first $1,000 that you

spend, that company will pay for that.

Others, it's going to be maybe a 50/50 situation.

But you’re always going to have some kind of a limit.

And so if it's first dollar coverage, typically what that means is that you get the services,

including cleanings and maybe some extraction of different things, and they'll reimburse

you up to $1,000.

Now, some of the plans will have the dentist file the claim with the plan.

Others are going to have you actually pay the bill and then you turn in a form to get

reimbursed.

All right?

So it's going to be $1,000 if its first dollar coverage.

That's very common.

Or the plan may give you benefits up to 50/50.

Now, when plans go 50/50, what they typically will do - will provide for a set of x-rays

and a couple of cleans a year at no cost to you.

And then everything else beyond that, they will split the expense with you 50/50 up to

the plan limit.

All right?

So that's the way that works.

And then there are a few plans throughout the country that will allow you to actually

add dental benefits to the plan, meaning they don't include any as part of the package.

So you can buy separate dental benefits.

And those are going to range anywhere from typically about 25 to 50 dollars on a monthly

basis.

And so if it looks like that plan is good for you and that Dentist is in the network,

it may be worth the extra premium to get that dental add on.

All right?

So that's for those of you that are going to take an advantage plan.

You’ll have some type of benefit as part of the package.

Now, the second option for those of you that would like to have dental benefits, if you

decide to get original Medicare, and you get a supplemental plan, you will have the opportunity

to be able to add a dental benefit to that plan.

Now, sometimes the supplemental plan will offer it or sometimes you go in the open market

and actually get a standalone plan.

OK?

So supplemental plans are typically not going to include it, but it could be available.

So when we look at these add on plans or these standalone plans, here's some features you

gotta be aware of begin network.

Now, here's my advice to you, if you are going to go with the supplemental plan and you want

to have dental benefit, what I would do before I want to buy a plan is I would talk to your

dentist and find out what plans that dentist likes and takes, because, number one, you'll

get better pricing.

Number two, the claims process will go much better.

So ask the dentist what they like and take.

Now, if you don't have a dentist or you're willing to change your dentist, then what

I would do: I'd go out and shop for plans because you’ll be able to find a dentist

that takes that particular plan.

All right?

And so that's what we mean by network, cause almost always it’s better to go to a network

provider.

Now, when it comes to premiums with these separate or standalone dental plans, these

are going to range anywhere from typically about 30 to probably 60 dollars on a monthly

basis.

All right?

And so those would be your monthly premiums.

And of course, if I have a lower premium, I'm going to have a lower annual benefit;

a higher premium, a higher annual benefit.

And so when we look at these particular plans, we're going to see these plans are going to

range anywhere from about $1,000 up to $2,000 on an annual basis, meaning that's what the

company is willing to spend for your dental coverage.

All right?

Now let's talk the details of the service.

Every dental plan is going to be somewhere in this: Number one, we are going to have

preventive benefits.

We're going to have what is called basic services, which are your extractions, your fillings,

your low-cost items.

And then you're going to have major services, root canals, crowns, sometimes dental implants,

different things like that.

So preventive been benefits when it comes to coverage, this is immediate, which means

as soon as you have the plan, you can begin to get your cleanings and those kinds of things.

There is no waiting period.

Now, basic services for that coverage.

Typically what happens is this: You're going to have an 80/20 benefit, which means the

plan is going to pay 80 percent and you're going to be responsible for 20 percent.

When it comes to major services.

Again, your root canals and implants and those kinds of things almost always it’s going

gonna be 50/50.

Now we talk about waiting periods, this means this: that sometimes the companies do not

cover you immediately.

They're going to make you go through this period of time.

Now, when it comes to the coverage for preventive, there is going to be no waiting period whatsoever.

You don't have to worry about that.

You're covered.

But when it comes to basic, some of the plans are going to make you wait six months and

you'll pay six months worth of premium before they'll cover those basic services.

And sometimes the plans on the major services make you wait 12 months.

So, again, you have to pay some premium before they begin to cover those benefits.

All right?

Now, there are some ways through certain companies to get waiting periods waived.

And some companies will allow if you prove that you had dental coverage and that dental

coverage has not lapsed any more than 60 days, that many times those companies will waive

the waiting periods.

All right?

Some companies will; some companies won't.

But you do have to find out about waiting periods.

And then again, back to the annual limit.

What we're talking about is the combined of all these different services, they're going

to cover somewhere between $1,000-$2,000 on an annual basis.

And almost always, the dentist is going to be the one that's going to file the claim.

And then you just have to simply pay whatever your particular coinsurance is here.

That 80/20 or the 50/50.

All right?

And so some of you this is going to be a real important issue because you have ongoing teeth

issues and so you will probably get your money back out of your dental plan.

Others of you who have very healthy teeth, if you just have cleanings, you may not get

your money back out of your dental plan.

But it's a decision you have to make.

And these are your options.