What Does Dental Insurance Cover?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 10/06/2018

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Statistics published by the Johns Hopkins School of Public Health (in 2016) show that only about 12% of seniors have dental insurance. The lack of dental insurance may partially explain why only half of all seniors have seen a dentist in the past 12 months, according to studies by the National Institutes of Health. In fact, 23% of seniors haven’t been to the dentist in the past five years.

Under Original Medicare, there are no benefits for routine dental care. If you’re wondering how to get dental insurance if you’re enrolled in Medicare, here’s what you need to know.

What does dental insurance typically cover?

The National Association of Dental Plans, a nonprofit organization that researches and reports on dental benefits in the U.S., breaks down dental services into three main categories:

  • Preventive care, such as annual cleanings, exams, and x-rays.
  • Basic procedures, such as fillings, root canals, and extractions.
  • Major procedures, such as dentures, crowns, bridges, and implants.

Most dental plans offer complete coverage for preventive care, although you may have to pay a copayment at the time of service depending on the plan you choose.

Most plans also provide some benefits for basic procedures, such as filling a cavity or removing a badly broken or decayed tooth. You’ll generally pay a deductible, copayment, and/or coinsurance amount for these services.

Some plans also have limited benefits for more complex procedures such as root canals and periodontal treatment for gum disease, for example. You’ll generally pay more out of pocket for these services, however.

Before you buy dental insurance, keep in mind that many dental plans place a limit, or cap, on the amount they will pay for your dental care each year. Once you reach that limit, your plan won’t pay anything, even for procedures that would otherwise be covered.

Do I have to buy dental insurance if I have Medicare Advantage?

Unlike Original Medicare, which is administered by the federal government, Medicare Advantage plans are offered by private insurance companies contracted with Medicare. Because they are private plans, they can offer additional benefits, such as routine dental care, beyond those available under Original Medicare.

Many, though not all, Medicare Advantage plans do offer coverage for routine dental services, such as annual exams, cleanings, x-rays, and fluoride treatments. You may have a copayment or coinsurance amount for covered services, so be sure to check your health insurance plan documents carefully to see what’s covered and what you’re expected to pay for a particular dental service.

Can you tell me how to get dental insurance if I have Original Medicare?

If you have Original Medicare or Medicare Advantage, you can still buy individual dental insurance to help cover your dental expenses. Individual dental insurance plans are usually offered in one of two types:

  • Managed care plans, which generally require you to get care from network dental providers; you usually only pay a copayment at the time of service.
  • Indemnity plans, where you see any dentist you like, but you pay for your care in full and then the plan reimburses you for its portion.

You’ll have to pay an additional monthly premium for an individual dental insurance plan. If you have a Medicare Supplement insurance plan, or Medigap, keep in mind that most plans do not cover out-of-pocket costs associated with dental care.

Need more information about Medicare and dental insurance?

I am happy to help you find the information you need; you can schedule a phone call or request an email by clicking on the buttons below. You can also find out about Medicare plan options in your area by clicking the Compare Plans button. Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

The provider network may change at any time. You will receive notice when necessary.

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