We have helped thousands of people with their Medicare over the years, and one of the biggest concerns people have when going onto Medicare is Dental coverage. Our clients want great dental coverage because, as they age, their teeth may need more expensive work.
Many Medicare plans advertise their Dental benefits. They promise coverage for expensive procedures like Extractions, Implants, Bridges, and more. But are they misleading you?
In this article, we'll explain why you shouldn't take a Medicare plan based on dental benefits, how dental insurance works, and what type of dental insurance may be best for you. Let's dive in!
Medicare Dental Coverage
Original Medicare doesn't cover dental. When you see an advertisement for a Medicare plan with dental coverage built in, it will most likely be a Medicare Advantage plan. A few Medicare Supplement companies do bundle Dental coverage with their Supplements, but they tend to be separate policies with a separate premium. Any Medicare policy with Dental included is typically a Medicare Advantage plan.
How Dental Coverage Works
Standalone dental coverage tends to work on a 100/80/50 structure. They will cover 100% of preventative work. Preventative work includes cleanings, X-rays, fluoride, etc. They will cover 80% of "basic" work. Basic work includes cavity fillings and may consist of extractions and root canals, depending on the plan. The insurance will cover 80% of the cost, and you will pay 20%. The final piece is 50% of major procedures. Major dental work includes crowns, implants, bridges, and other dental surgeries. This is how standalone dental plans work and how many dental plans you get through your employer insurance function.
Medicare Advantage used to work on this structure. In recent years, however, it has become less standardized. Some plans will cover 100% of preventative work but won’t cover ANY major work. Other plans cover 100% of preventative work and 50% of major work with a cap. They have elected to eliminate the “basic” work category, which covers 80% of the total. Things like cavities and root canals may be placed in “preventative” or “major” depending on the policy. Some policies give you a few thousand dollar allowance for anything that pops up. There are no preventative or major work categories, just a blanket benefit.
Be sure to talk with a broker to fully understand what you have signed up for and what your benefits are.
Dental Insurance Caps
Medicare Advantage plans heavily advertise coverage for implants, extractions, crowns, and more. However, coverage does not necessarily mean the insurance policy pays for everything. It means the policy pays 50 % or 80% if you're lucky.
But there's another level to this. Most Medicare Advantage and dental plans cap their contribution to dental work at between $500 and $2000 annually, which means any costs beyond that are your responsibility.
Let's give an example. You take a Medicare Advantage plan due to its dental benefit. You go to your dentist and need $8,000 in dental work. Ouch. Your Medicare Advantage plan does cover the necessary procedures but caps their contributions at $1500 annually. You are still responsible for $6500 when all is said and done.
You took a Medicare Advantage plan for its dental benefits but still have thousands of dollars’ worth of bills. Although a 50% split was advertised, you ended up paying 81% of the bill.
Dental Insurance Waiting Periods
Dental insurance plans often have waiting periods for major work. Just about every plan allows you to get your preventative dental care right away. But many will make you wait a whole year with the policy before you can get a major surgery like a bridge or an implant.
Other plans may offer a sliding scale for the percentage of major work they cover. Year 1 could cover 10% of all major work, year 2 could cover 50%, and year 3 could cover 60%. They will still have an annual cap, but they reward you for keeping the same plan for consecutive years.
There are plans with no waiting period, but these plans usually require a full-year commitment. You can get major dental work done quickly, but you can’t cancel the policy after the work is done.
When it comes to Medicare Advantage, there is often no waiting period. But be sure to check your coverage before signing up to make sure there are no surprises.
Is Great Dental Coverage Out There?
The unfortunate truth is that no dental coverage is perfect. We've worked with many insurance companies and haven't seen a single policy that covers major dental surgeries 100%. There is always a 50/50 split with some cap.
We do have a few solutions to help you out.
What To Do About Dental?
Our recommendation is to start by seeing what works best with your dentist. Each dentist or dentist office has its preference for which company or policy type they recommend. We can give you a policy we think you’ll love, but if your dentist doesn’t take it, it won’t matter. If we have a list of the companies and the plans they prefer, we can help you choose the best one. This holds for both Medicare Advantage plans and standalone dental plans.
Next, decide the goal of your dental coverage. Are you just looking for cleanings and X-rays? Do you have serious dental work coming up in the next month or two? Or do you anticipate having major work done, but likely not for some time?
If you are looking for just cleanings and x-rays, you can get a plan that has a lower monthly premium because it isn’t looking to cover major work as much. Your preventative work will be covered, and you may have a small benefit if something major comes up.
If you have major work coming up soon but don’t have coverage, you can get a policy that waives any waiting periods. The policy will likely lock you into a one-year contract, but the benefit can be worth it. Once you know you have a major dental surgery coming, you can start a policy on the 1st of the following month.
If you want to take a longer-term route, you could opt for a dental policy with a higher benefit and a waiting period. This way, you can get all your cleanings covered and a greater percentage of any future major dental surgeries covered.
If you fall into this camp and have a Medicare Advantage plan, see if the policy offers a dental rider. Dental riders can give you more coverage for dental treatment for a slight increase in your monthly premium.
Dental Discount
Another option for dental coverage is a Dental Discount plan. These plans offer set copays for dental procedures for a low annual or monthly fee, usually $100-$150/year.
While you will now have to pay for your cleanings and X-rays, the copays for major work may be lower due to a lower negotiated rate. These plans usually don't have a waiting period either, so if you have major work coming up, this could save you a bit of money in a short turnaround.
Conclusion
Unfortunately, there is no perfect dental coverage out there. While dental benefits are heavily advertised with Medicare plans, they often don't cover major dental work as well as you'd be led to believe. We recommend choosing your Medicare plan based on its hospital, medical, and prescription coverage before focusing on dental benefits.
If you need dental coverage, first zone in on your dental needs. Then talk to your dentist about what companies and plans they prefer. Next, speak with a broker about your dental options.
Be sure to talk to the brokers at NJ Life and Health to get all your options. We will also personalize our recommendations based on your specific dental situation.
We are licensed in 24 states and would happily guide you through the dental landscape. Reach us at our website, www.njlifeandhealth.com, or call our Toms River, NJ office at 848-226-6897. We also have many other educational videos on our YouTube channel to watch on your own time. Thanks again and see you in the next video.