Generally, Medicare Part A and Part B, do not cover routine dental care such as cleanings, fillings, tooth extractions and other dental services. Medicare Part A may cover some dental – related to hospitalization, but will not cover any follow up visits to a dentist after that hospitalization. The good news is Medicare Beneficiaries do have some options to help pay for those dental procedures not covered by Medicare.   

Stand-alone Dental Plans 

Stand-alone dental plans usually have a monthly premium.  They are offered by carriers, and can be purchased at any time, due to and do not having enrollment periods. Stand-alone dental plans, typically, do not have age limits, but some may have maximum benefit amounts, enrollment fees, restrictions, and waiting periods. These dental plans are categorized as either Dental HMO (DHMO) or Dental PPO (DPPO), and the benefits differ for each plan. 

Dental HMO vs. Dental PPO Plans. What is the difference?  

Dental HMO (DHMO) 

  • Typically, do not have deductibles. 
  • Shares a percentage of the cost and do not require the deductible to be met prior to coverage. 
  • Most DHMO’s do not have an annual maximum. 
  • Must see an in-network provider, accept in an emergency.  
  • Must pick a primary dentist and see that dentist for referrals.  
  • Generally, waiting periods. 

Dental PPO (DPPO) 

  • Annual deductible.  
  • Coinsurance coverage once deductible is met.  
  • Has an annual maximum. 
  • Flexibility to use a dentist in or out of network, but the cost will be less with an in-network provider. 
  • No primary dentist. 
  • Some plans may have waiting periods. 

Medicare Advantage Plans Which Include Dental Benefits

Another option for Medicare Beneficiaries is a Medicare Advantage Plan (MAPD). Some offer a preventative or comprehensive dental benefit included in their plan.

Preventative dental is referred to as routine dental care, and includes dental exams, cleanings, and x-rays. Comprehensive dental is coverage for anything not in the preventative dental category, such as tooth extractions, crowns, and root canals. Coverage will vary with each Medicare Advantage Plan, and there will be a maximum benefit amount that the carrier will cover per year. Refer to your Evidence of Coverage for your MAPD plan to see if you currently have dental coverage.

Dental Coverage varies from plan to plan, so it’s important to know before going into a procedure what is covered and what is not. If you have questions regarding stand alone dental plans or MAPD plans, call Hovis & Associates at (800) 411-0737. We Make Dental SIMPLE!

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