Medicare Dental Insurance
The Basics
Medicare provides limited dental insurance. Learn more about what Medicare does cover here.
What is missing? Preventative and comprehensive dental is not presently covered by Medicare Part A or Part B.
Several private insurance companies specialize in offering this coverage.
How do you find them? Use your favorite web browser and doing a simple internet search for ‘dental insurance’.
Several Idaho Medicare Advantage plans include this coverage in their plan’s monthly premium. You have to read the details about your share of the cost and other plan rules. This information is found in the plan’s ‘Evidence of Coverage’ document. We have found the higher level plan documents (their marketing literature) offer a brief high level description which is designed to get your attention. This level of information typically DOES NOT contain the details you need when comparing plans to each other. We recommend Idaho residents take the time to understand the details of any dental, health and prescription drug insurance before they enroll in a plan. We can help you with this.
Some plans have an optional dental plan with it’s own premium. Not all Idaho Counties have Medicare Advantage plans which include dental coverage.
Points to consider before you start reviewing Medicare Dental Insurance plans
Networks
Some plans have defined networks of dentists…some do not. If you are interested in a plan with a defined network, be sure your dentists are in the plan. Then confirm the plan has multiple choices of other dental specialists (endodontists, periodontists, etc.). Be sure and check out what any additional fees will be in place if you use out of network dentists.
Periodontal and Orthodontia Coverage
If periodontal coverage is important to you be sure the plan(s) you are considering cover this type of service. Some plans limit the number of visits per year they will cover. We are noticing some plans with dental networks have few periodontists in their network.
Orthodontia care can be important to some people that didn’t get this type of work taken care of while they were younger. Will the plan(s) you are considering cover this?
Be sure and understand the annual cap on any Medicare Dental Insurance plan you consider
We have seen some plans cap their annual payouts to $500, $1,000, $1,500, or $2000 and up. What does this mean? When the plan’s share of the members dental cost hit the plan’s cap, they stop covering plan members dental coverage for the rest of the calendar year.
Typically the higher the plan’s annual cap, the higher the monthly premium.
Does the plan have deductible(s) or waiting periods?
Some plans have deductibles before the plan will start paying its share. This means money going out of your pocket before the plan starts paying for services you use.
They can also have waiting periods for all but level 1 services (preventative). Be sure you understand the rules of any plan you are considering.
Some plans increase their share of the reimbursement for covered services during the 2nd and/or 3rd year you are a member. For example, during the 1st calendar year you are a member, they may pay 25% of the cost of an extraction, crown, root canal, oral surgery, etc. Starting the 2nd year, this may increase to 50%. Joining plans with this feature later in the calendar year may make sense.
Be sure you understand the terminology contained in the plan’s documents. Some plans include the dental billing codes of the services they cover. This is done to further clarify what they do cover and what they do not.
Be sure you understand what the policy covers and how it works before enrolling.
You might include your dental professionals in reviewing these documents.
They may have further observations on which plans they would enroll in their selves (and why) if they were going to join a plan.
Your Options if you stay with Original Medicare (Part A and B)
This is where using a browser and an internet search to find plans should be useful.
Other items to keep in mind
We are aware some local dentists may offer discounts on the services you use if you agree to get all of your dental services from their office. If you are attracted to this messaging, be sure and understand the skill set of dentist(s) at that office. A dental specialist (periodontist for example) may provide a more thorough service than what is available at a general practice dental office.
Generally speaking, people that just use ‘preventative dental care’, may not feel these plans offer value. Why? Because your annual out of pocket cost may be lower without a dental plan if you just pay cash for the services you receive.
If you are a consistent user of services beyond preventative dental, it makes sense to consider some of these plans.
If you are a veteran, we suggest you consider your options found here.
Your dental insurance options if you select a Medicare Advantage plan
Some Idaho Counties have Medicare advantage plans which offer attractive preventative and comprehensive dental insurance. This coverage can be included in the plan’s monthly premium or with a separate premium.
Dental insurance in some Idaho Medicare Advantage plans
We are liking what we are seeing in some of the dental insurance offerings included in Idaho Medicare Advantage plans. For example, some plans include, at no extra premium, both preventative and comprehensive dental with no copays. The maximum dollar amount the plan will cover varies by plan.
Some plans may offer preventative dental with or without copays but not include comprehensive dental.
Some plans have comprehensive services available at an extra premium.
Many plans have a defined network of dentists plan members should use.
Be aware lower population Idaho Counties may have few dentists in networks of Medicare Advantage plans. Some of them may not be accepting new patients.
If a member goes outside of the plan’s network to get services, their share of the costs may be higher. We are aware of plan(s) that let the plan member use any dentist. We have noticed plans which are local to Idaho can have broader/deeper dental networks.
Idaho residents call us if you want help understanding the differences between your choices.
Have a good idea of your dental costs if you do not have insurance
Before you select any plan, be sure you think through your needs. This includes analyzing how much you have been paying annually for dental services.
If you are considering a plan with a monthly premium, you may be better off just paying for dental services as you use them.
We are familiar and licensed with all Medicare Advantage plans offering dental coverage in Idaho.