Medicare Dental Insurance
The Basics
Medicare provides limited dental insurance. Learn more about what Medicare does cover here.
What is missing?
Medicare Part A or Part B do not presently cover preventative and comprehensive dental.
Several private insurance companies specialize in offering this coverage.
How do you find them?
Use your favorite web browser and do a simple internet search for ‘dental insurance’.
If you build a ‘short list’ of plans to consider, be sure and get the details of covered services. These may NOT be in the ‘marketing literature’, but can be found in the actual ‘policy document’.
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.
Points to consider when reviewing 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 did not get this type of work taken care of while they were younger. Will the plan(s) you are considering cover this?
Other Tidbits.
The plan’s annual cap.
Be sure and understand the annual cap on reimbursable costs for any 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 hits 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.
The Deductible and Waiting Periods.
Does the plan have deductible(s) or waiting periods?
Some plans have deductibles before the plan 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 second and/or third year you are a member. For example, during the first calendar year you are a member, they may pay 25% of the cost of an extraction, crown, root canal, oral surgery, etc. Starting the second year, this may increase to 50%. Joining plans with this feature later in the calendar year may make sense.
Dental terminology.
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.
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 your dental services from their office.
If you are attracted to this messaging, be sure and understand the skill set of dentists(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.
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
If you are shopping for a Medicare Advantage plan with dental coverage and want help, contact us. We are licensed with all plans available to Idaho residents that include this coverage.
We are not licensed with insurance companies offering dental plans which are not embedded into either a Medigap or a Medicare Advantage plan.
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.
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