What Dental Care Does Medicare Part A Cover
Medicare Part A won’t cover dental services such as cleaning, fillings, root canals, crowns, extractions or dentures.
However, if you have an emergency or complicated dental procedure where you need to go to the hospital, Medicare Part A can cover your hospital care. This could include jaw surgery, tooth extractions before cancer radiation treatments, splints for facial fractures, an oral exam before a kidney transplant or other major treatments.
In these situations where you need hospital treatment for your jaw, mouth or teeth, we recommend that you check the billing codes for each service to confirm your coverage.
Overview Of Humana Dental Insurance
Humana has been offering dental insurance products since 1961, giving the company plenty of experience developing a large network of quality dental professionals. It offers HMO and PPO plans, though HMOs are becoming rare and are only offered in eight states. The company has PPO plan options in all 50 states and a discount dental option in 43 states.
High Cost Is A Barrier To Dental Care
Seniors or retirement-age adults often lose their employer-provided dental insurance at a time when their dental needs and costs are increasing. Consider these statistics from the Centers for Disease Control and Prevention :
- About two out of three adults 65 and older have gum disease.
- One in five adults 65 and older have untreated tooth decay.
- One in five adults aged 65 and older have lost all of their teeth.
At the same time, more than half of seniors say theyve had to delay dental care due to the high cost, and 23% of Medicare enrollees say theyve delayed or gone without dental care, according to statistics from the Kaiser Family Foundation.
Overall, the need for senior dental care is clear, but what about dental insurance?
Dental insurance can be a valuable tool to protect you from the high cost of dental care. Like any insurance, deciding whether its worth the cost or not depends on your specific needs.
If you only need twice yearly cleanings and X-rays, youd probably spend more on an insurance premium than you would if you paid out of pocket. But most seniors are likely to need more care than that, making dental insurance a viable way to help offset those costs. For example, 19% of Medicare beneficiaries spend over $1,000 a year on dental care .
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When Is The Enrollment Period
There are various Medicare enrollment periods during which a person can enroll in or switch Medicare Advantage plans.
- Initial eligibility period : A person can enroll in Medicare Advantage during their IEP. This period starts 3 months before the month in which they turn 65, includes their birthday month, and ends 3 months later.
- General enrollment period : People can make one change during the GEP, which runs from January 31 to March 31 each year. They can also switch from an Advantage plan to original Medicare or change Advantage plans.
- Medicare open enrollment period : The OEP runs from October 15 to December 7 each year. A person can enroll in, switch, or drop an Advantage plan. The OEP is also known as the annual enrollment period .
- Medicare Advantage open enrollment period: Between January 1 and March 31 each year, a person can change from an Advantage plan to original Medicare or enroll in a Medicare Part D prescription drug plan.
To enroll in a Medicare Advantage plan, a person must have original Medicare and live in the planâs coverage area.
How Much Dental Coverage Do Seniors Need
Seniors are more likely than younger patients to need major services like crowns, root canals, and dentures. Because these procedures can be expensive without insurance, its usually a good idea to purchase as much insurance coverage as you can comfortably afford. Its also a good idea to set aside money for future dental expenses.
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What Does Dental Insurance Typically Exclude
The most affordable dental insurance plans typically exclude coverage for basic and major services and only cover preventive care such as cleanings. Here are some examples of excluded coverages:
- Basic services like fillings or major services like crowns or bridges
- Natural or alternative treatments like acupuncture
- Some companies limit anesthesia in certain circumstances
- Many companies exclude orthodontics, even on their top-tier plans
- Pain management may be limited or excluded and subject to frequency limits and waiting periods
- Pre-existing conditions
Once you reach the annual coverage maximum, you will receive no more coverage, and additional work will be excluded until the next year.
When considering exclusions on dental insurance, remember that you have various choices of coverage. Dental insurance plans vary depending on the provider, with the least expensive plans often providing only very limited preventive or routine services. The benefit level you choose will determine how much coverage you have vs. how much work will be paid out of pocket.
Here is an overview of what each type of coverage is typically defined as.
Best For Preventive Care: Cigna
We selected Cigna as the best for preventive care because they are not only affordable, but they have $0 deductible and $0 copay preventive dental plans and make life easy with 24/7 customer service and zero-paperwork claims.
In-network preventive care paid at 100%
No waiting period for preventive/diagnostic care
Online claims handling and an app to manage claims
24/7 service and access to a health information line
Basic plan only covers preventive services
$1,000/$1,500 maximum annual benefit
Cigna has been in business for more than 225 years and currently serves over 17 million U.S. dental insurance customers individually and through employee benefit programs. AM Best gives Cigna an A rating for financial strength. Cigna was our number-one choice for best for preventive care for seniors based on several factors, which include:
- No deductible and no copay for preventive care that includes cleanings and routine x-rays
- A nationwide network of over 92,700+ dentists
- No need to file claims in-networkyour dentist does it for you
- Their Brighter Score tool rates dentists based on affordability and patient experience
- 24/7/365 customer support and more
There is a six-month waiting period for basic coverages and 12 months for major work. If you have 12 months of prior continuous insurance with another provider, you can make the switch to Cigna, and the waiting periods may be waived.
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Best For Annual Maximums: Renaissance Dental
With a high annual maximum of $3,000, Renaissance Dental is a good choice for seniors who have a major dental expense coming up.
Plans with no waiting period
Participating dentists submit the claim for you
Loyalty program with increasing annual maximums
Possibility to bundle dental with vision care
Cleanings covered up to twice a year on some plans
Annual maximum of $3,000 is only available in the Max Plus Plan
Can be expensive depending on the state
No orthodontics for seniors
Renaissance was founded in 1957 and covers over 13 million people for dental, vision, life, and disability insurance. They have an AM Best Financial Strength Rating of A+ .
Premiums for Renaissance plans can vary a lot. You can see your price on their website.
Renaissance has no waiting periods on cleanings on any plan. Nor is there a waiting period for fillings or crowns on the MAX Choice Plan and MAX Choice Plus.Annual maximums range from $1,000 on their very basic plans up to $3,000 on the top tier plan. There is a $50 deductible for individual plans and a $150 deductible for family plans.
Some of Renaissances basic plans exclude major work like root canals or crowns. However, if you remain insured with them, they reward loyalty with a coverage increase on major work each year, providing up to 50% coverage for major work starting at year two.
Humanaone Dental Savings Plus Discount Plan
This is the simplest and most affordable dental program offered by Humana, and the Savings Plus is a discount plan as opposed to traditional coverage. Typically, members pay a set price per individual, per couple, or per family to enjoy immediate discounts of up to 40 percent on many dental services through in-network providers with no waiting periods.
Many providers offer enrollment to uninsured patients in HumanOne Dental Savings right in their office to cover expenses for their visit that day. Beyond general dentists, members also qualify for discounts with specialists, including orthodontists, oral surgeons, and endodontists, periodontists. Benefits include:
- Cleanings, exams, x-rays, crowns, implants, root canals, dentures, and more
- No annual limits and no waiting periods
- All patients qualified
- No pre-authorizations for treatment
- No paperwork to fill out and patients pay only the plans set amount per service
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Option : Standalone Dental Plan For Seniors
Some health insurers offer dental coverage for seniors as standalone dental plans. These add-on plans are a great choice for dental coverage if you only have Original Medicare or if you have a Medicare Supplement plan.
When selecting a plan, compare coverage details and plan specifics because there is a broad range of policies on access and restrictions. Each plan will specify how much it covers for preventative dental care, basic services or major services. Most plans have a network of providers, and checking this list can make sure you have access to your preferred dentist.
The best dental insurance plans for seniors are from DentaQuest, Aetna and Humana.
DentaQuest: best customer satisfaction
Remember to compare plans based on the waiting period, and some policies may not cover major services until you’ve had the policy for several months. Humana is a great option if you need dental care immediately because most plans have no waiting period for major services like root canals, crowns and dentures.
Many providers may also offer an alternative to dental insurance called a dental discount program. These dental network programs aren’t the best fit for everyone, but we recommend them as one of the five ways to get a cheap dental cleaning without insurance.
Best Value: Delta Dental
Delta Dental offers plans geared toward seniors either through the AARP and directly on their website. They provide a lot of information and resources for retirees on their site, and they were one of the few insurers we reviewed offering immediate coverage for fillings, denture repair, tooth removal, and root canals in the AARP Plan.
No waiting periods for many services
Guaranteed acceptance for AARP members
12 month waiting period for major work on some plans
PPO plans feature deductibles and maximums
Delta Dental is the leading provider of dental insurance in the U.S., offering coverage in all states and serving over 80 million Americans. Delta Dental is a not-for-profit organization made up of 39 independent Delta Dental companies. They have an AM Best financial strength rating of A .
Delta Dental has contracted with AARP to provide members with special pricing to help seniors fit dental insurance into their budgets, and there are HMO and PPO plans available. The HMO is the cheapest option, followed by the PPO B, and lastly, the PPO A is the most expensive option. The PPO plans allow you to choose any dentist, while the HMO plan utilizes a network of dental facilities.
There is no annual maximum and no deductible on the DeltaCare USA plan. The PPO plans have an annual maximum of $1,000 to $1,500 with deductibles ranging from $40 to $90 depending on service and plan.
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Does Medicare Cover Dental Work
No. However, there are some exceptions:
- X-rays related to treating a fractured jaw or facial bone
- Removal of teeth to prepare the jaw for radiation treatment of a tumor
- An oral or dental exam performed on an inpatient basis as part of a work-up before kidney transplant surgery or heart valve replacement
- Dental care that is integral to another Medicare-covered procedure, e.g., wiring teeth when treating a jaw fracture
So, if you have Original Medicare , most regular dental care will not be covered. However, if you have a Medicare Advantage plan , theres a good chance that your plan includes dental benefits. As of 2020, 88% of Medicare Advantage plans offer some type of dental coverage, according to the Kaiser Family Foundation.
How Much Coverage Does Dental Insurance Provide
Dental plans require you to pay many of the same out-of-pocket costs as regular health insurance, including a monthly premium, a deductible, copays and coinsurance.
The coinsurance you pay will likely be more than youre used to paying. For example, Medicare beneficiaries are typically responsible for 20% coinsurance, but its not unusual for dental plans to require 40% coinsurance or higher.
Another important factor to consider is that dental insurance plans often have a cap , and its usually very low . After you meet the maximum, youll pay for 100% of the cost of your care.
For years when preventive care and a filling or two are the only services you need, that works just fine. But if you need more than very basic dental work, you will quickly exceed that benefit. For example, the cost of a root canal and crown together can be upward of $3,000.
There are plans that have no annual limit, but be aware that even dental insurance that bills itself as comprehensive or full coverage almost certainly will not cover 100% of the cost of your dental care.
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How Will You Plan To Pay Unexpected Dental Bills
Planning ahead can be particularly important, especially if you’re on a fixed retirement income. With the national average Social Security benefit at about $1,650 a month,2 paying out-of-pocket for a root canal costing $900 or more, for example, can be difficult for many people. And keep in mind Medicare doesn’t cover dental care.3
So, just as you would plan for unexpected medical bills, you also need to consider how you’ll pay for unexpected dental bills. But there’s good news. You can get help paying big dental bills with affordable dental insurance from Physicians Mutual Insurance Company.
The Dentist And The Entire Cost
Dentists are open to negotiating prices and often will offer a discount if you pay for a procedure when you get the service.
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Aflac pays the most general dentist, usually change depending on dhmo plans for seniors and should note of prior to humana dental insurance for seniors could mean much?
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How Much Life Insurance Do I Need? The reason for the difference in effective dates is due to the member having to select a primary care dentist and being included in the monthly membership rosters sent to providers. What dental services are available on the NHS?
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This is too many ways to twelve months for humana dental insurance products are longer offers a variety of the covered.
|Depending on your health care needs, Cigna offers an increased range of services, whether that is more intensive treatments, personalized care treatments, or more individual specialist attention. Preventative Plus for Veterans gives extra discounts on prescriptions.. End Endowment Subscribe to our calendar to receive notifications and updates!
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What Are Dental Discount Cards
Another facet of dental insurance for seniors is whats known as dental discount cards or savings plans. These cards are supplemental to dental insurance and not a replacement instead, a cardholder will pay an annual fee instead of a monthly premium. A discount plan holder will receive special discounts and reduced prices on select procedures outlined in the plan.
While dental discount plans arent insurance, they could be a cheaper option for those who cant afford insurance and instead pay for all dental work out of pocket. Discount plans, like insurance, give customers a limited list of providers to choose from. Practitioners who participate in the dental discount plan have agreed to the reduced pricing structure associated with the card. These discount plans are not insurance, and payment for dental procedures is given directly to dentists.
Aetna Best Dental Provider Network For Seniors
Aetna comes second in our list of dental insurance companies as their dental provider network works in conjunction with the Careington network, making them one of the largest dental provider networks in the country.
Dental plans from Aetna also allow policyholders to utilize benefits for vision and hearing along with dental coverage. To enroll in an Aetna dental plan, you do not need to be eligible for Medicare. The plans are guaranteed issue, meaning there are no health questions necessary for enrollment.
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Aetna dental provides 60% basic and preventive coverage from day one. After the first year, basic and preventive coverage jumps to 70%. In the third year and every year moving forward, preventive and basic services receive 80% coverage. For major dental benefits, a 12-month waiting period applies. Once the waiting period expires, you receive 60% coverage each year moving forward for major services.
Option : Medicare Advantage Plans With Dental Coverage
Dental coverage varies widely by Medicare Advantage plan. In some cases, you have to pay extra to have dental care included in your plan. There could also be options for basic or premium coverage, letting you choose the dental plan that works for you.
Look for plans that offer low-cost or free preventative services. If you need more expensive treatments, pay attention to the plan’s cost-sharing percentage and the cap on how much the plan will cover each year.
The best Medicare Advantage plans for dental coverage are from AARP/UnitedHealthcare, Aetna and Highmark.
AARP: largest network of dentists
Among our picks for the best Medicare Advantage plans, Aetna has the cheapest monthly costs. The company reimburses policyholders for in-network dental coverage, and it provides the option for expanded dental benefits at an additional monthly cost. This can be a great way to manage your expenses if you need significant dental services in the upcoming policy year.
If you’re signing up for a new Medicare Advantage plan, you can choose your dental coverage options during the plan selection process. If you’re already enrolled in Medicare Advantage, talk to your provider about what dental coverage options are available to you, and if there is no add-on coverage available, you may be able to enroll in a standalone dental policy.