Dental Benefits with Medicare Advantage

By Martin Hurst, Insurance Service Representative

Medicare provides essential health care coverage for individuals over 65, but it does not cover routine dental services such as cleanings, exams, fillings, or dentures. For those in need of dental care, there are a couple options to enhance your Medicare coverage. You can consider Medicare Advantage plans that include dental benefits or opt for a standalone dental insurance plan.

While Medicare Advantage plans can be beneficial, they aren’t the best choice for everyone. These plans often face criticism due to having limited provider networks, higher out-of-pocket costs, and a lack of transparency. These issues can restrict access to care and may provide fewer benefits than expected. It’s important to note that enrolling in a Medicare Advantage plan typically means losing your Medicare supplement plan.

When considering dental plans, we recommend assessing your individual needs and determining the total cost, (including premiums, deductibles, and potential copayments) as well as any waiting periods for certain procedures. Waiting periods for major dental procedures, like crowns or dentures, may apply, and it’s essential to understand these requirements when choosing a plan. For example, treatments like wisdom teeth removal may have waiting periods before coverage kicks in. For individuals with Medicare Supplement plans (Medigap), dental coverage can be added, or separate dental insurance can be purchased. However, it’s important to check whether your preferred dentists are included in a Medicare Advantage plan’s network, because some plans may limit which provider you can visit. As your dental needs increase, it’s vital to carefully consider all available options to ensure both immediate and long-term coverage.

I recently worked with a client who had been enrolled in a Medicare Supplement plan for several years. His dental needs had changed, and he needed his wisdom teeth removed in the near future, which is considered major dental surgery not typically covered by basic dental plans. After reviewing a variety of dental coverage options based on his specific needs, we found several plans that provided coverage for surgical extractions, each with different waiting periods and premiums. One plan had a 12-month waiting period before covering such procedures, while another had no waiting period, but came with a higher premium. By carefully weighing his options, we helped him find a plan that balanced cost with timely coverage, ensuring he was prepared for his dental needs.

To learn more about Medicare and dental insurance options, please contact Martin Hurst at martin.hurst@wismedassure.org or call 608.442.3728.