By Marcus A. Brummett  –  June 21 2017

Many people are unsure about Dental Coverage.  Is it worth it?  Does Medicare cover it?  What IS covered?

Let’s start out by answering what Medicare Covers.  I quote directly from Medicare.gov

  • “Medicare doesn’t cover most dental care, dental procedures, or supplies, like cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices.  Medicare Part A (Hospital Insurance) will pay for certain dental services that you get when you’re in a hospital. Part A can pay for if you need to have emergency or complicated dental procedures, even though the dental care isn’t covered.”

You can learn more about Part A coverage here: Helping Hand Medicare: Part A

So, original Medicare doesn’t invest much into dental care.  What next?  I will cut to the meat of it quickly.  I have yet to see a dental plan from any insurance carrier or discount plan that was very impressive.  Many people who have a plan and have a covered procedure can still expect a potentially large bill. They also usually come with a long list of procedures that are not covered, though many typical procedures are covered.  Many on Medicare who have a dental plan have gotten their plan through an add-on to their Medicare Advantage Plan or an individual Dental policy. These plans typically cost $300 – $400 a year, have various deductibles and co-pays, and free cleanings.  Sounds fine.  However, most of these policies have a Maximum Benefit of only $1000.  I have seen plans cover up to $2000 with a premium closer to $400 – $500 a year.

Now let’s evaluate these Medicare advantage plan’s and individual dental plans:

Example 1 :

If you have a Max. Benefit of $1000 AND you have a premium of $350, then you have $650 in actual benefit.   Most come with a free cleaning if you visit an in-network doctor, and often even an out-of-network doctor as well.  So that should save you around $200 a year.  So in total you could save $850 if you had a major procedure that was covered.

Example 2 :

If you have a Max. Benefit of $2000 AND you have a premium of $450, then you have $1650 in actual benefit.   After savings from your cleanings $1850.  So in total you could save up to $1850 if you had a major procedure that was covered.  That’s about a 35% increase in premium for  over a 217% increase in benefit from option 1. 

So here’s my question to you:

What’s important to you?  Is having coverage in case you need or want an unforeseen procedure important to you?  Do you need work done often or do you just go for your 2 yearly cleanings?  This is where each person has to decide what’s best for themselves.  So here’s the 3 basic paths you can look to:

Option 1:

You can avoid paying extra premiums and pay out of pocket for cleanings and any procedure that comes up.

Option 2:

If you know you need work done and the Dental Plan covers that service, then it would likely be a wise choice to purchase a policy.  You need to make sure the plan will pay for the Dentist you are using.  He or She may not have to be in network, but they do have to accept and file the plan.  In this scenario, your plan must also have out-of-network benefits.  If not, you will need to either change Dentists or find a different plan.

Option 3:

Maybe you have great Dental health and have no immediate needs, but you want to insure yourself in case an unforeseen problem occurs.  This is insurance after all.  We carry it on our cars, our houses, our families, and ourselves in case something happens.  Often we do this because we’ve experienced loss ourselves and have seen others go through it.  Dental insurance is no different.  It’s ultimately a service paid for that we hope is not needed, but are glad it’s there when we do.

Aside from the Medicare Advantage Plan’s and Individual dental plans, you can also seek out cost-reduction plans also called dental savings or discount plans.  These premiums will run somewhere between $50 and $200 a year.  Their cost sharing can change from plan to plan and they most often have a specific network of Dentists that you must use to receive the benefit.   Their cost sharing is a bit more vaguely worded than a typical dental plan.  This makes them harder to break down into precise cost comparisons.  Though they often list specific costs for each procedure, you must contact the company and review the procedure to determine if the listed co-pay is actually the entire cost for which you are responsible.  These plans don’t usually come with a limited Maximum Benefit, but also don’t usually cover as wide of a range of things as a standard dental plan will.   These plans can be very attractive if you have a dentist in network already.  Their low premium combined with their co-pays are competitive.

Whether you pick a Discount Plan or a Standard Dental Plan, you will be at less risk for a high cost out-of-pocket Dental service.  It’s now time to find specific plans in your area and compare them.  They change from county to county and the right fit changes from person to person.  I hope this article helped provide some perspective and empowered you to make a wise choice.  If you need more specific advice, have questions, or would like to enroll into a plan you can contact me here  or call 423-760-0318.

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