How Much Is A Medicare Advantage Plan’s Free Dental Care Really Worth?

A buddy texted me lately about his neighbor.

“I’m reaching out for Jerry. He has free dental via his Medicare Benefit plan. He has no prime tooth left and desires dentures. His dentist quoted him $1,800. He had some fillings and such earlier this yr and there was no invoice. He needs to know why now, nearly $2,000?”

Medicare protection of dental providers

Earlier than determining Jerry’s scenario, let’s evaluate some fundamentals about Medicare.

• Medicare doesn’t cowl routine dental care, preventive providers, most dental procedures corresponding to fillings and tooth extractions, or dental units like dentures and braces.
• Medicare can cowl medically essential dental procedures which might be an integral a part of a lined service, corresponding to reconstruction of a jaw following an accident.
• Efficient in 2023, Medicare pays for diagnostic and remedy providers to remove a dental an infection previous to or with, an organ transplant, bone marrow transplant or cardiac valve substitute. (Beforehand, Medicare lined solely the examination.)
• Medicare additionally covers extraction of tooth to arrange the jaw for radiation remedy and reconstruction after tumor removing.

What to find out about Medicare Benefit dental care

• Most Medicare Benefit plans (98%) provide dental advantages, included within the plan’s premium.
• The protection can differ. Some plans provide solely preventive dental providers, corresponding to oral exams, cleanings, dental X-rays, and fluoride remedies. Different plans present complete dental to keep up and deal with issues, together with fillings, extractions, and root canals. Many provide a mixture of the 2 providers.
• Plans can set a most restrict, probably the most it’s going to pay in a calendar yr for lined providers. In 2021, the typical restrict was $1,300.
• Many plans provide a possibility to improve the providers for a further price. For instance, paying a month-to-month premium of $35 can improve the plan’s most restrict and/or add extra lined providers.

In case your Medicare Benefit plan affords dental protection, know these necessary factors.

• Test the plan’s listing to discover a dentist. In-network care is at all times your best choice. If the plan covers out-of-network providers, chances are you’ll pay extra.
• Overview the Proof of Protection (EOC) for advantages, protection standards, exclusions or limits on the frequency and greenback worth of remedies. As an illustration, some plans cowl dental implants.
• Take note of any guidelines. One common plan’s EOC notes if the care you want will price greater than $300, you or your dentist ought to submit a pretreatment plan. This is able to verify that the providers are lined and supply an estimate of the price.
• Discover out the plan’s annual most restrict. If you happen to want in depth dental remedies, get a quote first.
• Examine how the fee works for these providers. If you happen to use community suppliers, the plan could pay them straight. Some plans have a reimbursement allowance. You possibly can see any supplier, however you would need to pay the invoice after which submit receipts.
• Consider the price and advantages of a plan improve. Would paying extra on a month-to-month foundation present the protection you want?

Again to Jerry. I checked the Proof of Protection for his plan, accessible on the plan’s web site. He has protection for exams, cleanings, fillings, crowns, bridges, root canals, and partial and full dentures with a restrict of $1,000. The dental work Jerry had accomplished earlier in spring doubtless reached that restrict so he must pay for procedures going ahead this yr or postpone no matter he can till subsequent yr.

Medicare’s Open Enrollment Interval is across the nook, October 15-December 7. It’s a good time to evaluate your Medicare Benefit plan’s advantages, prices and protection, and take a look at what different choices they provide. Nevertheless, your medical care and medicines needs to be your precedence.

And keep in mind, “free dental care” is free solely as much as the plan’s most restrict.