Dental Benefits with Medicare Plans

Buying insurance used to be very easy. Your employer gave you three options and you chose the one you liked. Now you are turning 65, and there are options with Medicare that you didn’t even know existed. 

Medicare has two basic types: original Medicare and Medicare advantage. Original Medicare is managed by the federal government and is not operated for profit. Medicare Advantage plans are managed by private insurance companies which are often operated for profit. These insurance companies get a flat-rate payment from the government to provide health care for the enrollee. They manage costs in order to provide the needed services and still potentially have a profit. They also will offer “extra benefits” to entice seniors to use their plan. One of those extra benefits is dental insurance, but is it worth it? We have broken down the differences between the Medicare plans and have included a few things we have observed about the plans.

Original Medicare:

• Managed by the Federal Government and is a not for profit program
• Freedom to go to any doctor or hospital in the country that accepts Medicare
• No network or geographic restrictions
• In most cases do not need a referral
• Care is controlled by Doctor as long as Medicare covers procedure
• Need a Medigap policy (Part C, D, F, G, K, L, M, N) to cover expenses that Medicare doesn’t cover
• No out-of-pocket expenses cap
• Need prescription drug policy (Part D)
• Does not have dental benefits

Medicare Advantage:

• Managed by private insurance companies
• HMO or PPO Managed Care plans
• Must go to in-network doctors and hospitals
• Networks are based geographically; if nonemergency care is needed away from home, plan may not cover it
• Bundles hospital, doctor and prescription drug coverage
• Most have extra benefits like basic dental (look for plans with Allowance Plans for dental), vision, and hearing
• Has a cap on out-of-pocket expenses
• Good plan if healthy, more difficult to get need care for serious illness

Before making your decision look at several plans, Original Medicare plus Medigap plans, and Medicare Advantage plans. Look for what best suits your health needs, not at what has the cheapest plan. Usually the cheapest plan will also have the lowest benefits, and will end up costing you more. If you decide on a Medicare Advantage plan, get one that has a dental allowance plan. This will give you a set dollar amount each year for your dental needs. The plan will pay all fees until the allowance is used for that year. 

 Two plans we have had good results with are Aetna Direct Member Reimbursement Allowance and Cigna Medicare Advantage Dental Allowance Plans. These plans have dental allowances ranging from $500.00 to $3,000.00 annually. The Aetna plan requires the patient to pay up front, and send the receipt and reimbursement form in for payment. The Cigna plan pays the dentist directly.

The good news is, if you choose a plan and decide it is not working for you, open enrollment occurs every fall and you are able to make changes to your plan for the following year. Everyone has different health needs and Medicare has lots of options to meet those needs.