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Kaiser Medicare Advantage Dental Benefits

Medicare Advantage Dental Benefits

Medicare Advantage Enrollment | Kaiser Permanente

Medicare Advantage plans may provide extra benefits that are not covered under traditional Medicare, such as dental, vision, hearing, and fitness benefits. The cost of these benefits may be covered using rebate dollars. Plans can also charge additional premiums for such benefits. In 2021, 94% of Medicare Advantage enrollees in individual plans, have access to some dental coverage. The majority of these Medicare Advantage enrollees have access to a plan with more extensive coverage, while 14% had access to preventive coverage only. Preventive dental coverage under Medicare Advantage plans generally includes oral exams, cleanings, dental x-rays, and sometimes fluoride treatments. More extensive benefits cover a range of services, including restorative services , endodontics , periodontics , prosthodontics , and oral surgery.

The Scope of Covered Dental Benefits Varies Across Medicare Advantage Plans

Virtually all Medicare Advantage enrollees in plans that offer access to dental benefits , have access to preventive services, including oral exams , cleanings , and x-rays , although fewer enrollees have access to fluoride treatment .

like other dental benefits, coverage for dentures varies across plans

Medicare Advantage Plans That Offer Dental Benefits Typically Have an Annual Dollar Cap on Dental Coverage

Preventive Services Are Often Covered Without Cost Sharing For More Extensive Dental Services, 50% Coinsurance and Caps Are the Norm

Using Kaiser Medicare Dental Coverage

Kaiser Medicare Advantage plans may only be used at Kaiser Permanente hospitals and medical facilities. The company operates hundreds of facilities, including dentist offices, in the states in which its plans are sold.

Kaiser Medicare plans are often structured as HMO plans, which is a type of coordinated care. That means plan members utilize a primary care physician who coordinates care and issues referrals within the Kaiser network.

Do All Medicare Advantage Plans Cover Dental Services

No â although many Medicare Advantage plans cover routine dental care, not all do. That� � âs why it may be a good idea for you to compare Medicare Advantage plans. That way, you can see which Medicare Advantage plans cover dental services and other benefits that are important to you. For example, if routine vision and hearing care are important to you, you can look for such coverage when you compare plans.

One easy and quick way to compare Medicare Advantage plans â with no obligation to enroll â is to use eHealthâs plan comparison tool. All you need to do to get started is enter your zip code on this page.

You may have to pay a deductible and/or coinsurance or copayment for these services in Medicare Advantage plans with dental coverage.

Itâs important to keep in mind that Medicare Advantage plans are offered by private insurance companies contracted with Medicare. These private insurance companies must cover everything that Original Medicare covers, and might offer additional coverage as well. Routine dental services would be considered additional coverage.

Medicare Advantage dental services may vary from plan to plan. As you browse through Medicare Advantage plan descriptions, look under the âdental servicesâ section. If it says âMedicare-covered benefitsâ you may not get any coverage beyond what Original Medicare covers, which does not include routine care.

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Kaiser Permanente Dental Coverage

Kaiser Permanente Medicare Advantage plans include the limited dental coverage that is found in Original Medicare , and certain plans may also cover routine dental care that includes exams, teeth cleanings and X-rays, along with more advanced care such as:

  • Diagnostic services

Kaiser Medicare Advantage members who do not have dental benefits included in their plan may be able to purchase Advantage Plus, which is the companys optional supplemental benefits package. This package, available for an added premium, includes dental, vision and hearing coverage.

Open Enrollment Ends Dec 7 For The 2023 Year If Ads And Options Are Confusing Expert Advice Can Help

Kaiser Dental Insurance / Kaiser Permanente Dental Plan On Vimeo

This Nov. 8, 2018, file photo shows a page from the 2019 U.S. Medicare Handbook in Washington.

Pablo Martinez Monsivais, Associated Press

If your answering machine, mailbox and email inbox have been filled with ads concerning Medicares open enrollment period, which ends Dec. 7, youre in good company. Close to 65 million Americans are facing the annual task of picking their best health coverage.

Its not as easy as throwing a dart at the board.

As Jeannie Fuglesten Biniek, a senior policy analyst at the Kaiser Family Foundation and a co-author of a recent literature review comparing Medicare Advantage and traditional Medicare, recently told The New York Times, Its a very consequential decision and the most important thing is to be informed.

Theres a lot to unpack:

Medicare beneficiaries pay a monthly premium for the different parts of Medicare. Part A provides hospital care, Part B provides physician and outpatient care and Part D provides drug benefits. Patients with original Medicare may also purchase supplemental insurance, which is sometimes called Medigap. Part C insurance is a Medicare Advantage plan, which often includes parts A, B and D, according to Medicare.gov.

Traditional Medicare pays for services as they are needed.

Enrollment between the two types of Medicare is close to even: 48% are in Medicare Advantage plans now.

While the differences between the two are real, Biniek said that most people are satisfied with their plan, whichever one they chose.

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Enrolling In Kaiser Medicare Dental Coverage

Follow these steps to apply for a Kaiser Medicare plan that may include dental coverage.

  • Enroll in both Medicare Part A and Part B. This is a requirement for applying for any Medicare Advantage plan.
  • Be sure you live in one of the states in which Kaiser sells Medicare Advantage plans. That list includes California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, or Washington D.C. You may only enroll in Medicare Advantage plans that are sold where you live.
  • Leverage the help off a licensed insurance agent to help you find Kaiser Permanente Medicare Advantage plans available in your area and to review the costs and benefits.
  • Be sure to indicate to the agent that you wish to enroll in Advantage Pus, Kaisers optional supplemental benefits package that includes dental coverage.
  • Be ready to enroll when its time. You may only enroll in Medicare Advantage plans at certain times of the year, such as when you first enroll in Original Medicare and during the Annual Enrollment Period that takes place each fall.
  • Keep in mind that many Medicare Advantage plans include dental coverage, and many do so for a $0 monthly premium. An agent who is licensed on behalf of multiple insurance carriers can help you review additional dental plan options available in your location.

    Emergency Or Urgent Dental Care

    Emergency or urgent care administered at a Kaiser-approved facility requires a small copay and all other applicable copayments, coinsurance or other plan charges apply. Such care delivered at a non-Kaiser facility requires a larger copayment, and plan members are responsible for all charges exceeding a certain limit.

    The annual dental benefit maximum does not apply to emergency or urgent care, which includes care for pain relief, acute infection, hemorrhage or injury.

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    Advantage Plus Optional Supplemental Benefits

    Get more value from your Kaiser Permanente Medicare health plan by adding Advantage Plus. Youll get additional benefits such as dental, vision, hearing, and more all in one convenient package so you save time and money.

    Enrollment dates

    You have a limited time to enroll in Advantage Plus. It depends on when you enroll in a Kaiser Permanente Medicare health plan.

    If you are a new Kaiser Permanente Medicare health plan member, are switching to a different Kaiser Permanente Medicare health plan or you have moved to a different Kaiser Permanente service area that offers Advantage Plus:

    You can add Advantage Plus within 30 days of your Kaiser Permanente Medicare health plan effective date.

    Coverage for Advantage Plus is typically effective the first day of the month following the date we receive your completed Advantage Plus enrollment form.

    • You may enroll between October 15 and December 31, 2022, for coverage to be effective on January 1, 2023.
    • You may enroll between January 1 and March 31, 2023, for coverage to be effective the first day of the month following the date we received your completed Advantage Plus enrollment form. The Advantage Plus enrollment form must be received in our office by March 31, 2023.

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    What Do Kaiser Medicare Advantage Plans Offer

    Medicare Advantage (HMO) Plan Helps Denise Live Her Best Life | Kaiser Permanente

    Medicare Advantage plans help with savings by using networks of healthcare resources. By doing so, these plans cover many of the out-of-pocket expenses not covered by Original Medicare. Many Medicare Advantage plans also offer benefits that go far beyond what you get with Original Medicare, and Kaiser Permanentes Medicare Advantage plans are one such example. Hereâs what these plans have to offer, according to Kaiser Permanenteâs official website.

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    What Are The Different Types Of Dentists

    General Dentists: provide all the services you need to maintain healthy teeth and gums.These services include preventive care like cleanings and checkups, along with restorative services suchas fillings, root canals, crowns and other treatments for broken or missing teeth. They also providecosmetic services such as overlays and whitening treatments.

    Endodontists: help heal infections of the soft tissue inside the tooth and are typicallythe dental specialist youd see if you need a root canal treatment.

    Oral and maxillofacial surgeons: focus on treating problems related to the hard and softtissues of the face, mouth, and jaws. Youd likely go to an oral surgeon if you have an impacted wisdomtooth or need another type of other complicated extraction.

    Orthodontists: correct the position of misaligned teeth and jaws, typically this is donewith braces although treatments using other dental devices are also utilized.

    Periodontists: these dentists specialize in treating complex cases of gum disease, alongwith other infections or problems involving the tissues that support the teeth.

    Prosthodontists: restore damaged teeth or replace missing ones, with procedures thatinclude dental implants, bridges, crowns and dentures.

    Pediatric Dentists: provide dental care for children and young adults.

    How To Enroll In Medicare Plans That Include Dental Insurance

    You can enroll in a Medicare Advantage plan when you first become eligible for Medicare or during the open enrollment period, which runs from Oct. 15 to Dec. 7 this year, says Worstell. He suggests visiting Medicares plan comparison website and entering your ZIP code to see each plan youre eligible for and whether they include dental benefits. You can click into each plan summary to learn more about what that dental coverage includes.

    You can also enroll in a Medigap plan at any time throughout the year, says Worstell. However, he suggests doing so when you first become eligible for Medicare, since thats when youre likely to get the best rate.

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    Does Kaiser Senior Advantage Cover Cataract Surgery

    • Kaiser Senior Advantage plans do cover cataract surgery. All Medicare Advantage plans cover cataract surgery, and some Kaiser Medicare plans may cover extra vision benefits such as prescription glasses, eye exams and more.

    Cataracts are a symptom of aging, and more than half of adults over the age of 80 are either living with cataracts or have had surgery to correct them.

    Fortunately, Medicare Part B provides coverage for cataract surgery. But what about a Medicare Advantage plan like Kaiser Senior Advantage?

    All Medicare Advantage plans including Kaiser Senior Advantage Medicare plans are required to cover all of the same services and items that are covered by Original Medicare . And because Original Medicare covers cataract surgery, so too do all Medicare Advantage plans including Kaiser Senior Advantage plans.

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    What Should I Know About Drug Plans

    Western Dental

    Unlike most Medicare Advantage plans, traditional Medicare does not include drug coverage. For that, you must buy a separate Part D plan.

    For 2023, beneficiaries can typically choose between 24 stand-alone Part D plans, at premiums that range from $6 to $111 a month and average $43 for policies available nationwide, said Juliette Cubanski, the deputy director of the program on Medicare policy at the Kaiser Family Foundation.

    If youre the person who doesnt take many medications or only uses generics, the best strategy might be to sign up for the plan with the lowest premium, Dr. Cubanski said. But if you take a lot of medications, the most important thing is whether the drugs you take, especially the most expensive ones, are covered by the plan.

    Different plans cover different drugs and place them in different pricing tiers, so how much you pay for them varies. And, to make comparisons more dizzying, certain pharmacy chains are preferred by certain plans, so you could pay more at CVS than at Walmart for the same drug, or vice versa.

    How does Part D work? First, most stand-alone plans have a deductible: $505 in 2023. You pay that amount out of pocket before coverage kicks in.

    Drugs on the next highest tier, for nonpreferred brand-name drugs, usually involve coinsurance paying a percentage of the drugs list price rather than a flat co-pay. For national stand-alone plans, that ranges from 34 to 50 percent, Dr. Cubanski said.

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    Why Choose Medicare Advantage

    Now that youve learned about the 4 parts of Medicare and when to enroll, its time to consider which plan best fits your needs Original Medicare or a Medicare Advantage plan.

    Good health is essential, so finding a plan that supports your health, lifestyle, and budget is important. Consider your care needs and what your life may be like after you turn 65. You might want a plan that includes affordable prescription drug coverage and limits how much you spend out of pocket. From added benefits to more predictable costs, Medicare Advantage offers more than Original Medicare alone.

    Medicare Advantage combines everything you get in Original Medicare with other benefits, like prescription drug coverage. Medicare Advantage plans also have predictable costs with set copays, which can make it easier to plan your expenses.

    Youll need to enroll in Original Medicare with the federal government before you sign up for Medicare Advantage from a private health care provider. Then the private provider will become your primary insurer.

    Get care designed to make your life easier choose a Kaiser Permanente Medicare Advantage plan

    With Kaiser Permanente, your doctor, specialists, and health plan all work together to make it easier for you to get care. And when you move your coverage to a Kaiser Permanente Medicare Advantage plan, youll get comprehensive care at a great value.

    You can count on:

    Value and affordability

    Ease and convenience

    Quality and service

    Get more information

    How Current Proposals Would Add A Dental Benefit To Medicare

    In the 116th Congress, the House of Representatives passed the Elijah E. Cummings Lower Drug Costs Now Act , which among many provisions, provided for dental coverage under Part B of the Medicare program, starting in 2025 if enacted into law. Medicare would cover 80% of the cost of preventive services and basic treatments, and would phase up coverage for more major treatments, covering 10% of the cost in 2025, increasing 10 percentage points per year to 50% in 2029 and thereafter. The Congressional Budget Office estimated this benefit would cost almost $238 billion over 10 years . The recently reintroduced version of H.R. 3 does not include coverage for a dental benefit.

    Representative Doggett introduced the Medicare Dental, Vision, and Hearing Benefit Act in July 2021 that would provide dental coverage under Medicare Part B. In contrast to H.R.3, the proposal, according to a press release, would require no coinsurance for preventive services, and impose a 20% coinsurance for more extensive benefits, which is similar to how the Part B benefit is structured for physician and other outpatient services, and is lower than the 50% coinsurance typically charged by Medicare Advantage plans.

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    What We Like About Kaiser Medicare Advantage

    • No copays for preventive care: Regardless of the plan you choose, you will not pay copays for qualifying preventive care. That means if you need to go to the doctor for vaccines, blood tests, checkups, or similar care, you will not have to pay anything. This could end up saving you hundreds of dollars per year in out-of-pocket medical expenses.
    • Emergency coverage abroad: One of Kaiser’s biggest advantages over other providers is its coverage for seniors who travel abroad. With Kaiser, you can travel anywhere in the world with the peace of mind that you have emergency health coverage if you need it.
    • Comprehensive telehealth care: Many seniors struggle with mobility issues, which can make even routine doctor’s visits a challenge. Kaiser offers various telehealth services so Part C enrollees can call or video chat with providers from the comfort of their own homes.
    • Multifaceted Kaiser Permanente app: Kaiser has a mobile app to make communication and scheduling even easier. You can ask non-routine medical questions and schedule appointments with your doctor. This way, you do not need to wait on hold to speak to a medical professional or representative at your local clinic. If you forget when you have an appointment or need to review medical information, you can open the app to view or change appointments, read test results, and look over notes from your doctor.

    Is Medicare Advantage Cheaper Than Medicare

    Medical Dental: Integrated Care for a Healthier, Happier You | Kaiser Permanente

    The costs of providing benefits to enrollees in private Medicare Advantage plans are slightly less, on average, than what traditional Medicare spends per beneficiary in the same county. However, MA plans that are able to keep their costs comparatively low are concentrated in a fairly small number of U.S. counties.

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