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Medicare Advantage Dental Benefits In Review

Medicare Advantage Dental | Are “Free” Dental Benefits Worth It?

2022 Medicare Advantage Dental Benefits in Review

Medicare Advantage the alternative to traditional Medicare which allows seniors to receive Part A and B benefits through private insurancecontinues to rise in popularity. As of April 2022, almost half ¹ of all Medicare beneficiaries are enrolled in an MA plan. Due to the aging population and steady growth in demand, the market continues to experience increased competition with new plans entering the market and existing plans expanding their geographic footprint. Large National plans and Blue Cross Blue Shield Association Companies alike are exploring strategies to retain and grow their market share by focusing on member experience and offering plans in new geographies. They are competing against provider-sponsored plans and industry start-ups that aim to disrupt legacy players and gain market share. Medicare Advantage Organizations need to offer effective and targeted supplemental benefits that support holistic care and elevate the member experience to achieve their enrollment targets.

As we highlighted in our previous Executive Brief, offering competitive supplemental dental benefits can help MAOs increase membership while positively impacting overall health outcomes. We have refreshed our previous analysis of the Individual MA supplemental dental benefit market data through 2022 to synthesize new insights and recommendations for MAOs to consider when developing a forward-looking MA supplemental benefits strategy.

Which Medicare Advantage Plans Offer Dental Coverage

Not all Medicare Advantage Plans offer dental coverage. When they do, the services can vary greatly, even within companies. A company may offer dental in one state, but not another, Hill says. If youre looking for dental, you can look up a specific company youre interested in and check with their network of dentists to see which one you like best.

Some samples of available Medicare Advantage Plan dental coverage in 2022 include:

  • Aetna: Dental coverage for as low as $0 monthly premium but with a cap of $750. Coverage up to $3,000 is available but for an additional monthly premium.
  • Cigna: Available to beneficiaries in 23 states and the District of Columbia, dental coverage is offered for as low as $0 monthly premiums in some plans but the coverage limits vary.
  • Humana: Dental coverage for as low as $0 monthly premium with most preventative services costing $35 per service and other services requiring copays of 50% to 70%.
  • Kaiser: Dental coverage is available for an additional premium, but only when grouped with hearing and vision.
  • United Healthcare: Dental coverage premiums range from $0 to over $100 per month, with coverage generally up to $2,000.

Medicare Advantage Covering Early Dental Implant Steps

Finding a Medicare Advantage Plan that covers the early-stage dental implant treatment steps is often easier because these procedures have broad applications.

Dental implant costs for seniors on Medicare are typically the lowest when you can get your plan to pay for these beginning phases. Advantage plans have two components that might honor claims.

  • Dental element addressing oral care. Getting insurance to pay for tooth implants means that plan explicitly lists the specific procedure step as a covered benefit.
  • Medical element mirroring Parts A & B. Getting the health insurance component to cover tooth implants means demonstrating that the procedure is medically necessary: treating a disease, condition, illness, or injury.
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    Best Dental Insurance For Seniors On Medicare Of 2022

    We suggest the best products through an unbiased review process, and advertisers make their choices. You can receive compensation by visiting the recommended partner.

    Medicare Part A and Medicare Part B do not cover routine dental treatment. The policy can help cover dental care costs incurred during surgery or in emergencies.

    Dental Care For Patients Before Or After Organ Transplantation

    Medicare Advantage vs Medicare Supplement

    As noted above, the standard of care for transplant candidates includes the prevention and elimination of oral infection. Such care involves an oral examination that includes visual and tactile inspection of the mouth and is usually accompanied by x-rays. An oral examination also typically includes instruction in personal oral hygiene intended to help patients avoid posttransplant gingivitis and other oral problems. At least one controlled study has found less gingivitis, plaque, or gingival overgrowth in transplant patients who received hygiene instruction compared to those who did not .

    Dental prophylaxis removes plaque, a tenacious film of germs that adheres to the teeth, and calculus that can build up to cause periodontal disease. When periodontal disease is diagnosed, treatmentwhich can be limited or quite extensiveremoves hardened plaque, calculus, and infected tissue under the gum and smoothes the root surfaces of teeth so that damaged tissue can heal and reattach to the teeth. If damage to teeth or gums is serious enough, teeth may have to be extracted. If the base of the tooth root is infected, a root canal may be performed.

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    Best For Potential New Offerings: Wellcare


    WellCare is our top choice for a newcomer to the field of Medicare Advantage plans. Founded in 1985, it’s an up-and-coming provider.

    • Access to a personal emergency response system

    • Easy to navigate website

    • Only available in 36 states

    • Not as established as some other providers

    Founded in 1985, WellCare is a relative newcomer compared to other insurers. We picked them as one to watch for potential new offerings in their Medicare Advantage Plans for two reasons: In 2018, WellCare acquired Aetnas Part D prescription drug plan , and in 2020, they were acquired by Centene, one of the largest providers of Medicaid. This deal-making activity could result in new Medicare Advantage Plan offerings that address specific pricing or feature needs.

    Benefits offered with some WellCare Medicare Advantage Plans include over-the-counter coverage and access to a personal emergency response system. The OTC benefit is a fixed dollar amount for non-prescription medications and wellness-oriented items that can be shipped directly to you. The personal emergency response system, for people who live alone or are left alone for long periods, is connected to your phone and allows you to get emergency help with the push of a button.

    WellCare has greatly expanded its Medicare Advantage offerings since merging with Centene plans are available in 36 states for 2022. The companies offer a full range of plans .

    Do Medicare Supplement Plans Cover Dental

    Medicare Supplement plansalso known as Medigap plansdont directly cover dental, but they pick up some of the out-of-pocket costs like copayments, coinsurance and deductibles, says Worstell. Plus, many insurance companies that sell Medigap plans offer you the option of adding a dental or vision package for an additional premium, he adds. They dont all do that, but a lot of carriers these days are now offering it.

    My advice to all incoming Medicare beneficiaries is to ask yourself, How do I plan to pay for my dental care? Do you have the funds to pay for it out of pocket? If not, you should strongly consider a Medicare Advantage plan or a standalone dental insurance plan from a Medicare carrier or insurance carrier, advises Worstells.

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    Should I Purchase A Private Dental Plan Or The Medicare Advantage Plan Free Dental Coverage

    If you can afford to buy a dental plan your best option is to buy a PPO plan offered as a standalone option or in some cases offered by the Medicare Advantage plan for an additional premium.

    When a Medicare Advantage plan offers dental coverage is typically offered as an HMO dental plan. It is vital to review any plan you are considering prior to purchasing it to ensure the needed coverage is included.

    The implications of choosing a dental plan should be considered before making a decision. For example, PPO plans have annual or lifetime maximums on coverage, which could result in out-of-pocket costs for services that exceed the maximum.

    It is also important to consider whether the plan has in-network or out-of-network providers, as this can impact the cost of care.

    Even when selecting a PPO dental plan it can be more cost-effective to use an in-network dentist.

    What Are Your Options If Your Medicare Advantage Plan Doesnt Offer Dental Coverage

    Get Medicare with Dental Coverage from UnitedHealthcare

    If your Medicare Advantage Plan doesnt offer dental coverage, you have a few options.

    • You can change your Medicare Advantage Plan to a plan that offers dental coverage.
    • You also have the option of purchasing a stand-alone dental plan.

    The disadvantage to purchasing a standalone dental plan is that it may have a waiting period before you can access the full benefits of the plan.

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    How Much Does Medicare Advantage Dental Coverage Cost

    You generally will pay a copayment or coinsurance for most Medicare Advantage dental coverage, such as 50% coinsurance or a $50 copayment. If you have a Medicare Advantage plan that only covers âMedicare coveredâ benefits you may have to pay for routine services, such as cleanings and fillings 100% out of pocket. Medicare Advantage plans with more comprehensive dental coverage may have higher monthly premiums.

    You also may have to use a provider within the planâs network in order to be covered. There also may be an annual limit on Medicare Advantage dental coverage.

    Do Any Medicare Plans Cover Dentures

    Original Medicare Medicare Part A and Part B typically does not cover dentures or other dental services.

    Some Medicare Advantage plans and other Medicare-related insurance or savings plans may offer options to help pay for dentures or other dental services.

    Medicare Plans and Denture CoverageNew to Signing Up for Medicare?

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    Consider Your Local Plan Options

    Different plan types may offer a better fit depending on where you live and work. MA plans use health provider networks and many do not cover out-of-network services or charge additional fees to access non-network providers. It is worth ensuring that your prospective provider offers coverage in your area.

    For example, if you have no plans to move, a Medicare Advantage HMO that offers coverage in your city could suit your needs well. But if you have a new job lined up or your residence could change soon, enrolling in this type of plan may tie you to a network you cannot use.

    Find and compare plans in your area. You can also contact a trusted insurance agent for advice on which local plans may meet your needs.

    When it comes to coverage, your Part D formulary should also play a role. The formulary is the list of drugs your MA plan covers, so you should ensure that your recurring medications are covered. While this list can change anytime, your insurance company must notify you of any changes. In addition, all formularies must contain at least two types of drugs per category.

    What Services Do Medicare Advantage Dental Plans Cover

    Did you know Medicare Advantage is also known as Part C and provides ...

    Medicare Advantage dental plans are basically universal across the board. The benefits are normally the same. However the annual allowance may differ by plan. Below, you can look at the benefits that typically are included in a Medicare Advantage dental plan and coverage:

    • Preventive services
    • Comprehensive services like dentures or root canals
    • Fluoride treatment
    • Annual allowance like preventive and comprehensive treatments

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    What Additional Services Does Medicare Advantage Cover

    In addition to routine dental care, a Medicare Advantage plan may cover other services that Original Medicare generally doesnât cover such as:

    • Routine vision including eyeglass lenses and frames
    • Routine hearing including hearing aids
    • Prescription drugs

    Still have questions about comparing Medicare Advantage plans? You can call eHealth to speak with a licensed insurance agent. If youâd like to explore the various Medicare coverage options in your area, use the Browse Plans button on this page.

    This article only provides general information and is not a solicitation for any specific product. Please see details, limitations, and availability onthe specific product detail pages for any products offered by eHealth.

    Medicare information is everywhere. What is hard is knowing which information to trust. Because eHealthâs Medicare related content is compliant with CMS regulations, you can rest assured youâre getting accurate information so you can make the right decisions for your coverage.Read more to learn about our Compliance Program.

    What Dental Care Services Are Covered By Medicare

    When it comes to Medicare and dental coverage, only Medicare Advantage Plans may offer dental coverage and not all of them do. This coverage is typically basic and could include:

    • And possibly more

    Make sure to review all details of any Medicare Advantage Plan before you enroll. Plans may differ based on the insurance company and even your location. Dental coverage often comes with limits on how many dental care services are covered in a plan year, maximum cost allowances, and more.

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    Compare Medicare Part D Plan Coverage

    Learn more about finding the best Medicare drug plan coverage.

    The American Association for Medicare Supplement Insurance advocates and provides information for seniors on Medicare. In addition AAMSI hosts the national online directory giving consumers free access to find local independent Medicare insurance agents.

    Do All Medicare Advantage Plans Come With Dental Coverage

    Dental Coverage with Medicare Advantage Plans

    All Medicare Advantage Plans have dental coverage. Medicare Advantage Plans have to cover everything that Original Medicare covers. Dental is very limited when you are only covered by Original Medicare. However, if you have a Medicare Advantage Plan, there could be some added benefits.

    For example, you may be offered an annual allowance that can be used on your dental coverage for certain comprehensive services. Typically, cleanings and X-rays are covered as part of preventive services and normally include two cleanings including X-rays during the visit annually.

    The best part about dental coverage on the Medicare Advantage Plan is that it is all-inclusive with the plan, and there is no waiting period. Even if the Medicare Advantage doesnt have a monthly premium, itll still offer dental coverage in most cases.

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    What Dental Services Are Covered Under Medicare Advantage

    Medicare Advantage dentistry is usually a basic dental plan that involves yearly cleanings and X-ray tests and can also cover additional services such as dental removal. Some insurance plans have an annual limit of coverage, although the plan can cover comprehensive services.

    Alternatively, plans require authorization to perform more complicated tasks. Approximately 82% of patients in Medicare Advantage require a dental appointment.

    Best For Member Satisfaction: Kaiser Permanente

    Average Medicare star rating: 5 out of 5.

    Service area: Available in eight states and Washington, D.C.

    Standout feature: Kaiser Permanente netted the top spot out of nine providers on J.D. Powers most recent U.S. Medicare Advantage study, which is based on customer satisfaction.

    Kaiser Permanente is the fifth-largest provider of Medicare Advantage plans, and the company gets high ratings from the CMS as well as outside ratings agencies. Most of Kaisers Medicare Advantage plans come with dental coverage.


    • About nine out of 10 Kaiser Permanente Medicare Advantage plans offer preventive dental coverage, and 84% also offer comprehensive dental coverage.

    • Most of Kaisers plans offer access to supplemental dental coverage if you need it, for as little as $9 per month.

    • Of the seven Medicare health plans that got a 5 out of 5 rating from the National Committee for Quality Assurance in 2021, four of them are Kaiser plans.


    • Kaisers comprehensive dental coverage includes an average of only four covered services per plan.

    • Kaiser Permanente plans are available in only eight states and Washington, D.C.

    • Kaiser offers only HMO plans, so members must use Kaisers network of providers.

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    When Medicare Advantage Plans Cover Dental Implant Steps

    If you are wondering which Medicare Advantage plans cover dental implants, you may want to break down the problem by treatment steps.

    First, Medicare is primarily health insurance that covers medically necessary oral care. Therefore, all Advantage plans might pay for specific early-stage procedures.

    Second, the optional dental riders you can purchase might also pay for some early treatments that prepare your jaw and gums even if they exclude coverage for implants.

    Third, several companies promote Advantage plans that cover implants but offer them in select regions. Therefore, you have to verify before you buy.

    Best For Size Of Dental Network: Unitedhealthcare

    Designing a Competitive Supplemental Dental Benefit for Your Medicare ...

    Average Medicare star rating: 4.2 out of 5.

    Service area: Available in 50 states and Washington, D.C.

    Standout feature: UnitedHealthcare has the largest network of dental providers of all Medicare Advantage companies, with approximately 100,000 providers.

    UnitedHealthcare is the biggest provider of Medicare Advantage plans in the U.S., with a presence in all 50 states and plans available in almost three-quarters of U.S. counties. UnitedHealthcare also partners with AARP and insures Medicare products with the AARP name. Many of UHCs members are in plans with high star ratings.


    • UHC offers the largest Medicare dental network, with approximately 100,000 providers.

    • UHC plans with comprehensive dental coverage include an average of six services per plan.

    • Three-quarters of UHC Medicare Advantage members are in highly rated plans.


    • Only 75% of UHC plans offer comprehensive dental coverage, one of the lowest among the major Medicare Advantage providers.

    • UHC tied for sixth out of nine providers on J.D. Powers latest Medicare Advantage study, which measured member satisfaction.

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    How Do Medicare Advantage Plans Help Seniors

    Medicare Advantage plans are supplemental insurance plans that provide coverage for procedures that Medicare doesnt provide. Theyre purchased separately by the Medicare beneficiary who will receive an ID card for their Medicare Advantage plan thats separate from their Medicare ID card. A Medicare Advantage plan has low deductibles, reduced out-of-pocket expenses, and cost-sharing provisions, so its affordable for more seniors.

    MedicareAdvantage.com reports that the average 2018 Advantage premium was about $420 annually, which is about $35 monthly. Advantage subscribers have a network of providers from which to choose, and they often have access to hearing, vision, and prescription drug benefits. If you have questions on Advantage plans, call our Western Massachusetts office and we can help you.

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