Assessment Approach: Intervention Population And Outcomes
The selection of conditions and services for assessment was guided in part by historical context. A few months before the passage of the 1997 Balanced Budget Act, legislation had been introduced, first, to cover a specific set of medically necessary dental services that were described as cost-effective and, more generally, to provide for future coverage of other services subsequently determined to result in reductions in expendituresthat exceed expenditures resulting from such coverage . This latter requirement is quite stringent generally, services are considered to be cost-effective whether or not they produce cost savings that fully offset direct service costs. The more restrictive language reflects the rules that Congress has adopted requiring increases in spending in one area to be offset by cuts elsewhere or by increased taxes.
The five conditions listed in the 1997 bill had been presented in prior analyses of health conditions that sought to identify those for which the cost of covering inpatient dental services would likely be offset by savings related to complications avoided, especially additional hospitalization . The five conditions were
valvular heart disease.
The population of interest includes Medicare beneficiaries age 65 and over as well as younger people qualified for Medicare on grounds of disability or diagnosis of end-stage renal disease . Evidence related to all age groups was reviewed.
Medicare Advantage Dental Coverage
Some Medicare Advantage plans include dental insurance, and others dont. Dental benefits vary from plan to plan. Some plans cover only standard services, while others cover a wider range of dental procedures.
The easiest way to know what your plan covers is to do research beforehand. Every Medicare Advantage plan offers an outline of coverage available on Medicare.gov. Here, you can see what benefits your plan offers and where those benefits are accepted. You should never go into Medicare Advantage blind. Knowledge is key when enrolling in a Medicare Advantage plan.
Other Medicare Vision And Dental Plans
Humana Medicare Advantage Plans
Like other Medicare Advantage Plans, Humana Plans also offer coverage for everything included with Original Medicare . Although there are a variety of these plans which will vary in regional availability, many plans offer additional benefits like:
- Dental coverage
- Annual preventative care coverage
- Coverage for alternative modalities like acupuncture
Humana offers different types of plans and your benefits will depend upon which plan you go for. To choose a specific plan, youâll have to check the Humana official website and compare the benefits of different plans available in your area.
Aetna Medicare Advantage Plans
These plans on your overall well-being and are one of the most popular Medicare Advantage Plans. Most Aetna Medicare Advantage Plans cover routine dental care and prescription drugs. A few plans may also cover 24/7 access to Aetnaâs âAsk a Nurseâ phone hotline, routine vaccinations, and home delivery of medicines.
Cigna Medicare Advantage Plans
Like most MA plans, these plans offer more comprehensive medical coverage than Original Medicare Plans. Many of these plans cover important medical services such as:
Many plans also offer Part D or prescription drug coverage.
Kaiser Medicare Advantage Plans
Anthem Blue Cross and Blue Shield Medicare Advantage Plan
- No-cost Fitness benefits
- 24/7 teleconsultation with providers
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Does Medicare Cover Vision And Dental
Original Medicare does not cover routine dental or vision care. There are certain circumstances under which Original Medicare may provide some coverage for dental or vision care in an emergency setting or as part of surgery preparation.
However, you may be able to receive routine dental and vision coverage by enrolling in a Medicare Advantage plan that includes dental and vision benefits.
Does Medicare Cover Dental Health
En español | Original Medicare has no dental plan. It does not cover most routine dental services such as exams, cleanings and X-rays procedures related to dental health, such as fillings, extractions and root canals or dentures and other dental devices.
However, original Medicare can pay some costs associated with emergency or medically necessary dental care.
For example, Medicare Part A, which includes hospital insurance, could cover having teeth pulled in preparation for radiation treatment of jaw cancer, or inpatient care if you need a complicated or emergency dental procedure while in the hospital, such as jaw reconstruction after an accident.
If you rely on Medicare and want coverage for regular oral care, look into Medicare Advantage plans. These policies, offered by private insurance companies, include all original Medicare coverage and often have extra benefits such as dental services .
Another option is Medicare Supplemental Insurance, better known as Medigap. These plans, also sold by private insurers, cover some out-of-pocket costs for Medicare treatment. They do not specifically include extra benefits, but some Medigap providers offer clients options for dental coverage, or discounts on out-of-pocket costs for oral care. If you have Medigap, ask if your provider offers related dental benefits.
Editor’s note: This article was originally published on July 15, 2015. It has been updated with the latest information regarding Medicare coverage in 2020.
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What Kind Of Dental Care Does Medicare Advantage Cover And What Does It Cost
Most Medicare Part C plans cover basic dental care, such as exams, cleaning and fillings and more extensive procedures, such as root canals, tooth extractions, crowns and dentures. Because these plans are sold through private insurance companies, the types of coverage can vary. Seniors should research what each available plan covers before deciding on one. Applicants may also wish to have a dental exam and ask for advice when choosing a plan the dentist may see a need for additional service coverage down the line, so having a plan that will cover future services is important.
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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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Dental Care For Patients Before Or After Organ Transplantation
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.
How Does Medicare Advantage Dental Coverage Work
Medicare Advantage plans are the primary method for dental coverage under Medicare.
Whatâs usually covered:
- Tooth extractions
Medicare Advantage are bundled plans that combine add-on benefits such as dental or vision with Original Medicare and additional cost-sharing for medical needs. About 94% of Medicare Advantage plans offer the option for dental coverage. However, sometimes there is an additional fee to include dental coverage in your plan.
For example, the standard Medicare Advantage plan from Kaiser Permanente does’t include dental care, but if you upgrade to the Medicare Advantage Plus plan, you’ll get dental, vision and hearing coverage.
The level of dental coverage with Medicare Advantage plans varies. Some have an annual payout limit, such as only contributing $1,500 to your dental care each year. Other plans could have coverage specifications on the number of cleanings per year or denture coverage.
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When Should You Get A Standalone Dental Plan
If you’re not signing up for a Medicare Advantage plan that gives you unified coverage across medical and dental, a standalone dental plan is the next best way to get coverage.
You can purchase a plan directly from a private insurance company, and most let you sign up for dental insurance even if you don’t have medical insurance through the company. This plan won’t be connected to your other coverage through the Medicare program, but it can help you get cost-savings benefits so you get the dental services you need.
Benefits of standalone dental plans:
- Choose the level of coverage you want, with plans ranging from basic or preventative coverage to plans that cover more extensive dental treatments.
- Select the insurance company that has your preferred dentists in its network of providers without this choice influencing your medical plan.
Dental plans for seniors include Dental HMOs, which generally have lower monthly costs but only cover care from an in-network dentist. If you’d rather have the flexibility to see any dentist, choose a Dental PPO plan that provides broader coverage but generally costs more each month.
Traditional Dental Coverage Is Not The Only Option For Seniors
If you dont have dental insurance coverage through an employer, a Medicare Advantage plan, or a stand-alone plan, and you cant afford to get one, theres another good option. Its the dental savings plan, often called discount dental. Its not insurance, and its not meant to be. Its a guaranteed discount, typically in the range of 40-60 percent, on all of the common treatments you need.Cigna.com, Discount Dental Programs, Accessed November 17, 2021
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Do All Medicare Advantage Plans Cover Dental Services
Its 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 are able to 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 dental services section. If it says Medicare-covered benefits you may not get any coverage beyond what Original Medicare covers, which does not include routine care.
All Medicare Advantage plans cover Medicare-covered dental services. You will generally pay a copayment for this, such as $45.
Oral Health Problems And Heart Valve Disease
The oral cavity in general, and common oral infections in particular, can provide sources of organisms that may lead to heart valve infection, which in turn can lead to endocarditis. Clinicians have observed an association between oral disease and endocarditis, and describes a causal model offering a possible explanation .
The oral cavity harbors a lot of bacteria, most commonly in the form of plaque, but also associated with gingivitis, periodontitis, and periapical disease . Oral flora, particularly streptococcus, are implicated in approximately 40 percent of cases of infective endocarditis . Bacteremia can arise from dental procedures but also from such routine activities as tooth brushing and chewing, especially if extensive oral infection and inflammation are present. Patients with dentures may develop bacteremias associated with poorly fitting dentures.
Although dental procedures for hygiene, restoration, or extraction of diseased teeth can cause breaks in the epithelium lining the mouth that allow bacteria to spill into the bloodstream causing bacteremia, most cases of orally related endocarditis are not attributed to dental procedures . The burden of oral disease of itself is a concern for the patient at high risk of endocarditis .
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Medicare Advantage Dental Benefits
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
Medicare Considers Expanding Dental Benefits For Certain Medical Conditions
Proposed changes in Medicare rules could soon pave the way for a significant expansion in Medicare-covered dental services, while falling short of the comprehensive benefits that many Democratic lawmakers have advocated.
Thats because, under current law, Medicare can pay for limited dental care only if it is medically necessary to safely treat another covered medical condition. In July, officials proposed adding conditions that qualify and sought public comment. Any changes could be announced in November and take effect as soon as January.
The review by the Centers for Medicare & Medicaid Services follows an unsuccessful effort by congressional Democrats to pass comprehensive Medicare dental coverage for all beneficiaries, a move that would require changes in federal law. Sen. Bernie Sanders sought in vain to add that to the Democrats last major piece of legislation, the Inflation Reduction Act, which passed in August. As defeat appeared imminent, consumer and seniors advocacy groups along with dozens of lawmakers urged CMS to take independent action.
Dr. Biana Roykh, senior associate dean for clinical affairs at Columbia Universitys College of Dental Medicine, called CMS proposal a step in the right direction. But she cautioned that it doesnt yet address the full extent of dental needs among seniors. Were not solving the problems upstream by tackling the causes of dental decay, including a lack of routine care, she said.
Options For Adding Dental To Medicare Coverage
If you are on Original Medicare, or your Advantage plan doesnt include sufficient dental benefits, you can still save on your dental care.
Dental Insurance you can purchase your own dental insurance . Dental insurance is great for people who have excellent oral health, as it typically provides good discounts on preventive care likeannual checkups and cleanings, along with fillings and other basic procedures. But since, as noted above, dental insurance has annual caps on coverage it may not fit your budget for restorative care such as root canals, crowns, bridges, dental implants, and dentures.
The cost of an individual dental insurance policy is around $350-400 a year. For a family, the cost is around $600. Be aware that you are likely to save more if you purchase dental insurance as part of a Medicaid Advantage plan. But if Medicaid Advantage doesnt meet your needs , you may want to consider private insurance.
Dental Savings Plans These plans are an affordable alternative to traditional dental insurance. Plan members can save 10-60% on most dental procedures, including preventive and restorative care from any of the 140,000 participating dentists nationwide.
Best Medicare Advantage Dental Plans
What is the best dental insurance plan? Original Medicare does not cover dental services like cleaning, fillets or extractions. In order to obtain dental care seniors can either buy a separate plan or use an insurance plan that provides some type of cost support. Medicare Advantage is a bundled alternative to original Medicare sold from privately held insurers. It includes Medicare Part B and Part A and most frequently Part D benefits.
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What Dental Care Is Covered By Medicare Part A
Medicare Part A does not offer dental treatments like cleaning or dental fillings. However, Medicare Part A covers dental procedures that require a dental emergency and require hospital admission.
This could include teeth splints before cancer radiotherapy, jaw surgery or dental surgery before kidney transplant surgery if needed. When it comes time to get dental treatment at the hospital you must check the billing code of the service to confirm your coverage.
Comparing Medicare Plans For Dental Coverage
You may also want to consider dental coverage outside of Medicare. You may have options, such as:
- Stand-alone dental insurance. These plans require you to pay a separate premium for coverage.
- Spouse or partner employee-sponsored insurance plan. If its possible to sign up for coverage under a spouses dental plan, that may be a less expensive option.
- Dental discount groups. These dont provide insurance coverage, but they allow members to get dental services at a lower cost.
- Medicaid. Depending on the state you live in and your financial situation, you may be eligible for dental care through Medicaid.
- Program of All-Inclusive Care for the Elderly . The PACE program can help you get coordinated care within your local community, including dental services.
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