Two-thirds of all people on Medicare do not have dental coverage, according to the Kaiser Family Foundation. Among Medicare beneficiaries who used dental services, the average personal expenditure for dental care was $ 874 in 2018, and a fifth spent more than $ 1,000 out of pocket, according to Kaiser.
For traditional health insurance to pay for dental treatment, it must be deemed necessary as part of a covered procedure – for example, a tooth extraction required for radiation therapy. Likewise, the program does not cover hearing aids (which are notoriously expensive, often four-digit), exams, or most eye care.
Most Medicare Advantage plans provide some level of dental, vision, and hearing care. Some plans charge additional premiums for these services, but they are often provided at no additional cost to beneficiaries. Instead, they’re funded by Medicare’s complex Advantage payment system, which includes premiums that the government pays to plans based on quality ratings and discounts, which are granted under certain circumstances.
“A portion of the savings has to be spent directly on recipient care, and it’s allocated to these additional benefits,” said Allyson Y. Schwartz, president and CEO of the Better Medicare Alliance, a Medicare Advantage research and advocacy group. .
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But the limits of what these plans cover vary widely. Among people on plans offering both preventive and more extensive dental benefits, 43% faced annual caps, typically around $ 1,000, according to a Kaiser study.
“Some provide prevention and diagnostic services but don’t cover more expensive treatments,” said Tricia Neuman, executive director of the Kaiser Family Foundation’s Medicare policy program. “Others also cover more expensive services, like implants, but have high coinsurance requirements or annual dollar limits. It’s better than nothing, but people with relatively poor dental coverage can be caught off guard when they see their bill.
Some seniors buy an individual commercial policy just for dental care, but these plans also expose them to high out-of-pocket costs for the more expensive procedures. For example, a 66-year-old New Yorker could choose between a base ($ 24 per month) or a premium ($ 48 per month) Delta Dental PPO plan, both with an annual deductible of $ 50. The basic plan pays a maximum of $ 1,000 per year in care and the premium plan $ 1,500.