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What are my dental insurance options while on Medicare?

Whether you are new to Medicare, or have been on it for many years, this is a common question among Medicare beneficiaries.  Dental care is vital to maintaining your dental and overall health. Small issues can quickly become expensive if left untreated, even for a short time.  Therefore, it is critical to understand your dental insurance options while on Medicare and New Jersey Medicare Brokers can help.

Does Original Medicare include dental coverage?

When you elect to take Medicare, you may choose to keep Original Medicare Part A (hospital) and Part B (doctor). However, Original Medicare does NOT include dental coverage (nor vision or hearing benefits) and must be added as a standalone policy for a separate monthly premium.

Standalone dental plans can be purchased outside of the Medical Annual Election Period (October 15th thru December 7th each year) and can begin as soon as next month.

Here are some things to consider if you seek a standalone dental plan while on Original Medicare:

  1. Understand the dental network: make sure your preferred dentist, endodontist, or periodontist is in-network with the plan. If you select a PPO plan, you may be able to see an out-of-network provider, but the coverage/reimbursements may be lower.
  2. Look at the fine print: many plans will have deductibles, co-insurances and waiting periods (6 or 12 months) for procedures like fillings and more comprehensive work like crowns and bridges. Preventive dental work like cleanings, sealants and x-rays usually do not have a waiting period. Not all dental plans will cover cosmetic work like implants, so be sure to check before purchasing a plan.
  3. Select the right amount of coverage: plans will specify an annual maximum out-of-pocket (i.e. $1,000 annual maximum) or may offer a phase-in approach to the maximum out-of-pocket ($1,000 year 1, $1,250 year 2, and $1,500 year 3). After you have exhausted the annual maximum out-of-pocket, you will be responsible for all additional dental expenses.
  4. Consider combining other ancillary products into one plan: Some insurance companies will offer vision and hearing plans alongside dental. If you are interested in vision or hearing benefits, you may want to consider a standalone insurance policy that covers all-in-one.

Does my Medicare Advantage (Part C) plan include dental coverage?

If you’re on a Medicare Advantage plan, you may have dental included with your plan or dental insurance may be offered as an add on for an additional fee to your Medicare Advantage coverage. Be sure to check your plan’s Summary of Benefits of Evidence of Coverage document to understand what’s included with the plan. If you need help locating this information, contact us.


What about dental discount plans?

A low-cost alternative for dental could be a dental discount plan. They are offered by some insurance companies for a flat annual fee, usually lower than traditional standalone dental plans.

Dental discount plans are NOT insurance and only serve to provide a discount for preventive, basic and comprehensive work at participating dentists.  You could also speak with your dentist office about whether they offer a discount program, which is becoming a popular and affordable way to cover cleanings and other preventive work.

Do you want to learn more about your dental insurance options?

Contact us for more information about standalone dental plans, Medicare Advantage plan dental benefits, & dental discount plans in New Jersey.  We would be happy to review your coverage options and get you set up with the best plan for your budget and dental health needs.


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