My mother recently turned 65 and joined Medicare Parts A and B, but she urgently needs dental coverage. Where can I look to help her find appropriate dental coverage? Are there special enrollment periods for this like there are for other Medicare options? Thank you for your help!
Medicare doesn’t cover dental except for emergency room services. Your mother has a few options:
Medicare Advantage – If it’s been less than 3 months since she got Medicare, she has a special enrollment period to enroll. It’s best to do this with an agent.
Standalone Dental Policy – These typically have drawbacks, like waiting periods, monthly premiums, and coinsurance.
Self-Pay – Some dentists offer in-house financing, which can be helpful.
Medigap with Dental Discounts – UHC has a plan that includes some dental discounts.
In my experience, Medicare Advantage plans I’ve had over the years offered some dental and vision care, but it’s all limited, especially in terms of dollar coverage. I had plans with coverage ranging from $500 to $1,500.
Some plans provided a fixed dollar amount to use as needed. Others covered one or two exams, x-rays, and cleanings per year. Benefits increased slightly over time, but the coverage remained limited. You won’t find dental insurance—whether standalone or in MA plans—that offers substantial coverage for dental needs.
I reviewed many plans and found that costs and coverage vary greatly. Most plans offer immediate coverage for preventive services like exams, x-rays, and cleanings, though some require a 6-month waiting period. For anything beyond preventive care, the coverage and waiting periods depend on the premium.
In many cases, I found that the cost of premiums covered the value of preventive services only. If you’re looking for extensive coverage, you may be better off setting aside funds in a savings account instead of paying premiums.
Dental insurance has never provided extensive coverage, and this hasn’t changed. If you do choose a plan, make sure to consider network restrictions and any additional waiting periods for non-preventive services.
Don’t let people tell you that MA dental coverage is comprehensive—it’s usually limited and network-restricted. I found that the only fully in-network dentists were in large, chain dental offices, which didn’t appeal to me.
Shop carefully, evaluate the services you need, and check if the network restrictions align with your preferences. If you’re considering an MA plan, read the dental benefits carefully to understand dollar limits, services covered, and provider restrictions.
@duke
The problem with forgoing insurance is that without it, I’d pay $314 for a bill instead of $158 with insurance, where I owe nothing. This dual billing system forces people to get insurance to avoid price gouging. This issue isn’t confined to dental care.
The AARP/UnitedHealthcare Medigap plan offers a dental benefit with the Dentegra network of dentists. Note, this isn’t dental insurance; it’s a discount plan. Another option is to find a dental practice that offers a membership plan with reduced costs for dental services. Standalone dental insurance with significant benefits often has high premiums close to the value of the benefits.
Some Medicare Advantage plans, like mine, claim to cover dental, but I’d be wary of these because they place control over medical decisions with the insurance company, whose main priority is profit. I only have one because I’m too young for Medigap. Also, finding an in-network dentist nearby has been difficult. I need a root canal, but the only listed dentist nearby doesn’t have the necessary equipment.
Delta Dental is one of the worst offenders in dental insurance.
Medicare Advantage Plans have drawbacks. You must use in-network providers, and they often deny more claims than Original Medicare. For reliable guidance, contact a SHIP Counselor. They’re trained to help Medicare recipients, and their services are free, provided by organizations that assist the elderly. Find one near you: https://www.shiphelp.org/
@Adley
It’s misleading to say Medicare Advantage plans don’t deliver what they promise. You’re spreading misinformation.
Steele said:
@Adley
It’s misleading to say Medicare Advantage plans don’t deliver what they promise. You’re spreading misinformation.
People can verify my claims by researching Senate investigations into Medicare Advantage plans. Just make sure the information source isn’t funded by a Medicare Advantage provider.
@Adley
Medigap may not be an option if underwriting doesn’t approve her. In that case, a local broker can help find a suitable Advantage plan. It’s essential to ensure her doctors and prescriptions are covered, and the plan includes necessary dental services.
@Adley
Thanks, that’s very helpful.
I don’t want a Medicare Part C Advantage plan since it limits my choice of doctors, but I need extensive dental work.
If she turned 65 recently, she might still be within her initial enrollment period for a Medicare Advantage plan, which typically includes some dental coverage. Otherwise, standalone dental policies don’t require a specific enrollment period.
I recommend looking into Medicare Advantage or Medigap. Original Medicare alone may not provide sufficient coverage. Talking to a local broker will help identify available plan options.
The simple answer is she can enroll in a standalone dental plan just like before she started Medicare, without a specific enrollment period. Some people prefer traditional dental plans, while others prefer indemnity (reimbursement) plans. Medicare Advantage plans often include dental but vary by region, so verify coverage details.
Popular dental providers include:
Delta Dental
Humana
Indemnity Providers:
Aetna
Allstate/National General
Medico
Manhattan Life
Ameritas
If she hasn’t enrolled in a supplemental plan to cover Medicare’s 20% gap, she should consider one. It’s also essential to have Part D prescription coverage to avoid penalties later.