Traditional Medicare and Medicare Advantage Plans
Some people can receive health coverage from Medicare, which is a “federal health insurance program for… People who are 65 or older,” “Certain younger people with disabilities,” and “People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)” (“What’s Medicare?”). Unfortunately, original Medicare provides limited dental coverage. However, people could enroll into Medicare Advantage Plans for dental coverage.
Traditional Medicare plans only cover dental coverage under certain conditions, leading to long-term costs in hospitalizations and emergency care. They do not pay for services, such as “Cleanings and oral exams,” “Fillings,” “Crowns,” and more (Cross 2017). Though, preventive care, such as cleanings, can help mitigate future dental and health complications (Reinberg 2017). According to Jory Cross, a “Licensed Insurance Agent,” “Medicare Part A may cover certain dental services performed in a hospital if it’s a necessary part of a covered service” (Cross 2017). Medicare Part B could pay for those dental services that the person undergoes as an outpatient (Cross 2017). After receiving treatment in the hospital, original Medicare may not cover “post-treatment dental services once the specific issue has been treated” (Cross 2017). Due to Medicare’s lack of dental coverage, “According to a study published in Health Affairs, in a given year, three-quarters of low-income Medicare beneficiaries do not receive any dental care at all. Among higher-income beneficiaries, the figure is about one-quarter” (Frakt 2018). As people’s health deteriorate due to dental problems, more people go to hospitals and emergency rooms, for which Medicare must cover (Adams 2018).
People could enroll into Medicare Advantage Plans for dental coverage (Cross 2017). Since beneficiaries receive coverage from private insurance companies contracted with Medicare, plans could differ (Cross 2017). For instance, plans may pay for “routine dental exams, cleanings, X-rays, fillings, crowns, root canals, and more” (Cross 2017). They may have networks of dentists that patients could go to for coverage (Cross 2017). While they could go to dentists outside of their networks in some plans, they are responsible for higher out-of-pocket payments (Cross 2017). However, beneficiaries should check their Medicare Advantage plans regularly because their “‘providers can and do change the coverage options annually’” (“Options for Obtaining Dental Coverage Under Medicare 2018” 2017). Despite the benefits of dental coverage, “recipients living outside of major cities may find that there are no Medicare Advantage insurers in their area. According to a recent report from the Kaiser Family Foundation, 147 counties across 14 states lack a Medicare Advantage insurer this year” (“Options for Obtaining Dental Coverage Under Medicare 2018” 2017). Furthermore, people still have to deal with rules, such as prior authorization (Frakt 2018).
Traditional Medicare is flawed due to its limits on dental coverage. While Medicare Advantage Plans also contain flaws, their dental coverage could help people with their oral health. Thereby, people could better their oral health, preventing future health problems.