Two-thirds of all people on Medicare don’t have dental coverage, according to the Kaiser Family Foundation. Among Medicare beneficiaries who used dental services, average out-of-pocket spending on dental care was $874 in 2018, and one-fifth spent more than $1,000 out of pocket, according to Kaiser.
For traditional Medicare to pay for dental care, it must be deemed necessary as part of a covered procedure — for example, a tooth extraction needed in preparation for radiation treatment. Likewise, the program does not cover hearing aids (which are notoriously expensive, often running into four figures) or exams, or most vision care.
Most Medicare Advantage plans offer some level of dental, vision and hearing care. Some plans charge additional premiums for these services, but often they come with no additional charge to beneficiaries. Instead, they are funded through Medicare’s complex Advantage payment system, which includes bonuses the government pays to plans based on quality ratings, and rebates, which are given in certain circumstances.
“Some of the savings must be spent directly on care for beneficiaries, and they go into these extra benefits,” said Allyson Y. Schwartz, president and chief executive officer of the Better Medicare Alliance, a Medicare Advantage research and advocacy group.
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But the limits on what those plans cover vary widely. Among people in plans that offered both preventive and more extensive dental benefits, 43 percent faced annual dollar caps, typically around $1,000, Kaiser research shows.
“Some provide preventive and diagnostic services but don’t cover more expensive treatments,” said Tricia Neuman, executive director of the Medicare policy program at the Kaiser Family Foundation. “Others also cover pricier services, like implants, but have high coinsurance requirements or annual dollar limits. It’s better than nothing, but people with relatively skimpy dental coverage may be caught off guard when they see their bill.”
Some seniors buy a commercial, individual policy just for dental care, but these plans also leave them exposed to high out-of-pocket costs for the most expensive procedures. For example, a 66-year-old resident of New York City could choose between a basic ($24 per month) or premium ($48 per month) Delta Dental P.P.O. plan, both with a $50 annual deductible. The basic plan pays a maximum of $1,000 per year in care and the premium plan $1,500.