Losing employer dental benefits when enrolling in Medicare … what do I do?

on Feb 15, 2024

Dear Toni,

I will be eligible for Medicare in July and am now receiving cancer treatment. I am currently on my ex-employer’s COBRA and searching for dental care when I go on Medicare in July. The only dental/vision plans I am finding are in Medicare Advantage plans, but my cancer facility has advised me to not go in that direction because many Medicare Advantage plans are no longer accepted at their facility.

Is there a dental plan that Medicare offers? Please advise.

--Tammy from Alvin, Texas

Hello Tammy:

“What’s NOT Covered by Part A & Part B?” is explained on page 55 of the 2024 Medicare & You handbook. It states:

Medicare does not cover everything and if you need certain services that Medicare Part A and Part B doesn’t cover, you will have to pay for them yourself unless:

-- You have other coverage (including Medicaid) to cover the costs.

-- You are in a Medicare Advantage Plan or Medicare Cost Plan that covers these services. Medicare Advantage Plans and Medicare Cost Plans may cover some extra benefits, like fitness programs and vision, hearing, and dental services.

Some of the items and services that Original Medicare does not cover include:

-- Eye examinations (for prescription eyeglasses)

-- Long-term care

-- Cosmetic surgery

-- Massage therapy

-- Routine physical exams

-- Hearing aids and exams for fitting them

-- Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)

-- Covered items or services you get from an opt out doctor or doctor not accepting Medicare (go to page 60)

-- Most dental care: Original Medicare doesn't cover dental services like routine cleanings, fillings, tooth extractions, or items like dentures. However, in some cases, Original Medicare may pay for some dental services related to specific medical procedures like:

-- A heart valve repair or replacement

-- An organ transplant

-- Cancer-related treatments

Since Medicare does not cover dental, Tammy, I would recommend that you talk to your dentist and see which dental insurance plans he/she prefers. (Chapter 2 of Toni’s Medicare Survival Guide Advanced edition also discusses what is not covered by Medicare.)

When purchasing a dental plan, there are two types to pick from (verify which type of plan your dentist accepts before purchasing):

1. Traditional (or indemnity) dental insurance plans are generally higher in premium, and the preventive services are usually covered at 100%; basic restorative is generally covered up to 80%, and major procedures at 50%. Recently, new dental plans have been released which help with the costs of dental claims such as fillings, crowns, and root canals. A major surprise is that these plans begin immediately with no wait.

2. Discount dental insurance plans are generally less expensive than traditional plans. These plans provide a discount for services, but your dentist must be part of the plan’s network and agree to give the dental discount.

You can use either type of dental plan with Original Medicare with or without a Medicare supplement or with a Medicare Advantage plan. Again, make sure that the plan you choose is accepted by the dentist you like.

You did not ask about vision benefits, Tammy, but readers may want to know that the Medicare handbook discusses eyeglasses after cataract surgery. This is a limited benefit because Medicare will cover one pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery that implants an intraocular lens. The Medicare Part B deductible will apply for the surgery, and after you meet the Part B deductible, you pay 20% of the

Medicare-approved amount for your corrective lenses after the surgery.

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Visit www.seniorresource.com/medicaremoments to listen to Toni’s Medicare Moments podcasts. Toni’s new course, Confused about Medicare, a downloadable video series, and the “Medicare Survival Guide Advanced” edition are both available at www.tonisays.com.