Medicare and Dental Care: What You Should Know

It’s no secret Medicare doesn’t cover dental work. The only way Medicare will pay for anything tooth-related is if it’s integral to other medical treatments. For example, jaw reconstruction after a car accident or removing a tooth before radiation treatment for oral cancer (Medicare Resources). 

A lot of Medicare beneficiaries are confused about dental care – should you buy dental insurance? What about Medicare Advantage plans that promise extra dental benefits? And perhaps most importantly, what can you do to prevent expensive dental work?

We teamed up with Dr. Kevin M. Artime, DMD at Artime & Wherley Family Dentistry here in Decatur, IL, to discover the truth about dental work in your senior years.

We also got some insider information from Teresa Anderson, who has worked in the dental field for 24 years. She has extensive experience dealing with insurance claims and monthly statements.

Dental Work After Age 60

Dr. Artime says about 25% of his patients are over age 60. In reality, dental work in your later years can be the most expensive. Older teeth are weaker, and you may need more treatment.

Large fillings

Dr. Artime says one of the most common dental problems he sees among the senior population is the breakdown of teeth because of large fillings. Large fillings make your teeth weaker, which leads to extensive treatments like crowns, extractions, and implants.

While there are some preventative measures you can take to reduce expensive dental work in your golden years, Dr. Artime says there’s not much you can do when you have big fillings. Wear and tear isn’t easily reversible or preventable.

Gumline decay

Dr. Artime says the most common dental concern for patients in the 80+ age range is decay around the gumline. A low-quality diet filled with simple sugar and high-carb foods combined with not taking care of your teeth can cause this decay. Medications like antidepressants and blood pressure prescriptions can dry out your mouth, and before long, this combination invites decay to occur.

That’s also the good news – tweaking your diet by avoiding foods like chips, bread, and sweet treats can prevent decay. “A healthy diet of proper protein, limited carbs, and lots of fruits and veggies not only benefits for your teeth but your entire body,” Dr. Artime explains.

He also advises his patients to work with their doctor to see if their medications can be limited.

Dentures

The trouble with the 80+ age range is often thanks to dentures. “You lose your chewing power,” Dr. Artime says. “You can’t eat as many raw fruits and vegetables, so your diet changes to easier things to chew – and that’s usually processed foods.”

Dentures limit the healthy choices you have, so Dr. Artime works with his patients to explore all other options first. “Your teeth are so important – it’s the beginning of your digestion,” he says. “If you have dentures, you’re limited on what you can take in.”

Preventing Expensive Dental Work

To sum things up, not all dental work is preventable. If you have larger fillings, you’ll likely need some extensive treatment later in life, which can include crowns, extractions, and implants. Consider putting some money away each month in preparation for this.

You can prevent decay around the gumline by limiting medications that cause dry mouth and eating a healthy diet that focuses on limiting carbs and high-sugar foods.

Finally, don’t give in to getting dentures if you can help it. Dentures severely limit the kind of foods you can eat, which often leads to eating too many easy-to-chew processed foods.

Last but not least, Dr. Artime advises everyone to schedule regular dentist visits. “Don’t lose the desire to take care of your teeth!” he says.

Medicare Coverage for Dental Care

Medicare does cover dental care in scarce situations where dental work is required to do other medical treatments.

Dr. Artime says he’s never – not even once! – billed Medicare for any dental services he’s performed in his 33 years of practicing dental care. That speaks to how rare Medicare’s dental coverage is.

Since Medicare doesn’t offer dental coverage, many seniors look to Medicare Advantage plans – which often promise dental benefits – or dental plans sold by private insurance companies.

Medicare Advantage Dental Benefits

Medicare Advantage (MA) plans are all-in-one alternatives to Original Medicare. These plans, offered by private insurance companies, bundle your hospital insurance, medical insurance, and drug coverage into one plan. Many MA plans also include extra benefits that help pay for dental work.

Each plan determines what’s included, though it’s relatively common for preventative work, like annual cleanings and X-rays, to be covered. More complex treatments, like crowns or bridges, often have a waiting period and are only covered up to a certain amount. 

Teresa Anderson, who has worked in the dental field for 24 years and has extensive experience dealing with insurance claims, says the most popular Medicare Advantage plan she sees in Decatur is from Aetna.

“The only thing we find with the Aetna plan here in our office is the patients have to pay upfront,” she explains. “We give them a receipt, and they submit the claims themselves,” she says.

While she hasn’t seen any problems, she admits she doesn’t know the patients end up paying in the end. “The patient gets the reimbursement check,” she says.

Dental Insurance – Pros and Cons

Since Original Medicare doesn’t cover dental costs – and Medicare Advantage isn’t always the best option – many seniors look for other dental insurance options.

Private companies offer dental insurance, but Dr. Artime and Teresa aren't sure it makes sense for everyone.

“It depends on the patient and if they have a lot of needs,” Dr. Artime says. If your teeth are healthy and don’t have many fillings, he recommends just setting money aside each month to cover routine appointments and cleanings. He says an HSA can be a good option.

However, if you have many needs, Dr. Artime recommends talking to an insurance agent about possible plans.

Teresa says it’s essential to read the fine print on a dental plan before you buy it. “We’ve seen plans with waiting periods of 3 years, and once you get to the 3rd year, your premiums go up,” she explains.

At that point, many patients can’t afford the premiums. While you can use the plan for cleanings and the occasional filling, significant services aren’t covered for several years. And when you can finally use the plan for more expensive services, it’s common to be priced out.

Self-funding

Teresa recommends self-funding if you can. “Dental insurance is so different from medical insurance,” she says. “We tell patients just to add up what their dental premium would be every month and set that aside for their care.”

Many patients in Decatur, IL have insurance through a company they retired from (such as CAT), Teresa explains. Check with your employer to find out if you have any dental benefits.

Conclusion

Dr. Artime says with good oral health, patients can have healthier choices that affect the rest of their body. Take care of your teeth to prevent decay and dentures, and check out Artime & Wherley Family Dentistry for your dental needs.

To learn more about Medicare Advantage plans in Decatur, IL, as well as dental insurance options, reach out to our team of licensed agents at 217-423-8000.