Learning Center > Does Medicare Cover Dental?

Does Medicare Cover Dental?

As you age, you may begin having issues with your teeth. This may lead you to wonder, “How do I get dental coverage with Medicare?”

The truth is that most dental procedures are not covered by Original Medicare, although you may be able to get coverage through Medicare Advantage. This page will help you understand what’s covered and what’s not covered by Medicare when it comes to dental care.

What Dental Services Are Covered By Medicare?

There are some dental services you may need as you get older. This includes cleanings, cavity fillings, and even dental surgery. Let’s take a look at each one.

Does Medicare Pay For Dental Bone Grafts?

Original Medicare does not cover dental bone grafts unless they are performed while you are an inpatient in the hospital and it’s medically necessary. However, if you have a Medicare Advantage plan, you may have coverage.

Does Medicare Pay For Dental Cleanings?

Dental cleanings are not covered by Original Medicare. If you want to have dental coverage for cleanings, consider a Medicare Advantage plan.

Does Medicare Cover Dental Crowns?

Dental crowns are generally not covered by Medicare unless you are admitted to the hospital and it’s medically necessary. If you have a Medicare Advantage plan, you may be able to get coverage.

Does Medicare Cover Dental Surgery?

Dental surgery is not covered by Original Medicare unless it’s medically necessary while you are in the hospital. You may have coverage for dental surgery with some Medicare Advantage plans.

What Medicare Plans Cover Dental?

Medicare has a variety of parts, each with its own specific coverage. Do any Medicare plans cover dental? Let’s take a look.

Does Medicare Part A Cover Dental?

Medicare Part A, or hospital insurance, may cover certain dental procedures if you’re an inpatient at the hospital. It must be deemed medically necessary.

Medicare Part A may also pay for the hospital portion of your stay if you have to be an inpatient specifically for a dental procedure, although the procedure itself will not be covered.

Does Medicare Part B Cover Dental?

Medicare Part B, or doctor’s insurance, doesn’t cover dental procedures or appointments.

Does Medicare Part C Cover Dental?

Medicare Part C, also known as Medicare Advantage, is an entire replacement plan for Original Medicare. Many Medicare Advantage plans do include dental coverage. You’ll want to review the details and costs before you make a decision on a Medicare Advantage plan.

Does Medicare Advantage Cover Dental?

As we mentioned earlier, many, but not all, Medicare Advantage plans include some amount of dental coverage. You’ll want to compare plan prices and see what procedures are covered. Don’t forget that you may have out-of-pocket costs, like deductibles or copayments, as well. If you want dental coverage through Medicare, Medicare Part C is the way to go.

Does Medicare Part D Cover Dental?

Medicare Part D, which provides coverage for prescription drugs, does not include dental care coverage.

Medicare Advantage is the best way to get dental coverage with Medicare.

H2: Understanding Your Options for Medicare and Dental Procedures It’s important to ensure you’re getting the care you need with Medicare. If dental coverage is a concern, you’ll want to carefully consider which plans are available that provide coverage for dental procedures.

It’s best to talk to a licensed agent who can help you learn more about Medicare. Contact us to compare plans today!

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 a donut with a bite as a visual metaphor for the Medicare Donut Hole

If you choose to have Original Medicare with Medicare Part D added, you’ll receive prescription drug coverage through Medicare Part D. However, there can sometimes be a gap in the coverage of your prescriptions. This gap is known as the “donut hole,” and it’s a period of time where you pay out-of-pocket for your medications. However, you don’t pay the full amount, and once your out-of-pocket costs hit a specific level Medicare will resume coverage. What is the Medicare donut hole? This page will help you understand the donut hole and how to navigate it. How Does the Donut Hole Work in Medicare? The Medicare donut hole is a period of time where you’ve reached the limit of your Medicare Part D coverage, but haven’t hit the “catastrophic coverage” level where Medicare resumes assisting you with your prescription drug coverage. With Medicare Part D, the first portion of the year you’ll be paying toward your deductible. The deductible varies but can be up to $445 in 2021. Once you reach your deductible, your drug plan will kick in and you’ll pay your copayment or coinsurance for your medication. If the amount you and your plan pay toward prescription drugs reaches a certain level, you’ll enter the donut hole. Keep in mind that not everyone gets to the prescription donut hole — the gap was designed to encourage Medicare recipients to seek out lower-cost drugs and generics. The Medicare donut hole in 2021 starts at $4,130. When Does the Medicare Donut Hole End? The coverage gap ends when you reach the catastrophic coverage limit for the year. In 2021, this amount is $6,550. The good news is that the donut hole essentially closed in 2020, so that even when you hit the coverage gap, you won’t pay more than 25% of the cost of prescription drugs. However, around 95% of the cost will count toward moving you out of the hole. Do Medicare Advantage Plans Cover the Donut Hole? Medicare drug coverage — Part D — works the same in a Medicare Advantage plan as it does with a "Stand-alone” Part D plan. However, some Medicare Advantage plans offer more generous benefits during the donut hole than a stand-alone Part D plan does. Understanding your prescription drug coverage is essential so that you know if you’re likely to approach a coverage gap based on the price of your medication. If so, make sure you know what the costs will be during the donut hole period. Medicare Part D Plans Without the Donut Hole There are no Medicare Part D plans — including Medicare Advantage plans — without a coverage gap. However, some prescription plans have additional coverage options during the donut hole. For instance, your Medicare Advantage plan might include coverage for some generic medications even in the gap. Or, they may offer some drugs at a lower cost than 25%. It all depends on your plan and provider. The best way to avoid the donut hole is to work with your doctor to keep the cost of your medication low. If that’s not possible, the fact that you will pay no more than 25% of the full cost even in the coverage gap will help ease your mind. How Do I Get Out of the Medicare Donut Hole? If you’re in the Medicare Part D donut hole, the only way to get out is to spend enough to reach the catastrophic coverage threshold. The good news is that while you’re paying no more than 25% of the cost of the medication, close to 95% of the cost of the drugs is going toward your spending total. One way to manage the coverage gap “donut hole” is to work with your doctor to find effective low-cost and generic medications that will help you maintain your physical health. Here are some tips that can help: Use a generic or find a similar drug that has a generic Talk to your doctor about drug costs and whether specific prescriptions are really needed Shop around — different pharmacies offer different drug prices Compare Medicare plans each year to make sure you have affordable drug coverage Learn More About Medicare Costs and Plans Medicare costs can be confusing, especially when there is the possibility of a coverage gap in the middle of the year. Fortunately, even during the Medicare donut hole, you don’t have to pay more than 25% of a prescription drug price, and you may even pay less. If you’re interested in comparing Medicare plans to make sure your drug coverage meets your needs, talking to a licensed insurance agent can help. Learn more about your options and compare Medicare plans today!
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Medicare enrollment periods

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Medicare Part D offers important prescription drug coverage and is part of both Original Medicare and Medicare Advantage. As a result, it’s important to understand the Medicare Part D phases that occur each year. There are four Medicare Part D stages. Depending on your drug costs, you may not reach all four in a given year. However, it’s still vital to know what to expect in case your prescription drug needs increase over time. Here’s what you need to know. What are the 4 Stages of Medicare Part D? What are the Medicare Part D stages of coverage? As we mentioned, there are four of them. They start with the deductible period, then initial coverage, followed by the donut hole, and then catastrophic coverage. We’ll go in-depth into each stage so that you can fully understand how they work for you. Deductible Period During the deductible period, you pay the full price of your prescription drugs until you meet your Medicare Part D deductible. The deductible may vary from one plan to another, but Medicare does set a maximum limit. Medicare Part D Deductible 2021 In 2021 the deductible limit for Medicare Part D is $445. Some plans have a $0 deductible, meaning that you skip the first of the Medicare Part D payment stages and move straight into initial coverage. Other plans have a deductible that only applies to certain tiers of medications, while other medications are covered right away. For instance, generic medications may be covered immediately while name-brand medications have a deductible. Make sure you review the Medicare Part D deductible when you compare plans each year so you can choose the plan that’s best for your needs. Initial Coverage Once your deductible is met, you move into initial coverage. This is where your Medicare Part D plan covers your medication, and you only pay a copayment or coinsurance each time. Each plan will have a different list of covered medications and different out-of-pocket costs, so be sure to carefully review the details of your plan. The initial coverage period lasts until you hit $4,130 in total drug costs, which includes both the amount you have paid during the year and the amount your plan paid. Depending on your medical needs, you may not hit the limit, but if you do, you enter the coverage gap known as the Medicare donut hole. Medicare Part D Donut Hole Once you hit the Medicare Part D initial coverage limit, you enter a gap in coverage known as the donut hole. In the past, you had to pay a significant amount of your drug costs during this gap. The coverage gap for all drugs essentially closed in 2020, meaning your share of costs in the “donut hole” is limited to 25% of the drug cost (both brand-name and generic). This percentage will replace the copayment or coinsurance you were paying during the initial coverage period. S For a generic drug that costs $100, you would pay $25 for that drug during the donut hole. For brand-name drugs, even though you only pay 25% of the cost, around 95% of the cost will count toward your out-of-pocket total to move you out of the coverage gap. Once you have paid $6,550 in out-of-pocket costs for prescription drugs, you’ll exit the donut hole and enter catastrophic coverage. Medicare Part D Catastrophic Coverage The final stage of Medicare Part D is catastrophic coverage. What is catastrophic coverage in Medicare Part D? It’s a phase designed to help those who have especially high prescription drug costs. During catastrophic coverage, you’ll pay significantly lower copayments or coinsurance for your remaining prescriptions for the year. For Medicare Part D catastrophic coverage in 2021, you’ll pay 5% of the cost of drugs, and the plan pays for the remainder. Does Medicare Part D Have an Out-of-Pocket Maximum? There is no out-of-pocket maximum for Medicare Part D, but once you hit catastrophic coverage, your out-of-pocket costs drop significantly. Generally, you’ll pay a a minimum of $9.20 for brand-name medication and $3.70 for generic drugs, or 5% of retail costs, whichever is higher. Learn More About Medicare Part D Coverage Stages Medicare Part D is important coverage for many Medicare beneficiaries. That’s why it’s vital to understand the various Part D phases and whether you will enter them in a specific year. Comparing plans is easier with a licensed insurance agent by your side. Contact us to learn more or use our plan comparison tool to learn about plans in your area.
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