February 17, 2016
by: Margie Johnson
Ware, Aging and Health Specialist.
“Why doesn’t Medicare always cover glasses, hearing aids and
dentures?”
This
is by far one of the most common questions Medicare counselors have to field.
On paper, it seems like a no-brainier. Most older Americans will eventually
need these services, so there should be lots of coverage options for them,
right? Unfortunately, while Medicare is a government program, it is also an
insurance plan. And insurance is supposed to cover risks that perhaps can’t be
anticipated–whereas needing glasses, hearing aids and/or dentures are almost a
certainty as you age.
Those
of us who are members of the Baby Boomer generation might remember asking our
grandparents to take out their dentures so we could see their gums. If someone
lived long enough to have dental issues, they usually had had a number of teeth
pulled by the time they reached their golden years.
But
in the last 50 years a couple of things have happened. Many communities
fluoridated their water to prevent cavities. Pediatric dentistry became much more
common and parents were encouraged to take their children to the dentist early
and often to learn good dental hygiene. And companies began regularly offering
dental insurance as an employee benefit.
The
net effect of all these changes is that our generation is now joining Medicare
with almost a full set of teeth, with only the occasional implants, crowns,
fillings and bridges. This also means that we are a better “risk” for insurance
plans (like Medicare) to take on. The result? In the last few years, more and
more companies have been willing to sell individual insurance policies for
dental coverage to those over 65.
For
some individuals, retiree insurance includes the option of retaining your
dental coverage. For the rest of us, there are individual plans available in
most areas which may be worth exploring. Here are a few key tips to keep in
mind:
1.
Not sure where to start? Try taking the Medicare Questionnaire,
which can connect you to free professional advice from licensed benefits
advisors, including information about Medicare Advantage plans
in your area that may cover dental. You can also contact your local State
Health Assistance Insurance Program (SHIP) for access to
federally-funded Medicare counselling from trained staff members.
Depending
on the time of year, there may not be any upcoming enrollment periods to
switch to a plan that covers dental. But you can still use these resources
year-round to learn more about your options.
2.
Often you will find plans that charge $30 – $60 per month for insurance. You
might add up your dental expenses and say “But that’s what I’m paying out of
pocket now! It’s not worth it!” And it may not be. The key is to investigate
what is covered and what is not, and what your liability is in the case of a
major procedure. The following factors can have a big effect on your premium and/or
your ability to purchase an individual policy:
- Are you
joining after having been covered by an employer policy? If there’s not
too much of a gap, that helps.
- Are
you willing to pay a higher premium to have coverage the next month?
- Are
you willing to commit to a regular schedule of checkups?
- Can you find a plan that your
current dentist takes? Would you be willing to change practitioners if it
meant getting the advantage of insurance coverage?
3.
Some states offer stand-alone dental plans through the health insurance
Marketplaces. Check out NCOA’s guide to accessing dental, vision,
and hearing benefits to learn more. Another good resource is
the Tooth Wisdom project, a site created by
national nonprofit Oral Health America that aims to help older adults connect
to oral health resources in their community.
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