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Dental Insurance Purchasing Guide | |
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Dental Care Needs |
Recommended Dental Plan (s) |
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Preventive Care - Preferred Provider Plan |
Humana One Preventive Plus Dental Insurance Plan
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| Preventive Care - Any Dentist Plan I'm looking for affordable dental insurance coverage for preventive dentistry, but I'm unwilling to switch to a networked dentist if my existing dentist does not network with the dental insurance plan that I purchase. I'm willing to wait up to 12 months for coverage for major dentistry such as crowns, root canals and dentures, but I want immediate coverage for my dental cleaning, dental exam and dental x-rays. |
United Health One Dental Premier
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| Fillings, Extractions or Major Dentistry I am in urgent need of major dental services, such as a filling, crown, root canal, dentures or dental implants, and I cannot wait for any length of time to receive my dental care. However, I am unable to afford the cost of the care I need without some kind of dental coverage or dental discount plan. |
The iDental Plan by United Concordia offers a short waiting period (only 6 months) for major dentistry. our insurance agency is marketing this plan in the States of Colorado, Arizona and Texas. |
| Low-Income I am living on a limited income, and I need a plan that is competitively priced while offering deep discounts for routine, basic and major dental procedures. I am willing to switch dentists if I am unable to find a dental plan that is accepted by my current dentist. |
Dental Savings Plans
Avia Dental Plan - $8/mo |
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Dental, Vision & Fitness Discounts |
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Overview of Medicare Dental Coverage
Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Medicare will also make payment for oral examinations, but not treatment, preceding kidney transplantation or heart valve replacement, under certain circumstances. Such examination would be covered under Part A if performed by a dentist on the hospital's staff or under Part B if performed by a physician.
Statutory Dental Exclusion
Section 1862 (a)(12) of the Social Security Act states, "where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth, except that payment may be made under part A in the case of inpatient hospital services in connection with the provision of such dental services if the individual, because of his underlying medical condition and clinical status or because of the severity of the dental procedure, requires hospitalization in connection with the provision of such services."
Background
The dental exclusion was included as part of the initial Medicare program. In establishing the dental exclusion, Congress did not limit the exclusion to routine dental services, as it did for routine physical checkups or routine foot care, but instead it included a blanket exclusion of dental services.
The Congress has not amended the dental exclusion since 1980 when it made an exception for inpatient hospital services when the dental procedure itself made hospitalization necessary.
Coverage Principle
Coverage is not determined by the value or the necessity of the dental care but by the type of service provided and the anatomical structure on which the procedure is performed.
Services Excluded under Part B
The following two categories of services are excluded from coverage:
A primary service (regardless of cause or complexity) provided for the care, treatment, removal, or replacement of teeth or structures directly supporting teeth, e.g., preparation of the mouth for dentures, removal of diseased teeth in an infected jaw.
A secondary service that is related to the teeth or structures directly supporting the teeth unless it is incident to and an integral part of a covered primary service that is necessary to treat a non-dental condition (e.g., tumor removal) and it is performed at the same time as the covered primary service and by the same physician/dentist. In those cases in which these requirements are met and the secondary services are covered, Medicare does not make payment for the cost of dental appliances, such as dentures, even though the covered service resulted in the need for the teeth to be replaced, the cost of preparing the mouth for dentures, or the cost of directly repairing teeth or structures directly supporting teeth (e.g., alveolar process).
Exceptions to Services Excluded
The extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease.
An oral or dental examination performed on an inpatient basis as part of comprehensive workup prior to renal transplant surgery or performed in a RHC/FQHC prior to a heart valve replacement.
Definition
Structures directly supporting the teeth means the periodontium, which includes the gingivae, periodontal membrane, cementum of the teeth, and the alveolar bone (i.e. alveolar process and tooth