Supplemental Dental Insurance For Medicaid

Can I Get Medicaid Coverage For Past Dental Bills

If you had a dental procedure that you had to pay for out-of-pocket because you didn’t have health insurance, you should find out if you would have qualified for Medicaid during that time. Retroactive Medicaid can go back up to three months and cover dental bills you may have incurred.

Of course, this depends on if your state Medicaid plan covers dental for adults. If you want to see if you can get retroactive Medicaid for dental bills within the past three months, you should contact a Healthcare Navigator to help you, as it can be a complicated process.

What Is Supplementary Health And Dental Insurance

If you live in Ontario, you are probably covered under the government-funded Ontario Health Insurance Plan . When you are approved for OHIP, youll get an Ontario health card which enables you to go to a doctor, clinic, hospital or emergency room, and receive medical attention, tests and surgeries at no cost to you.

But OHIP only partially covers or doesnt cover some medical services like prescription drugs and vision care, and it does not cover dental care. To pay for medical needs and dental care that OHIP doesnt cover, you may want to consider purchasing supplementary health insurance also known as extended health insurance, or private health insurance, and supplementary dental insurance.

You might have supplementary health and dental insurance through your employer, known as group insurance, or you may decide to buy your own policies, known as individual insurance. Supplementary health and dental insurance is a way to get the medical services you need, at an affordable price. To find out more about the different types of supplementary health and dental insurance, visit Types of Supplementary Health and Dental Insurance.

Do You Need Supplementary Health Or Dental Insurance

If you are young and healthy, you might not need to buy supplementary health or dental coverage. It depends to an extent on what you are covered for under OHIP, a group plan or a parents group plan. For example, starting in January 2018, OHIP provides prescription drug coverage to youth 24 and under who are not covered by private benefits. Those children and youth are able to get more than 4,400 prescription medicines for free by showing their health card and prescription. Coverage is automatic, with no up-front costs. Read the news release to find out more. Check what you are covered for, take a look at your individual situation, and make a decision on whether what you have now is sufficient.

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What Is The Best Supplemental Dental Insurance For You

The best supplemental dental insurance plan is the one that fits the needs of you, your family, and your budget.

If you have a primary dental insurance plan through your or your partners employer, review the coverage to identify any gaps or services that you think you will need that are not covered. Are there waiting periods? Are the deductibles and copays high, meaning you will have to pay a lot out of your own pocket? Does the plan have restrictions such as no coverage to replace pre-existing missing teeth or no orthodontic coverage?

If your children or you want to get braces, the best supplemental dental insurance plan may be one that has orthodontic coverage. If you are missing several teeth and want to have them replaced but your primary plan doesnt cover for pre-existing conditions, you likely need to find a supplemental plan that provides a benefit regardless of when the teeth were pulled.

Perhaps you have a great medical insurance plan, but it does not include any provisions for dental care. The supplemental dental insurance plan that may work for you will be one that has comprehensive coverage to address yours and your family needs.

Premiums And Deductibles Can Vary Widely

The cost of dental insurance varies by plan, but the annual premium is usually between about $400 and $700, says McCarthy. But a low premium may not necessarily save you money if you have a high deductible or higher coinsurance, he adds. Thats why its important to compare different plans so you get a better sense of out-of-pocket costs.

Another option is a discount plan or a membership plan. Many dental offices now offer membership plans in which you pay a certain amount a monthusually between $20 and $40for a series of services that include things like two free exams and cleanings, annual X-rays and one emergency exam, says McCarthy. You may also get a discount on more extensive procedures like fillings and extractions. These types of plans are becoming more popular: About 1 in 4 dentists now offer them, according to a 2021 survey from the American Dental Association.

Some discount plans dont require a dental office membership. Instead, you pay a low monthly feeas low as $10 in some casesand receive significant discounts on everything from cleanings to root canals to orthodontics when you visit a participating dentist.

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How Does Medicare Advantage Dental Coverage Work

Medicare Advantage plans are the primary method for dental coverage under Medicare.

Whatâs usually covered:

• Tooth extractions

Medicare Advantage are bundled plans that combine add-on benefits such as dental or vision with Original Medicare and additional cost-sharing for medical needs. About 94% of Medicare Advantage plans offer the option for dental coverage. However, sometimes there is an additional fee to include dental coverage in your plan.

For example, the standard Medicare Advantage plan from Kaiser Permanente does’t include dental care, but if you upgrade to the Medicare Advantage Plus plan, you’ll get dental, vision and hearing coverage.

The level of dental coverage with Medicare Advantage plans varies. Some have an annual payout limit, such as only contributing $1,500 to your dental care each year. Other plans could have coverage specifications on the number of cleanings per year or denture coverage.

Medicaid Supplemental Insurance: An Introduction

Do you or does someone you love depend on Medicare for health care coverage? Are you wondering how Medicare coverage can be supplemented, either with another policy or by Medicaid as a secondary insurance provider?

Supplemental or secondary health insurance helps cover health care costs that arent usually covered by typical health insurance. Some supplemental insurance companies cover certain situations, such as hospital or disability insurance. Others pay for certain health conditions such as cancer.

When supplemental health insurance isnt an option, Medicaid can act as secondary insurance for those who qualify.

Keep reading to learn more about supplemental insurance and how Medicaid may work as secondary insurance to Medicare in some situations.

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Medicaid Dental Providers For Adults And Children

According to the American Dental Association, 36% of lower-income Americans have lived through untreated cavities. Dentists that take Medicaid can be hard to find, in fact, only 38% of dentists in the US accept Medicaid.

The low percentage of participation of Americans in Medicaid may be due to the facts that:

• Many states make it very difficult for providers to become dentists that accept Medicaid
• Those who can receive dental coverage from Medicaid in their state are unaware.

If you need to find a dentist that takes Medicaid, Medicare or CHIP, you can go to Dentaquest’s Find a Dentist page and search by state.

Another way to find a dentist that accepts Medicaid is simply by calling an office near you and asking.

Also, you’ll most likely receive a booklet along with your Medicaid insurance information. Inside should be listed all of the Medicaid dental providers in your area.

Are Supplemental Insurance Plans Worth It

Whether you require supplemental health insurance depends on various factors.

These include:

• How much insurance you prefer
• What you want to be insured for
• How much insurance, if any, fits your budget

Your savings situation should play an essential role in your choice whether to invest in Medicare supplemental insurance. If you were in the hospital for a couple of weeks or longer, would you have enough money to pay for your deductible, copays, and coinsurance? For many people, this is a very tall order.

Do you have accessible money through an HSA or FSA? If you do, then investing in supplemental health coverage may not be worthwhile.

Medicare supplemental insurance is most helpful if you think you may not have the money to cover unexpected medical bills. Look at the deductible, copays, and coinsurance on your health insurance plan and determine your chances of requiring supplemental coverage.

Assessing your family health history can also give you a suggestion of potential risks. Of course, its essential to measure how much you can afford to spend in insurance each month and how much you can afford if a severe illness or accident occurs.

If you are unable to afford a Medicare supplemental policy, Medicaid may act as secondary insurance for qualified applicants. If you think you may qualify for Medicaid, its best to apply before incurring any medical charges.

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Best Medicare Dental Coverage For Seniors

The best dental insurance for most seniors is a Medicare Advantage plan from AARP/UnitedHealthcare because of its large network of dentists. We also recommend Aetna for low-cost dental coverage. If you need dental care right away, a stand-alone plan from Humana can provide comprehensive benefits starting the first day of coverage.

Whats Medicaid Secondary Health Insurance

Now lets cover how Medicaid can serve as secondary health insurance to Medicare.

Medicare is the primary payer for services it covers. These services commonly include visits to the doctors office as well as care in a hospital, at home, or in a skilled nursing facility. When a covered person obtains services from a provider that accepts both Medicare and Medicaid as forms of coverage, Medicaid may cover shared Medicare costs such as copays and coinsurance.

Depending on income, Medicaid may provide cost-sharing help through the Qualified Medicare Beneficiary program. The program may also provide assistance with the cost of prescription drugs or optional coordination of care.

Thats why its important to know whether you are eligible for Medicaid and, if so, to be sure to apply for the program.

Whenever possible, its also important to ask your providers about your coverage and costs before receiving services.

If you currently carry a Medigap policy and are looking for Medicaid to replace it, make sure you understand the ramifications of cancelling that coverage and are fully approved for Medicaid before making any changes.

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What Do Dental Plans Cover

Depending on the plan you choose, our dental insurance benefits can include:

Dental Insurance Is Especially Helpful For Certain People

Dental insurance can lower the amount of money you owe out of pocket when paying for dental work. But there are certain people it may be particularly beneficial for:

People who visit the dentist often. Dental insurance is great for the person who goes in for regular checkups and cleanings, particularly if they have a history of periodontal disease, significant cavities, or missing teeth, says Thomas J. McCarthy, DDS, a dentist in Brookfield, Wisconsin, and dental adviser to Sporting Smiles. In addition, he says, anyone with a medical or physical compromise that affects their ability to properly care for their teeth should consider insurance. Some plans will even cover an extra visit for this reason.

Families with children. Dental insurance is also helpful for people with children, says McCarthy. so if your child needs umpteen cavity fillings, you have the peace of mind of knowing that theyre covered.

There are also limits on the amount youll have to pay for each child out of pocket for ACA-qualified stand-alone dental plans: $350 for one child and $700 for two or more children. After you reach this amount, your dental plan must cover everything. Some children may qualify for free or low-cost dental care through Medicaid and the Childrens Health Insurance Program .

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Supplemental Dental Insurance For Existing Coverage

A supplemental dental plan for existing coverage may be a good idea for you if you feel like you need extra or full-coverage dental. For example, if you need expensive treatment, like braces or a root canal and a crown, which will end up going over your current plan’s annual maximum limit.

Dental insurance plans typically will only cover costs of up to $2,000 per year, some go a bit higher, but not much. This maximum is fine for covering preventative care costs and minor treatments like deep cleaning or dental fillings.

But if you need anything else, you’re sure to go over the limit and that means you’ll be paying out of pocket.

Another reason you may want a supplemental plan is if your existing plan has a long waiting period for the treatment you need. In this case, you could look for a supplemental plan with no waiting period.

So how does it work?

Your existing dental insurance plan, whether it’s one you purchased on your own, or one you’re getting through your employer, is your primary plan. When you receive treatment, your dental provider sends the claim to this plan.

If not all of your treatment is covered by the primary plan, then your supplemental plan can take over and help cover some or all of the remaining costs on your dental bill.

Your supplemental plan can’t cover treatment until after your primary plan has paid. This is called coordination of benefits .

Reasons To Get Additional Dental Insurance

If you’re wondering whether or not you should get a supplemental dental plan, we’ve rounded up the main reasons why you might get one:

• Waiting period: If your current plan has a long waiting period for the treatment you need, a second plan may help you save money on work that you need done now
• Major services: If your current plan only covers the basics, a secondary plan could be handy if you need more extensive work done
• Provider options: If you have two plans, a larger network of providers is likely to be covered
• Annual maximums: Having a second plan can keep you from paying out of pocket once your first plan meets the annual coverage limit

If you want to get started comparing dental insurance plans, you can go to DentalInsurance.com. Simply enter your zip code and date of birth, and this online marketplace will let you browse a wide range of plans available in your state.

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Medicare Advantage Dental Benefits

Medicare Advantage plans may provide extra benefits that are not covered under traditional Medicare, such as dental, vision, hearing, and fitness benefits. The cost of these benefits may be covered using rebate dollars. Plans can also charge additional premiums for such benefits. In 2021, 94% of Medicare Advantage enrollees in individual plans, have access to some dental coverage. The majority of these Medicare Advantage enrollees have access to a plan with more extensive coverage, while 14% had access to preventive coverage only. Preventive dental coverage under Medicare Advantage plans generally includes oral exams, cleanings, dental x-rays, and sometimes fluoride treatments. More extensive benefits cover a range of services, including restorative services , endodontics , periodontics , prosthodontics , and oral surgery.

The Scope of Covered Dental Benefits Varies Across Medicare Advantage Plans

Virtually all Medicare Advantage enrollees in plans that offer access to dental benefits , have access to preventive services, including oral exams , cleanings , and x-rays , although fewer enrollees have access to fluoride treatment .

like other dental benefits, coverage for dentures varies across plans

Medicare Advantage Plans That Offer Dental Benefits Typically Have an Annual Dollar Cap on Dental Coverage

Preventive Services Are Often Covered Without Cost Sharing For More Extensive Dental Services, 50% Coinsurance and Caps Are the Norm

Medicare Supplemental Dental Insurance

When you retired, you may have lost access to a dental plan you enjoyed for years through your previous employer. Many seniors rely on Medicare for their health care coverage with over 60 million Medicare beneficiaries in 2020¹, but Traditional Medicare typically doesnt cover dental care. As a result, about 60% of seniors over the age of 65 dont have dental insurance.²

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Coordinating Dental Insurance Benefits

Whether youre using supplemental insurance, a second dental insurance policy, or a dental savings plan you should be aware of how your primary plan has any policies about coordinating benefits. This information can usually be found in your plans policy documents. If you cant locate the information, speak with your dentist or the members service team at your insurance providers member service team.

Rules about benefits coordination can vary, so it is critical to get the specific details about your plan from your healthcare provider or insurance company frankly, you may want to get the information from both. If youre on Medicare, you can just call the Benefits Coordination & Recovery Center at 1-855-798-2627.

Basically, coordination of benefits comes down to deciding which insurance plan is the primary payer which plan pays first. Just to make things more complicated, the payer who pays first isnt the first one to pay its the insurance company that is responsible for paying the bill up to the limits of your coverage. Anything remaining goes to the second payer, and perhaps even a third.