Many seniors and low-income people often skip important dental services due to a lack of funds. This puts them at a higher risk of developing gum disease, oral cancers, and other oral health concerns than those with access to regular dental care. Unfortunately, it is a common misconception that Medicare and Medicaid generally offer dental insurance. The truth is that neither program is required to cover dental care, at least not for adults. Fortunately, some recipients of each program might be eligible for dental services.
Medicaid, Children, and Dental Care
Children under the age of 18 are entitled to dental benefits under Medicaid as well as the Children’s Health Insurance Program (CHIP). Kids enrolled in Medicaid are at the very minimum provided with dental services to relieve infections and alleviate pain. Tooth restoration is also included, as are many dental maintenance services. Dental services for children are covered under the Early and Periodic Screening, Diagnostic, and Treatment benefit.
CHIP is a different program than Medicaid. It’s an income-based insurance program specifically for children up to the age of 19. To qualify, a family of four must make less than $49,200 annually. It’s important to note that some states offer higher limits, and that each insurance program is handled on a state level.
Every state has a different method of determining whether adults are eligible for dental care through Medicaid. Eighteen states, including Georgia, Utah, Maine, Idaho, and Arizona, offer emergency-only coverage for medically-necessary dental treatment. Other states, like Alabama, Hawaii, and Maryland, offer no coverage.
How to Apply for Medicaid
Medicaid is an insurance program available to low-income families, but where you live determines the income limit for applying. The federal poverty level for 2019 was $25,750 for a family of four. Individuals may apply for Medicaid via their state Medicaid office or through the Healthcare Marketplace at Healthcare.gov. Proof of income is required.
Medicare Coverage for Seniors
As mentioned before, Medicare does not cover dental healthcare. Original Medicare explicitly excludes cleaning, tooth extractions, dental devices, and supplies. However, seniors with Medicare Part A might be eligible for emergency dental services, provided they are performed as part of a necessary hospital stay. In some cases, complicated and extensive dental procedures might be covered.
Seniors that would like dental coverage included in their health insurance can choose a Medicare Advantage plan. Medicare Advantage, also known as Medicare Part C, works like private insurance, and seniors can choose from a number of providers. Most of these plans offer dental care. Those who prefer to use a specific dentist will need to confirm they are part of the Advantage plan’s network to get the most out of their coverage.
Another option for seniors with Medicare is to add a Medigap plan to their coverage. Medigap is a supplemental insurance policy that helps pay for copays and coinsurance. However, only emergency oral surgery may be available for limited coverage under a Medigap plan. It’s important to note that seniors cannot have both a Medigap plan and a Medicare Advantage plan at the same time.
How to Apply for Medicare
Seniors approaching their 65th birthday are allowed to enroll in Medicare three months before and three months after. This is the Initial Enrollment Period (IEP). During this time, seniors can sign up for Part A, hospital insurance, and Part B, medical coverage. Seniors that still have insurance through an employer may opt to delay enrollment in Part B. Applicants should be aware that coverage premiums rise by approximately 10 percent for each year they were eligible and did not enroll, but some seniors in this circumstance might be eligible for a Special Enrollment Period (SEP).
Each year from October 15 to December 7, the Social Security Administration (SSA) also offers an Open Enrollment Period (OEP), also known as the Annual Election Period (AEP). During this time, seniors may change plans. Further, those with a current Medicare Advantage plan have the option to revise their coverage from January through March.
People hoping to enroll in Medicare may do so online at SocialSecurity.gov, in person, or by contacting the SSA by phone Monday through Friday at 800-772-1213. To qualify for Medicare, applicants must have earned at least 40 work credits, which is equal to approximately one decade of employment. Some people without a work history may qualify for Medicare based on their spouse’s work history.
Stand-alone Dental Insurance
People with Medicare and Medicaid may also choose to purchase stand-alone dental insurance without affecting their health benefits. There are many different providers; some offer 100-percent coverage, while others act more as a discount program.
Oral health is just as important as physical and mental health. Unfortunately, many of the most vulnerable people in the United States — low-income and elderly residents — are often the ones unable to access dental care. Unfortunately, Medicaid and Medicare offer very little in the way of benefits, but there are circumstances where these vital care services are covered.