Helena Foutz, RSSA, Medicare Insurance Broker

About Your Teeth: Understanding Medicare Dental Coverage

November 25, 2023

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What is the biggest mistake seniors make when enrolling in Medicare?

Answer: #1, not knowing when to enroll or not enroll into Medicare Part B, then

#2, not knowing their options when they choose a plan.

How do you educate clients who are completely new to Medicare?

Answer: I give them a little history of Medicare and explain the two different ways one can take their Medicare coverage - either Original Medicare with a Supplement and a drug plan for the least restrictions, or a Medicare Advantage plan that also includes other benefits, like transportation, an over-the-counter (OTC) catalog, dental, vision, and more depending on their plans in their area.

What is the biggest disadvantage of Medicare Advantage?

Answer: If you have a Medicare Advantage HMO, you are limited to the doctors in the medical group you choose, and you are limited in which medical groups work with which HMO. For Medicare Advantage PPO plans, the biggest disadvantage is the copays and higher out of network costs and Maximum out of Pocket.

Will I be penalized if I do not enroll in Medicare when I turn 65?

Answer: If you have some form of creditable coverage (medication coverage at least as good as that from a Medicare prescription drug plan), then you can stay on your plan if you like and not incur a penalty. If you do not have an employer group plan with creditable coverage, you could incur a Late Enrollment Penalty for Part B after 12 months and Part D for every month after your Initial Enrollment Period!

I’m retiring next year—do I need to do anything with my Medicare?

Answer: It depends! How old are you? If you're a younger retiree and will still get health coverage from your employer, stay on that coverage. However, if you have already passed your Medicare Birthday (age 65) and didn't do anything, then you need to get going and apply for Medicare Part A and B. Some people apply for just Part A when they turn 65, so for those with Part A, they just need to apply for Part B and select a plan!

Is Medicare Part A enough for hospital coverage?

Answer: Medicare Part A has a $1,676 deductible and only covers for the first 60 days when you are first admitted, so no, it would be a good idea to have other coverage to make up the difference.

Why is the new $2,000 out-of-pocket maximum for drug costs important?

Answer: This new Medicare Part D $2,000 Maximum out of Pocket is important for the about 7% of seniors who use the more expensive medications that are in the higher tiers. After the Part D deductible and the retail cost of medication is applied to the $2,000 limit, one does not have to pay for medication for the rest of the year.

Is it true that Medicare pays for dental implants?

Answer: Who told you that? It does not! A few Medicare Advantage plans MAY have dental coverage that includes implants, but Original Medicare itself does not.

What demographic challenges will Medicare face in the coming years?

Answer: The Inflation Reduction Act of 2022 made changes to how private insurance (Medicare Advantage and prescription drug) carriers cover medications, and this washed over to other benefits. The insurance companies went from covering up to 25% of the cost of drugs to 60% of this cost, and to balance their books, some companies started charging the Medicare Part D drug deductible ($590 in 2025!), some reduced their formularies, most trimmed benefits like vision, dental, and transportation, and other companies simply stopped offering certain popular plans. These are just the current changes to date, and Medicare itself said terminate companies' abilities to offer Value-Based Insurance Design (VBID) benefits at the end of 2025. We'll all just have to see what happens!

Do I have to answer health questions when switching from one Supplemental/Medigap plan to another?

Answer: This depends. If you live in a Birthday Rule state, like California or Idaho, you have an opportunity to switch plans on a Guaranteed Issue basis around your birthday, which means you can be a serious health condition and still get a new plan with no questions asked. If you go at any other time of year, or your state doesn't offer a Birthday Rule, then yes, you may be asked health questions.

Does Medicare Advantage cover home health care?

Answer: Yes, if your doctor orders it. However, Medicare does not cover 24-hour-a-day care at your home, home meal delivery, homemaker services (like shopping and cleaning) unrelated to your care plan, or custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need. Some Medicare Advantage plans include some homemaker services when returning home from the hospital, so ask your broker.

How can I get dental and vision coverage with Medicare?

Answer: I like to say Original Medicare only covers you from the neck down, so no glasses, no dentures, or hearing aids! (They will cover the inside of your head, lol.) But if you want a side of dental and vision with your Medicare, then look to a Medicare Advantage (MA) plan. Many MA plans offer dental and vision, and it pays to shop around. But let your broker be your personal shopper - it doesn't cost you anything, and he or she knows all the plans!

What happens if I am already retired and collecting Social Security when I turn 65?

Answer: If you're already retired and collecting Social Security, then you will be mailed a Medicare card with both Part A and B on it. If you are still on an employer group plan that you really like and it doesn't cost much, you can file form CMS 1763 to return your Medicare for the time being and avoid paying for Part B every month.

How well does Medicare support seniors who need assisted living, or does it fall short?

Answer: Medicare is health insurance and does not pay for assisted living. It is a good idea to get either a long-term care (LTC) plan or a hybrid life insurance plan with an LTC rider.