UnitedHealthcare's Medicare plans and dental coverage: What to know
UnitedHealthcare (UHC) Medicare Advantage plans cover routine dental treatment, with some procedures having little to no out-of-pocket expense.
According to the Kaiser Family Foundation, an estimated 65% of Medicare-eligible individuals do not have dental coverage.
However, a person’s oral health is often strongly tied to their quality of life and overall health. As a result, many Medicare Advantage insurance companies offer additional dental health benefits.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare and dental plans
This article originally appeared on Medical News Today
Original Medicare covers dental services only when they are necessary after an accident or when cancer treatments require dental extractions or oral surgery.
However, Medicare Advantage plans often offer additional coverage, including dental benefits.
Many Medicare Advantage companies will divide their benefits into tiers. For example, some UHC plans have tiers that include Preventive, Basic, and Major, with different out-of-pocket expenses for each.
The table below shows which service is in which tier:
Preventive | Basic | Major | |
|---|---|---|---|
Oral examination | Yes | – | – |
Dental cleaning | Yes | – | – |
Basic fillings | – | Yes | – |
Extractions | – | Yes | – |
Crowns | – | – | Yes |
Root canals | – | – | Yes |
Oral surgery | – | – | Yes |
Bridges | – | – | Yes |
Choosing a plan
When evaluating a dental plan through Medicare Advantage, a person should consider their dental health needs, such as whether or not they need coverage for dental cleaning and whether or not they anticipate needing more extensive dental treatment.
Medicare Advantage plans will usually partner with dentists to create a network and allow for cost savings. However, if a person’s dentist is not part of a plan provider’s network, out-of-pocket costs may increase.
People can use their zip code to compare plans on UHC’s website. Alternatively, they can search for all available plans in their zip code using the Medicare plan finder tool.
Do UHC cover dental services?
Most UHC Medicare Advantage plans include $0 copayments for preventive dental care services.
Although specific plans and benefits can vary, some of the dental services that UHC’s plans may cover include:
cleanings
dentures
exams
extractions
fillings
oral surgery
prosthodontics
X-rays
UHC do not typically provide coverage or reimbursement for cosmetic dental services. Some examples of cosmetic services include tooth whitening and tooth bleaching.
Coverage and costs
The number of UHC plans available in an area can often differ.
For example, seven different Medicare Advantage plans are available to those with Los Angeles, CA, zip codes, six are available to those in Phoenix, AZ, and five are available to those in Charlotte, NC. Each plan may have different dental benefits.
In Charlotte, UHC’s Medicare Advantage Plan 2 (Health Maintenance Organization) offers routine dental benefits as part of the coverage, which has a $0 monthly premium.
Examples of coverage for this routine dental plan include:
a $0 deductible for dental coverage
a $0 copayment for filings and preventive and diagnostic services
coverage for both in- and out-of-network dentists
up to $1,000 per year for covered dental services
In Houston, TX, UHC offer the same plan with an option of adding a Platinum Dental Rider benefit. This additional coverage costs $45 per month in addition to a person’s existing plan but includes more comprehensive dental services.
Examples of these services include:
a $0 deductible
up to $1,500 per year for covered dental services
100% coverage for preventive care and fillings
50% coverage for additional in-network procedures, such as crowns and root canals
In addition to dental benefits secured through a Medicare Advantage plan, a person can also purchase a standalone dental plan from UHC, which the Golden Rule insurance company will fulfill.
The standalone plans range from Primary to Primary Preferred Plus. If a person has original Medicare but does not wish to transition to Medicare Advantage, they can consider these separate policies from UHC.
Additional benefits
As well as dental benefits, UHC offer coverage for several other services, including:
fitness benefits, such as free gym memberships
hearing care, such as $0 hearing exams and cost savings on hearing aids
telehealth, such as around-the-clock virtual visits
vision care, such as free annual eye exams and prescription lenses
Help with costs
If a person needs help to cover the cost of a dental health plan from UHC or another insurer, there are several options available. These include:
Medicaid: Medicaid is a program that receives federal and state funding to help those with low incomes obtain insurance coverage. Although the benefits may vary by state, they often include expanded care options, including dental.
Health departments: Local health departments may offer health fairs or gather resources for individuals who need extra assistance in paying for or receiving free or low cost dental care.
Nearby dental schools: If a person lives near a dental or dental hygiene school, they could receive free or low cost dental care.
Nonprofits: Local nonprofit organizations, such as the United Way, could connect a person with dental resources.
National organizations: Organizations such as the Dental Lifeline Network or the American Dental Partners Foundation can also connect a person with community resources for dental health.
Summary
Dental care services are an essential part of overall health that original Medicare does not cover.
UHC offer dental benefits as part of their Medicare Advantage plans. They also offer individual plans should a person wish to retain original Medicare.
Because the coverage options vary by region, a person can search for available plans using their zip code.
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View the original article on Medical News Today
