HMO Dental Insurance

One of the shortcomings of Original Medicare is the lack of dental coverage. Original Medicare does not cover dental unless the dental issue is related to or contributing to another major illness in the body. This means that just when seniors need help with their dental the most, often they have no dental coverage or are forced to get a separate private dental plan which can be very expensive.

Introduction to Medicare HMO Dental Plans

Dental care is often an option that can be added to your HMO medical insurance. These plans are generally part of the HMO Plan but they may also be quoted separately so that the Medicare recipient can choose which of the extra options they want included with their HMO Plan.

Generally HMO dental plans require a patient to choose a primary care dentist. Like the primary care physician, the primary care dentist will refer the patient to a dental specialist when needed.

What is covered under an HMO Dental Plan?

Each HMO dental plan will be unique and have its own set of rules for care and payment. However here is a list of the things that are generally covered under an HMO Dental Plan:

  • Oral and emergency exams
  • Preventative care
  • Cleanings
  • Oral hygienist consultation
  • X-rays
  • Fillings
  • Limited periodontal care

The following services are also covered but usually at a reduced rate:

  • Oral surgery
  • Crowns and bridges
  • Dentures and denture adjustments
  • Root canals
  • Implants
  • Periodontal surgery

Costs Associated with Medicare HMO Dental Plans

Dental Plans attached to Medicare HMO's are generally not very expensive. Generally there will be monthly premiums which are added onto the base HMO premium. In addition to the monthly premium participants are usually required to pay a co-pay every time they visit the dentist and a co-payment when they receive treatment. Often there may also be a cap on yearly amounts the plan will pay for and/or a deductible. The plans are geared towards basic healthy dental maintenance rather than catastrophic care. If you are in need of an entire new mouth of implants these may not be the right plans for you.

In addition, the out-of-pocket costs associated with Medicare HMO dental will dramatically increase if you want to see a dentist outside of the plan's network. The insurance company may in fact refuse to pay anything. While at first they may seem very strict, dental care is subjective and determining exactly what you might need is often a grey area.

Auntie Lou says, "Watch out for dentists in general I went to three of them once to get an opinion and each dentist wanted to drill on a different tooth! You only get one set of chompers- with dental care, less is more!"