Dental Coverage And Medical Insurance

Health is one of the essential aspects of your life, and as medical cost are snowballing, you need to have insurance that can cover you in case you face any health-related issues. Medical Insurance health coverage secures you against the risk of incurring unforeseen medical expenses. If you or your family members have emergency health issues or accidents, health insurance is one such service that can take care of your finances. Besides, having a health insurance policy gives you peace of mind in the time of medical or accident crises, and if covered, you are provided with quality health care services. In the United States, health insurance plans are intended for customers with varied needs. There are multiple health insurance plans which provide cover to individuals, to senior people, to family members, to expecting parents, etc.  

Health plans protect you from the expenses you have to bear for treating a wide range of illnesses. Multiple customized health insurance plans are available to suit the different set of requirements by different customers. 

What is health insurance and how does it work?

Most forms of health insurance protecting the costs of medical services include social insurance and private insurance such as Medicare, which pools resources to protect everyone in society. This also includes social welfare programs like Medicaid assisting people who cannot afford health coverage. In the United States of America, health insurance or better known as health coverage, health care coverage and health benefits are any programs that help pay for medical expenses.  It can be through privately purchased insurance, social insurance, or a social welfare program funded by the government.

Medicare - what is it?

A federal insurance program called Medicare is for people who are 65 years or older, younger people with infirmities and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Administered by the Centers for Medicare and Medicaid Services doesn’t provide coverage for outpatient prescription drugs. Medicare Advantage plan can fill the gap. 

Medicare Advantage provides additional coverage, such as vision and dental care. Medicare does not provide coverage for routine dental cleanings, fillings, o dentures.  Some Medicare Advantage plans cover necessary cleaning and x-rays but with a coverage cap of a certain amount. It is essential to understand what does your plan cover. 

What Dental care does the Medicare cover?

UNDER PART A – Medicare – dental benefits covered:

If you are protected with Medicare’s Part A, then it includes any emergencies or complicated dental procedures such as a jaw reconstruction as a result of a severe accident. Another example is when the extraction is inevitable for a patient under radiation treatment, this type of dental treatment or medical care is covered under Part A of the Medicare – Section 1862 (a)(12) of the Social security Act. If the patient has to go through Kidney transplant or heart valve replacement situations, Medicare will contribute towards oral examinations needed before the medical treatment.

UNDER PART B – Medicare – dental benefits covered:

When the patient needs prior examined before the kidney transplant or heart valve replacement, then dental benefits under the Part-B Medicare will be applicable.  However, there are two specific sets of services that Part B – Medicare will not cover. 

First, any services that are used to treat care, replace or remove teeth to structures supporting the teeth like pulling the teeth before getting dentures are not covered.

Second, any services that include those related to teeth and their supporting structures are not covered.  Any treatments needed to treat a non-dental condition and they are related to the teeth or supporting structure than Part-B will cover.  In this situation, the dental service must be performed at the same time and by the same physician or dentist as the other covered services for Medicare to pay its portion.

UNDER PART – C – Medicare Advantage Dental Policies

Medicare Advantage plans that cover dental care is usually offered by private insurance companies and are intended to cover all the necessary expenses covered under the original Medicare’s Part A and Part B Plan.  Listed below are different types of plans under Medicare Advantage:

  • HMOs (Health Maintenance Organizations)
  • PPOs (Preferred Provider Organizations)
  • PFFS (Private Fee-for-Service) Plans
  • SNP (Special Needs Plans)

Choosing of the plans listed above will depend on what benefits you would like covered and at what cost.  Also, another critical factor to consider would be to coinsurance or copayment that would be applicable.

What is DHMO & HMO and PPO?

The PPO and DHMO plans are the two most common types of Dental Insurance.

HMO or Dental health maintenance organization (DHMOs). In a DHMO’s a plan, a specific network of dentists who are in the system (network list) and participate in the insurance plan see patients for all of their care needs. The dentist is a part of DHMO network. DHMO plan reimburses the dentist a set sum per year. As contract and agreement by the insurance companies and the dentist, everything is covered.  

Preferred provider organizations (PPO’s). The dentist here is not a part of the network.  When you see these PPO dentists, your treatment is covered at a higher percentage.  The patients cover the differential cost.  The advantage is that you can see the dentist of your choice and many people prefer PPO dental plans because they are not tied to a specific list of dentist to choose. 

If one is paying out-of-pocket, then DHMO’s are a cheaper option and affordable as well. 

What are the Medicare PFFS (Private Fee-for-Service) Plans?

A Medicare PFFS plan is a type of plan similar to Medicare Advantage- Part C that is offered by private insurance companies. PFFS plans works differently than the original Medicare. The plan determines how much it will pay doctors or other health care providers or hospitals and how much you must pay when you get the care. Under the PFFS you have to join a PFFS network doctor or choose an out-of-network doctor, hospital or other providers who will accept the PFFS plan terms, the cost is usually lower when you join a PFFS network.

What is Medicare SNP (Special Needs Plans)?

Medicare SNP limits membership to a few groups such as people who live in certain institutions (like a nursing home), people who require nursing care at home and people who have specific chronic or disabling conditions like diabetes, End-Stage Renal diseases (ESRD) HIV/AIDS, prolonged heart failures or dementia. 

What is Dental Coverage through Medicare - PACE?

Programs of All-Inclusive Care for the Elderly (PACE) is another type of Medicare program that provides some dental care coverage.  PACE is a program only available in some states. The focus is on community care instead of going to a nursing home or other health care facility. Here a contract is made with the area healthcare specialists who provide people with dental care as well as other services needed. An Adult day primary care, meals, nursing home care, nutritional counseling, occupational or physical therapy, prescription drugs and much more are some other services that are covered under the Medicare – PACE.  

What is social welfare?

Welfare is government support for the citizens of the United States.  Welfare provided to people of any income level as with social security. A welfare state is where a particular state assumes responsibility for the health, education, and welfare of society. 

Over that, If anyone wants to add coverage for routine dental care with other medical and hospital coverage, it can be done with a Medicare Advantage plan. You can also keep Original Medicare, consider adding a Medigap plan with dental benefits or a separate dental plan.

Private Dental Insurance

There are many diversified health care insurance companies that offer a broad range of consumer-focused health insurance products and related care services. Along with the Medicare or Medicaid health care management services, private companies like Aetna, Delta and Cigna to mention a few offer medical health care coverages and a broad range including dental and vision, prescription coverage, behavioral health, group life and disability plans making it affordable and above all an extensive network of dentist across the USA.

A health insurance policy helps you manage your finances when you or your family members have to undergo medical treatment must be well thought-out. The costs of medical procedures and medicines are sharply rising, making even necessary treatments out-of-reach for ordinary people. Thus, PACE, Medicare Advantage or Stand-Alone-Dental insurance becomes the best option to minimize your out-of-pocket expenses, keeping your savings in reserve and giving you the benefit of cashless claims at network hospitals.

At Implants Pro Center™, San Francisco, we accept all major dental, Medicare, and medical PPO insurances, thereby reducing your worry about the cost of dental implant treatment or any oral surgeries. We also have a tremendously experienced and caring staff who will provide life-long care, maintenance, and support. Implants Pro Center™, San Francisco, is also equipped with all the modern technologies like CT-Scan, Intravenous Sedation, Platelet Rich Fibrin, etc. to provide nothing less than the best of services. You will be completely at ease for any of your procedure. Feel free to get in touch with us to schedule your free consultation.

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