Dental Coverage On Medicare

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This show does not offer investment products or investment advice. Welcome to Finishing Well with certified financial planner Hans Shile and today's show is dental coverage on Medicare, which doesn't even seem to make sense at first, but we're going to make some sense out of it as we go through that today. And so as I was thinking about this, because actually I know that Medicare itself doesn't offer any dental or vision insurance for that matter.

But in Medicare advantage plans, they sometimes offer that in order to get people to take their Medicare advantage. And so I was thinking that that's kind of a shell game actually is the best way I know to put it is in that. And Jesus talked about this in the Song of Solomon where he was talking to his beloved and he said to her, actually when he was trying to get her to go away with him, he says, catch for us the little foxes that spoil the vineyard while the blooms are young. And the idea is that these foxes are, you know, the false.

In Hebrew that word is sheker and it means a lie that somebody is setting you up to essentially take the bait. What you don't see in that is that that often there's a hook in there. And unfortunately with our spiritual lives, you know, we're going after false comforters or we're going after false worship or we're going after false something like that, not realizing the giant hook is in there, but insurance companies have been masters of this for a long time, haven't they, Hans?

They absolutely have. You know, it's just dental is when I have a client come to me and they're all about dental and it's usually because they've just been through a big expense or they've been through expenses over time and they've had group dental and maybe dental is the only place that they really use their group insurance. Or maybe they don't have group dental and they incurred some expenses or heard about somebody, so when they come in, if dental is the end all be all, I've got to sit down with them and I've got to get it in its appropriate place because what we need to be doing with Medicare and Medicare people is we need to be getting them into the right health insurance plan in case they have a $100,000 or $200,000 or $300,000 bill. And to make sure that they can go to the doctors that they need to and that they can get most of that bill paid by insurance and Medicare. That needs to be the priority. And then dental and prescription drugs for that matter are add-ons or extra things. They're still important, but they need to be put in the appropriate place. Yeah, it's really putting the cart before the horse, undoubtedly. When usually those dental coverages are so minute that they hardly even cover much of anything.

When we get into this today, I think you're going to see, wow, it's a real eye-opening experience. And so the first thing that Robby was talking about is that generally on Medicare Advantage plans, you get dental and vision. And if you're on a zero-premium plan, which most people are, in a way you could say, I'm not paying anything for it.

So great. And then most people don't dig into the benefits of what they really are. And for the front end of a bill, or for cleanings and fillings, really those two things, maybe a little bit of a crown, they're not bad. I mean, they have a typical $750 or $1,000 annual maximum, and they usually require copayments. And then the size of the copayments, when you go see the dentist, are going to be dependent on whether you go to a network dentist or an out-of-network dentist. And if you go to an out-of-network dentist, don't expect much out of that thing, because the copayment is going to be almost as much as the charge. And then on the vision plans, any of them, they're going to pay about a quarter to half of the whole cost, including the glasses.

I mean, I've got the best plan going. And on the Medicare Advantage plan, they're going to get you in the door. And they're going to get you an exam, probably for free or an out-of-pocket pay, and they're going to get you glasses like they issue in the military once every two years or something.

And if you want to go up from there and get bifocals and, I don't know, tinted lenses or whatever, you're going to end up paying for most of those yourself. But nonetheless, you get something with Medicare Advantage plans. And when I have a customer that is end-all, be-all, and they want to compare the dental plans of the various Medicare Advantage plans, I have to tell them, look, we need to be comparing the medical benefits and the hospital benefits and the network and the cost for medical stuff. This dental is just a tag-along. So if we're using this as the main event, that's a problem. Yeah, and not to mention, you know, it's kind of scary for me that somebody that might have a great Medicare supplement would consider dropping their supplement to get some dental insurance that's just $750 worth of coverage. It's a real scary thing just to begin with, right?

Oh, it is. And there's other reasons to go to our Medicare Advantage plans other than the dental benefits and the freebies. Now, if you're on Original Medicare and you have a supplement, I want you to understand, and you may already know this, you have no coverage for cleanings, fillings, crowns, extractions, dentures, implants. You do have coverage if you have cataract surgery.

That's a question that a lot of people ask me, or you had a detached retina and you needed that worked on. If you were in an accident and somehow your teeth were damaged, you have coverage under Medicare. We're talking about routine and then major stuff that is classified as dental. Medicare doesn't cover it. Your supplement doesn't cover it. But the good news is you can buy insurance and we sell it to pay for dental whether you're on Medicare or not. Right. You've got it yourself and you're not on Medicare yet, right? Yeah.

Well, I purchased this plan after I had my big event. So I had four extractions, four teeth extracted. One of them extracted itself for me. It was a prior crown. And then I had implants put in and they had to build up my bone in my gum using cow bone or something.

It's just a miracle what they could do. So that it would be sturdy enough to accept the implant. This went on for a year. And $25,000 later, I had wonderful teeth in there. And now I'm just as good as new, which I got to think this is a whole lot better than the old style of having dentures. And I probably have more to come. So I bought the best policy that I could get after this because I said I probably got more and my wife is going to have this probably in front of her.

We're in our low 60s, mid 60s. And I bought it based around this major stuff. So we have one company that offers a $5,000 annual maximum. And this whole thing cost me like 24 grand, 25 grand, but it was spread over two years. So for starters, we could get the $5,000 annual maximum twice. So we're going to get $10,000 if we had something that major. But we also, the policy only pays 50% of major stuff up to $5,000. So regardless of whether you have insurance or not, you're paying for some of this.

And I did go to the best people in Raleigh, at least in my opinion, who don't, you know, and I did that by choice because I got the money. But nonetheless, if this happens in the future, I've got dental insurance and we're using it now for the exams and my wife's used it for some small stuff. My son who's under 26 is on it. He's used it for some stuff. So we're getting benefits out of it, but we really bought this for the big stuff. Right. And actually, if somebody had gotten a Medicare Advantage type of health coverage, you know, with a maximum every year of a thousand, I mean, it wouldn't even have made a dent in a year of those dentures, so to speak.

Yeah. And I think that actually the stuff on the Medicare Advantage excludes implants anyhow. I mean, it just, because a lot of these dental plans exclude implants because it's still in its infancy or, you know, they've only been doing it for X number of years.

But we know the difference. We probably have 10 dental plans that we sell, maybe 15, but we pretty much do most of our business with two or three companies. And one of those is the NCD, National Care Dental, is the one I have, and it's backed up by Nationwide or, in other words, they're the insurance company behind it. And, you know, it's all about the $5,000 maximum. There's still, it has its own little rules of getting at the money, so this stuff is far from perfect.

Yeah. Anybody who's ever had much dental insurance has experienced, you know, parts of that, especially if it comes to braces and those kind of things for young people, but the point, you know, still is that, you know, the focus is the actual medical coverage that is the main purpose of the insurance, right? Because you could come up against some real issues that we've talked about before with Medicare Advantage plans, and so we got a whole lot more to talk about when it comes to this, when we come back. Of course, we're going to remind you that today's show is always brought to you by Cardinal Advisors, cardinaladvisors.com, or you can find Hans' book, The Complete Cardinal Guide to Planning for and Living in Retirement, that has the seven worries tabs, and one of those worries is Medicare or Medicare Advantage, that kind of thing. And it's all there in Hans' book, or you can just email Hans there at cardinaladvisors.com. And of course, there's a wonderful video with both Tom and Hans on dental insurance on Medicare that shows all sorts of plans with Tom's got the actual plans right up there, and that's on Cardinal Advisors on their YouTube channel, Cardinal Advisors. And so when we come back, we got some more to share on dental coverage on Medicare.

We'll be right back. Hans and I would love to take our show on the road to your church, Sunday School, Christian, or civic group. Here's a chance for you to advance the kingdom through financial resources by leveraging Hans' expertise in qualified charitable contributions, veterans aid and attendance, IRAs, Social Security, Medicare, and long-term care. Just go to cardinalguide.com and contact Hans to schedule a live recording of Finishing Well at your church, Sunday School, Christian, or civic group. Contact Hans at cardinalguide.com. That's cardinalguide.com. Welcome back to Finishing Well, a certified financial planner, Hans Scheil, and today's show, of course, is always brought to you by cardinalguide.com. And our show today is on dental coverage and actually vision coverage as well on Medicare.

And so Hans, take it away. Every one of these radio shows, there's a corresponding YouTube video that's at Cardinal Advisors. You can go there and you can just find today's radio show. You can find the video on that. And I think the video is just going to give you more background.

And at our website, cardinalguide.com, you would go under the Medicare tab and you'll find a handout that goes along with the YouTube show and the radio show where you could actually look at documents now that back up the things we were talking about on the YouTube channel. So, you know, what I was just telling Robbie, I said, I don't have any good stories around dental insurance, maybe other than my own. But that's not even really that great of a story because nobody's life has been changed by their dental insurance policy that I sold them.

I mean, I just don't have any stories around it because this is not that big of a deal. So if there's anything that we're going to move to the bottom of the priority list of things that we're going to help people with, it's going to be dental insurance. I mean, health insurance, medical insurance, hospital insurance, Medicare, long-term care insurance, life insurance, all those kind of things that we do, doing good investment planning.

I've got all kinds of stories about how we've changed people's lives. They're just not there with the dental thing, okay? That being said, let's talk about the plan a little bit.

I'll give you a chance to react to that a little bit, Robbie. Well, you know, my wife and I both, you know, as we get a little older, our teeth do this, that, and the other. And, you know, there's a lot of interesting ways to handle that. But most dental plans, you're going to pay at least half and then you're going to wait, you know, several years. And there's things you can do with, you know, your health care savings plan and all those things fit into it. But like you say, I mean, those aren't going to make the huge difference of long-term care insurance, oh my good, what a difference that makes in someone's lives. Or even, you know, my dad's policies because he never went to Medicare Advantage. He stayed with a Medicare supplement which cost him some money. But oh my goodness, did it save him money at the end of his life because, you know, he didn't pay anything out those, you know, last seven or eight months.

He spent most of the time in a hospital. So yeah, let's be clear, I bought this policy myself and I did that for several reasons. And so I've got the best of the best and I have that because when I spent $25,000 of our hard-earned money over a couple of years fixing my mouth, part of that was because I neglected some things for a few years and through the pandemic and, you know, a few problems that were in there got worse. And then I finally go in there and I started dressing everything. And, you know, as us married folks know, I got to deal with my spouse and my wife. And I mean it's like you paid how much?

For what? And it's like why are we doing this? And I'm just doing this because I want my teeth to be taken care of and we're having to pay for it just because our dental – we paid a little bit out of our dental insurance that we had before. But so I really bought it to appease her because the next time something like this happens or it happens to her, I'm going to say, oh, it's paid for by the dental insurance. So there's a little bit of that going on and budgeting. I also just think that we are going to be inclined to get the best care that we can. And a lot of people buy these dental insurance policies and then never use them.

They don't do all this stuff. And so I think we're going to be inclined to use it. And we use the vision part of it.

So let's talk a little bit about what I bought, okay? And so it has an annual maximum of $5,000. That means in any calendar year, it's not going to pay out more than five grand. And what it does is that there's 100 percent coverage on exams. So you go in for your dental exams twice a year. They pay the whole thing.

That's kind of cool. It makes you more inclined to go in and do it. It pays 80 percent for basic stuff, for cleanings, fillings, just anything that they do which is under the list of basic care. And you've got a $50 deductible on that. So when you go in and you get some fillings, you get your teeth cleaned, that's usually part of the exam that the cleaning would be 100 percent.

But I never pay that much attention to it. We get pretty good coverage on that. And then the place where they go to 50 percent coverage is on oral surgery, implants, crowns, endonics, periodontics, dentures, and anesthesia. They even pay for the anesthesia under this thing. So if you were going in and getting one of them, you know, you've got good coverage, it's still only 50 percent.

So that means you're paying the other half. But it's going to be nice enough coverage to get us in the door, appease her a little bit, and I think if we need more of this, we're still going to have some savings that we're just going to have to pay for it. And then when you get over to the vision, I actually use this on the vision, and I looked up the VSP and where they are and who takes it on their website, and it was just about a mile away. I went down there, I got the eye exam. It had like a $10 copay for a pretty extensive exam. The lady told me I'm going to need cataracts when I'm 67, which is three years. That was real encouraging, and she showed me why. And then I said, well, am I going to need them in both eyes? She said, well, the other one looks pretty good, but most of the time, yeah, a couple, three years later, then you're going to need the other one. And just so I can repeat myself, regular Medicare, my Medicare supplement is going to pay for that.

This is more for the exams. They do the glaucoma exam. You know, if you actually got glaucoma and you needed some kind of treatment, there's a level that that would fall under Medicare. But nonetheless, if you have this insurance, you know, it ended up, then I bought glasses from them because I needed new glasses, and I bought some of the nicest glasses that they had that are bifocals, but they go gradual.

They're not absolute ones. I bought probably the most expensive glasses that they sell, and they turn dark when I'm out in the light and all that kind of stuff. And, you know, my bill was like $900, and I got somewhere between $400 and $500 out of the insurance, so I still paid $400. But, you know, that was all at network prices, so I still feel like I got something out of it. And I even have prices that you're paying, like if you buy this whole package like I have, it's $100 a month for one person, and for a couple it's $173 a month.

So it's not cheap. But that's dental and vision, right? That's dental and vision.

That's the whole package. Now, you knock the vision out of there, you knock out about $20 a person per month. So, you know, maybe $25 a month per person per month.

But here's the deal. You don't have to buy the Cadillac's plan like I bought. You can buy plans down the chain a little bit from this, even from a different company.

You know, let's just say $40, $50 a month for one, and like $75, $80 a month for two. And the only real difference is you're going to have about a $2,500 maximum or $2,000 maximum for the dental. Right. And you can buy those along with a Medicare supplement, or even if you've got a different – based on your Medicare Advantage plan that you really like, there's no reason not to just buy a better dental and vision insurance, right? Well, yeah. You can get the two to work together and work on top of each other.

And if you really wanted to pare the price down, if you bought something like you get with the Medicare Advantage plan, that's $20, $25 a month from us. So we've got a whole assortment of companies. And, you know, like I said, this isn't going to change people's lives. It doesn't stop us from studying it, knowing it, helping people with it. I'm just finding a hard time to get too fired up about, you know, and passionate as I normally am about how I'm going to change your life through this one little maneuver of selling you a dental deposit. Right. Well, networks are still, you know, another area that, right, people got a favorite dentist that they've been going to for years and years and years, or they got a favorite eye doctor. You know, that's still part of trying to determine – you know, that's a challenge that, you know, people get the Medicare Advantage plan just to get this, not realizing that, oh, man, the network is going to come homing in on you big time. And so, you know, it's not so simple as just taking the bait with that, right?

Well, it absolutely is not. And, you know, I have clients that come to me that, you know, then they're looking for a particular network on the dental plan. And so we can actually accommodate that, but it's tricky because, you know, we have also plans that don't require a network. So, in other words, you can buy a private dental insurance plan that has no network, and it's just got a schedule in the policy that's kind of like a network, and then that's all they're going to pay. So networks are an issue.

The whole thing is an issue, let's just put it that way. And so I always have my salespeople work for me. I'm always, let's set expectations, just like I'm doing on the radio show. This stuff isn't that great. It speaks to the heart of why a lot of folks choose to stay on a regular Medicare with a Medicare supplement rather than go to Medicare Advantage to begin with, because the second you say Medicare Advantage, right, it comes with a whole network concept.

Oh, yeah. Yeah, I mean, we're basically pro-stay on original Medicare and get a supplement, and then if you want dental insurance, just buy a separate plan. That's generally pro, but not for everybody. I mean, then Medicare Advantage, if you're going to go there, you're typically going to go there for the zero premium.

I mean, that's one of the big reasons people go there and they're real happy with it, because they don't have to pay a Medicare supplement premium, nor do they have to pay for a drug plan, and then they get all these added benefits. So I try to be right down the middle on which direction to go is better, and the reason I'm right down the middle, it depends on your budget. It depends on what's going to break you, and I try to get you into something that has the potential of changing your life. I mean, that's all the stuff that we, and all the recommendations that we make as we try to get everybody in something with insurance that if something bad happens to them, that they're going to be in a good position through the insurance. Right, and that, to me, it's the beauty of taking the time to get somebody who really knows all the different angles to all the different things, because everybody's situation we talk about all the time is no cookie cutter approach, right? And in my own situation, I loved what happened with my dad's Medicare supplement, and so I started out with that with my own Medicare, but then realized that my network, as it turned out, my doctors and people I used would work well with Medicare Advantage, and for a time, I'm going that direction. However, I'm always keeping my eye on the Medicare.

Every year you can reevaluate it and look at what you need to do based on your health, based on your network, based on all sorts of factors if you have the friend, the contact, right, in Hans that you can go to cardinalguide.com. Cardinal Advisors is where you get to them on YouTube. And so thank you so much for listening. God bless. Yeah, and God bless America.