Dental and health insurance plans are paid by insurance carriers according to their insurance policy’s guidelines. The beneficiary is covered according to the insurance carrier’s service benefit plans. Dental and health care insurance plans can be purchased in combination. These plans include policies that are cover by preventive care such as necessary dental cleaning and x-rays.
Medicare Advantage Plans are called Part C Plans in Medicare. This plan provides additional coverage for dental treatments. A beneficiary should be well informed if their plan covers elective dental procedures. Some insurance plans may exclude cosmetic surgeries that may not fall in the category of being a medical necessity. These preventive care procedures are usually insured with the beneficiary paying a co-payment at the time of the dental visit. Since these procedures are listed under preventive care on the beneficiary’s plan, the insurance carrier will pay 100% of the reimbursement cost to the dental hygienist. Only fifty percent of a dental cosmetic procedure will be covered by most types of dental insurance.
Medicaid has a dental coverage called Early and Periodic Screening, Diagnostic and Treatment benefit (EPSDT) that is a required service under the state’s Medicaid insurance program. This is an excellent dental care and preventive insurance program for adults, especially the elderly. School-age and preschool children have also benefited from being covered by this dental and health insurance preventive program.
As for the difference in Medicare and Medicaid’s specified preventive and non-medically treatment coverages, the state decides if Medicaid indeed meets those requirements. An added benefit with the state’s Medicaid plan is that in the advent of a dental screening for treatment a condition is found, the state is responsible for the necessary services in treatment of that condition. Medicaid plans may not cover the treatment for that service, but it is under requirement to follow through the treatment and cover the service.