Kaiser Medicare Advantage Dental Coverage

Some Kaiser Permanente Medicare Advantage plans may or may not come with dental coverage benefits. Kaiser Medicare plan members may be able to add an optional supplemental benefits package to their plan to either add or enhance dental coverage.

Because Original Medicare (Medicare Part A and Part B) doesn’t typically cover routine dental care, many Medicare beneficiaries choose to apply for Medicare Advantage (Medicare Part C) plans that are sold by private insurance companies, which include all the benefits Original Medicare covers and may often include some benefits not found in Original Medicare. 

Do Kaiser Medicare Advantage Plans Include Dental?

Depending on the type of Kaiser Medicare plan you choose, you may receive coverage for preventive dental services such as exams, cleanings and x-rays every six months. Dental services may require a small copayment. 

More advanced dental services may also be covered at a reduced rate and may include diagnostic and restorative services, endodontics, periodontics, extractions and prosthodontics.

What are Kaiser Supplemental Dental Benefits?

“Advantage Plus” is a set of Kaiser optional benefits that may be added to a Medicare Advantage plan for an additional premium. The package includes dental, vision and hearing coverage. 

The dental coverage featured in this benefits package may include:

Preventive and Diagnostic Services

Kaiser Permanente supplemental Medicare dental coverage can include up to a certain limit in annual benefits for routine exams (two per year), bitewing X-rays (twice per year), full mouth X-rays (once every five years), cleanings (twice per year) and fluoride treatments (two per year). 

There is no copayment or coinsurance required for these services until the annual limit has been met. 

Restorative Services

After meeting a minimal deductible, plan members pay coinsurance up to the annual dental benefit maximum. 

Major restorative dental services may include:

• Fillings
• Periodontal cleaning
• Simple extractions
• Oral surgery
• Root canals and other endodontic services
• Bridges, crowns and other fixed prosthetics
• Removable prosthetics such as dentures

Nightguards

Kaiser Medicare plan members may be able to get dental nightguards, though they may require a coinsurance cost equal to a percentage of the full retail price.

Emergency or Urgent Dental Care

Emergency or urgent care administered at a Kaiser-approved facility requires a small copay and all other applicable copayments, coinsurance or other plan charges apply. Such care delivered at a non-Kaiser facility requires a larger copayment, and plan members are responsible for all charges exceeding a certain limit. 

The annual dental benefit maximum does not apply to emergency or urgent care, which includes care for pain relief, acute infection, hemorrhage or injury.

Using Kaiser Medicare Dental Coverage

Kaiser Medicare Advantage plans may only be used at Kaiser Permanente hospitals and medical facilities. The company operates hundreds of facilities, including dentist offices, in the states in which its plans are sold. 

Kaiser Medicare plans are often structured as HMO (Health Maintenance Organization) plans, which is a type of coordinated care. That means plan members utilize a primary care physician who coordinates care and issues referrals within the Kaiser network.

Additional Kaiser Medicare Advantage Coverage

Kaiser Medicare Advantage plans include all of the same basic benefits found in Original Medicare (Part A and Part B). That includes inpatient care administered at hospitals, skilled nursing facilities and other inpatient centers as well as doctor’s appointments, rehabilitation and outpatient procedures and appointments.

In addition to these basic benefits, Kaiser Medicare Advantage plans may also include prescription drug coverage and coverage for certain over-the-counter health items purchased from pharmacies or other retailers.  

Enrolling in Kaiser Medicare Dental Coverage

Follow these steps to apply for a Kaiser Medicare plan that may include dental coverage. 

1. Enroll in both Medicare Part A and Part B. This is a requirement for applying for any Medicare Advantage plan.
   
   
2. Be sure you live in one of the states in which Kaiser sells Medicare Advantage plans. That list includes California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington, or Washington D.C. You may only enroll in Medicare Advantage plans that are sold where you live.
   
   
3. Leverage the help of a licensed insurance agent to help you find Kaiser Permanente Medicare Advantage plans available in your area and to review the costs and benefits.
   
   
4. Be sure to indicate to the agent that you wish to enroll in Advantage Pus, Kaiser’s optional supplemental benefits package that includes dental coverage.
   
   
5. Be ready to enroll when it’s time. You may only enroll in Medicare Advantage plans at certain times of the year, such as when you first enroll in Original Medicare and during the Annual Enrollment Period (AEP) that takes place each fall. 

An agent who is licensed on behalf of multiple insurance carriers can help you review additional dental plan options available in your location.