Medicare covers many health-related services, but this usually excludes dental procedures.
If a person needs dental treatments, they may need to get additional dental coverage or enroll in a Medicare Advantage plan that offers dental benefits. Kaiser Permanente (Kaiser) are an example of a Medicare Advantage plan provider who offer dental services in their plans.
This article will explore Kaiser’s plans, including the dental benefits. It will also look at coverage and costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Kaiser are based in California and include the Kaiser Foundation Health Plan, the Permanente Medical Groups, and the Kaiser Foundation Hospitals and their subsidiaries.
The nonprofit health plan currently operates in eight states and the District of Columbia. In 2020, an estimated 12.4 million people were enrolled in the Kaiser health plans.
The Centers for Medicare and Medicaid Services rate Medicare Advantage (Part C) plans using a 5-star system, with 5 stars being the highest rating.
For 2021, more than 20 Medicare Advantage plans got 5-star ratings, and Kaiser was represented in six plans nationwide. These were:
- Kaiser Foundation HP (California)
- Kaiser Foundation HP of Colorado
- Kaiser Foundation HP of Georgia, Inc.
- Kaiser Foundation HP (Hawaii)
- Kaiser Foundation Health Plan of the Mid-Atlantic (Washington D.C., Maryland, and Virginia)
- Kaiser Foundation HP of the NW (Oregon and Washington)
Considerations for star ratings include customer service, care coordination, screenings, coverage, and timely decisions regarding coverage appeals.
In 2020, Kaiser offer services in the following regions:
- California (Northern and Southern)
- Colorado (Northern, Southern, and the Denver/Boulder area)
- Georgia
- Hawaii
- Maryland
- Oregon
- Virginia
- Washington
- Washington D.C.
Most of the company’s plans are Health Maintenance Organization (HMO) plans, which means that enrollees need to use the plan’s in-network doctor and healthcare facilities.
Kaiser also offer some Special Needs Plans, which aim to help people with special health or financial needs.
Two plan types include dental coverage: the Kaiser Permanente Senior Advantage Basic (HMO) and the Kaiser Permanente Senior Advantage Enhanced (HMO).
Both plans include the following preventive and diagnostic dental services:
- two oral exams
- two teeth cleanings
- two X-rays per calendar year
The table below outlines some 2021 costs for these plans:
| Benefits | Basic plan | Enhanced plan |
|---|---|---|
| Premium | $0 | $71 |
| Deductible | $0 | $0 |
| Dental | $20 per visit, which includes teeth cleaning $10 per visit without teeth cleaning $15 per post-operative visit | $20 per visit, which includes teeth cleaning $10 per visit without teeth cleaning $15 per post-operative visit |
Comprehensive coverage
In many areas, Kaiser offer an option of additional coverage known as Advantage Plus, which incurs an additional premium of $13 but provides comprehensive dental care.
Comprehensive dental care benefits vary based on the region. For example, in Kaiser’s Northern California region, a person enrolled in the Advantage Plus program and visiting an in-network dental provider would pay $0 for many preventive services, including oral evaluations, X-ray images, and caries risk assessments.
There may be additional costs, depending on the service the person uses. People can check this using the company’s Evidence of Coverage document.
In addition to preventive services, comprehensive services may also cover other procedures. The list below outlines some of these for the Northwest region:
- restorative work, such as a composite, one-surface filling ($97) or crown ($543 for resin with high noble metal)
- endodontic procedures, such as a root canal ($349 for an anterior tooth)
- oral and maxillofacial surgery, such as the extraction of an erupted tooth ($80)
- periodontal services, such as scaling and root planing ($125 for four or more teeth per quadrant)
- prosthodontics services, such as partial or complete dentures ($770 for complete maxillary or upper dentures)
Medicare Advantage (Part C) is an alternative to original Medicare and offers the same basic coverage. Some plans may also offer additional benefits, such as dental, hearing, and vision coverage. Some plans also include prescription drug coverage.
Private health insurance companies offer these plans, though a person will continue to pay their Medicare Part B premium, which is $148.50 in 2021. There may also be an additional Medicare Advantage plan premium, depending on the individual plan a person chooses.
Kaiser’s Medicare Advantage plan costs vary by region. A person can use this online tool to research the plans.
The costs for supplemental dental insurance and copays vary, and some Kaiser plans do not offer dental coverage. The table below provides more detail:
| Location | Plan | Premium | Dental coverage | Maximum cost for health services |
|---|---|---|---|---|
| Atlanta, Georgia Zip 30301 | Kaiser Permanente Senior Advantage Basic (HMO) | $0 | preventive and comprehensive, with limits | $6,400 in-network |
| Los Angeles, California Zip 90005 | Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) | $0 | none | $3,400 in-network |
| Honolulu, Hawaii Zip 96815 | Kaiser Permanente Senior Advantage Basic (HMO) | $78 | preventive and comprehensive, with limits | $7,550 in-network |
Kaiser’s Medicare Advantage plans offer basic or comprehensive dental coverage.
Before selecting a Kaiser dental plan, a person should check that their dental provider accepts it to ensure the greatest cost savings.
Plan premiums may vary based on a person’s region and the services they use.