If you are on Medicare and looking for a dentist in Springfield, MO, you’ll need to find out which ones take your Medicare plan. It’s important to know which ones work with your insurance so that you can get the most of your dental benefits.
Medicare and Dental Benefits
The first thing to find out is if your Medicare plan includes dental insurance.
Original Medicare, which consists of Parts A and B, does not include dental benefits. The same is true if you have a Medicare supplement (or Medigap) plan. However, there are other Medicare plans that do include dental coverage.
One option is a stand-alone dental insurance plan or a DVH (dental, vision, hearing) plan. These plans are not limited to Medicare enrollees, so anyone can benefit from them.
The second option is to enroll in a Medicare Advantage plan that includes dental coverage. These days, most Advantage plans do include dental benefits, but you should consult the plan’s evidence of coverage (EOC) to make sure it’s included.
Dental Insurance Networks
No matter which type of dental plan you have, you’ll need to know what network it belongs to. Some plans only allow for benefits if you see providers who are contracted with the company, while others offer out-of-network benefits. (However, you’ll probably pay more if you use a non-contracted provider.)
For example, if you have a PPO (Preferred Provider Organization) plan, you should try to find a dentist who is contracted with that specific PPO plan. These plans do allow you to see out-of-network providers, but you will pay more out-of-pocket. On the other hand, HMOs (Health Maintenance Organizations) require their members to only see in-network providers. There are no benefits allowed to non-contracted dentists.
There is one kind of Medicare Advantage plan that is a mixture of the PPO and HMO plan types: the HMO-POS. POS stands for Point of Service. These plans do allow for out-of-network benefits, just like the PPO plans. However, you may have a separate deductible. In addition, make sure the POS portion of the plan includes all providers. Sometimes, they only allow for outside benefits for certain aspects of your healthcare.
Find a Dentist in Springfield, MO
Now that you know what benefits your plan has, it’s time to find a dentist! There are a few ways you can find one that participates with your plan.
If you already have a dentist or know of a few you’d like to use, call the office and ask if they’re in-network with your plan. Some offices will even go so far as to look up your benefits over the phone, so make sure you have your ID card ready. Make sure to use the term “in-network,” as most offices will still file claims even if they don’t accept your plan.
You can also call the insurance company directly. Take a look at the back of your insurance card – there should be a customer service phone number listed. Call the number and ask for a list of contracted providers in your area.
For those of you who are computer-savvy, you can also access the provider directory on your insurance company’s website. Or, call the insurance agent who sold you the policy. They can help you navigate the website and find the information you’re looking for.
We’d still recommend asking the dental office about their participation status when you call to make the appointment. Sometimes the provider directories are not updated and have the potential to give you incorrect information.
If you need dental insurance, speak with our licensed insurance agents. We’ve got several affordable plans to choose from and will help you make a decision based on the coverage you need.