Medicare Supplement vs Medicare Advantage


— PROS & CONS — ▼ MEDICARE SUPPLEMENT ▼


PROS • Nationwide Medicare network, best suited for travelers


• Lower out-of-pocket max, depending on plan


• Reasonable premium • Can include gym/fitness discounts and other value-added benefits


• Foreign travel emergency coverage with some plans


CONS • Not guaranteed issue after initial eligibility


• No Part D prescription drug coverage (can also be a pro for choice of plan based on your needs)


• Higher premiums than MA plans • May have limited plan options for disability recipients


▼ MEDICARE ADVANTAGE ▼


PROS • Low-to-no plan premium • Additional value-added benefits (dental, vision, and hearing, gym/ fitness discounts)


• Specialized plans offered in some areas for illness or dual eligible beneficiaries


• Low utilization can greatly reduce annual costs


• Part D coverage may be included in plan


CONS • High out-of-pocket max • Provider network limitations (out- of-network providers may cost more)


• May not be able to change to an affordable Medicare Supplement plan later


• Plans may change each year • Not suited for prolonged stays out the service area


Honest Answers / Practical Solutions / Personal Service 800-944-7550 • MDIS4DDS.COM


ISSUE 6 | NOV/DEC 2022 | focus 17


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GROUP HEALTH PLAN,


CMS expands Medicare to cover medically necessary conditions requiring dental services


T


he ADA News reported the Centers for Medicare & Medicaid released a final rule


on November 1 saying it will now cover dental services for Medicare beneficiaries under cer- tain conditions deemed medically necessary. The expanded dental coverage will go into effect January 1. The ADA was pleased that CMS listened to many of the ADA’s sugges- tions on the draft rule, which the ADA shared in comments filed September 2. ADA told CMS it supported providing dental coverage for the following instances, all of which are included in the final rule:


• Reconstruction of a ridge when per- formed as a result of and at the same time as the surgical removal of a tumor.


• Stabilization or immobilization of teeth when done in connection with the reduc- tion of a jaw fracture.


• Extraction of teeth to prepare the jaw for radiation treatment of neoplastic disease.


• Dental splints only when used in con- junction with medically necessary treat- ment of a medical condition.


• Dental services—including both exami- nation and treatment—prior to cardiac valve replacement, valvuloplasty or organ transplant procedures.


The final rule stated that Medicare payment would be provided if these procedures were done on an outpatient or an inpatient basis. Coverage would also be provided for ancillary services such as X-rays, anesthesia, or the use of an operating room for medically necessary procedures that fall under the rule. CMS said it will implement an annual review process to assess whether to include additional services under the Medicare medically necessary dental benefit. The ADA will be involved in this process, and will work with CMS to encourage the agency to provide guidance to dentists on enrollment, billing, compliance, and other questions. More at bit.ly/3EFnKmD.


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