Denture/Dental coverage & MA plans

[LostDollar]

I’ve had clients use the Aetna MAPD dental for 2 years now and they all said they got completely reimbursed up to the limit. Just this Monday another client told he he got refunded within a couple of weeks.
I’m not sure how it is next year, but in 2021 they reimburse for everything except Fluoride. Odd.
It’s not a %, it’s not based on customary rates and no deductible. There’s no network because the client gets reimbursed.
That said, I still don’t do a ton of that plan.

No payment for adult flouride treatment is consistent with the provisions of the stand alone coverage I have.

 

[goillini52]

Starting in 2022 Aetna will have a network of dentists for their MAPD's. You don't have to go to a network dentist but if you do they will submit the claim and you will get the lower contracted amount so their $1000 or whatever their particular plan has for a maximum will go further. They are doing away with not reimbursing for opt out dentists which a couple people have discussed already. They said even dentists that are not in network can submit the claim for reimbursement. The clients haven't needed a claim form to send in the claim for a couple years. They just write their member ID# on the receipt and mail to the address on the back of their card. Best dental plan I have ever seen due to just a straight reimbursement of all claims up to the maximum.

I was just told that those networks aren't available in all markets. No networks in my area.

 

[Chazm]

They said yesterday that the only thing they won't reimburse for in 2022 is teeth whitening, because they don't feel it's medically necessary.

You’re right, not fluoride, it was teeth whitening.

 

[Real_AMG]

The two big things you need to verify when you’re comparing dental coverages are:

1. Annual limit for COMPREHENSIVE services
2. Co-insurance

Both of these are usually specified is the SoB if you read the fine print.