What popular preventative dental services care can I expect from the PIA & PIS plan?
Preferred Insurance plans are full coverage dental plans. For those who are Medicaid recipients collecting social security or a pension, you may be eligible to obtain an insurance plan at no additional, out of pocket expense for the duration of your LTC stay. There are no copayments or deductibles either!
The plan coverage includes:
- Preventative Care: - Regular visits, cleanings and fluoride application (NOT JUST FOR KIDS!)
- Basic Restorative Care: - Periodontal care, fillings and extractions
- Major Restorative Care: - Full coverage crowns, complete and partial dentures
Low Coverage Premiums and No Copay visits
Preferred Insurance offers no copay and no deductible, comprehensive dental coverage. We have an extensive network of doctors who may see you in a traditional office setting taking advantage of our transportation benefits and mobile dental teams capable of providing care at your LTC facility.
As a Preferred member, you are entitled to:
- Exams and Cleanings every 6 months
- Eligible for crowns and dentures following six (6) months of active, paid premium payment
- Denture replacement after three (3) years (not the typical five (5) and seven (7) years common with other dental insurances)
Preferred Coverage
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Contracted with On-Site Dental Care
Preferred Insurance has dental teams that may be available to provide onsite dental care. -
Comprehensive Plans
We provide a comprehensive dental coverage plan for the LTC resident with a limited budget. -
No Copay or Deductable
Medicaid recipients may incur zero out of pocket cost for the policy. -
Your Choice
Our plans offer you a vast selection of offices in your community, possibility of on-site care and a selection of annual maximum coverages that may make the most sense for you.
How does this work?
How can elderly long term care residents who are enrolled in Medicaid pay for the dental care they need? Fortunately, a solution known as Incurred Medical Expense (IME) billing can help the majority of long term care residents who depend on Medicaid afford to pay for the dental treatment they need without imposing additional costs on providers.
Residents who are eligible for Medicaid use their Social Security check and other income to pay their monthly nursing home costs. When the Incurred Medical Expense (IME) option processes, the resident’s monthly income pays for dental services instead of the nursing home. The Medicaid case worker will increase the amount Medicaid pays that month to the nursing home on behalf of the resident. The nursing home still receives full payment. Residents or their representatives must first make arrangements with their caseworkers to reduce monthly payments toward expenses at the nursing home for one or more months, and then are authorized to use those funds to pay for medically necessary dental care.
Essentially, it enables residents to use their monthly retirement income, usually applied to help pay for their nursing home care, to pay for medically necessary health care services not covered by their state’s Medicaid program. At the same time, the caseworker directs Medicaid to temporarily increase the amount it pays to the nursing facility by the same amounts each month. The end result of the IME billing process is that the facility’s residents receive necessary dental care, their dental providers are paid for the services they provided, and the nursing facility continues to be paid its normal monthly fees.
Please note that the IME process differs state by state. Contact your state Medicaid dental office for details of your state’s policies.
If you are not a Medicaid recipient, you will have to cover the cost of the plan as a private pay expense.
Click here to receive more information about the PIS or PIA dental insurance plans.