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- Most advanced dental plans cover 100% preventive and diagnostic care such as semi-annual cleanings, exams, and X-rays.
- Dental plans only cover a portion of other dental work, such as fillings, root canals, and extractions. Some plans do not cover major jobs at all.
- Most dental plans have an annual maximum benefit, after which you will pay for all dental care out of pocket.
- Some dental plans for older adults include overdentures, orthodontics, and oral surgery.
If you’re a Medicare beneficiary, chances are you’re already covered by Medicare. But what about your teeth? Getting regular dental care is vital to your overall health, but some older adults forgo proper care due to the high cost.
Dental insurance plans can help you, but only if you choose the right one. The following information details the basics you should know when deciding what is right.
What is dental insurance?
Many seniors think of dental insurance like health insurance for their teeth. While dental insurance does share some similarities with health insurance, there are some important differences between the two that you should understand.
Just like medical insurance, dental insurance also covers emergencies such as a broken towel or infection. Also, just like Medicare, preventive care is covered by most dental insurance.
The biggest difference between health insurance and dental insurance is how much coverage the policy provides and how the coverage works.
What does the senior dental plan cover?
The dental coverage you receive will depend on your plan, but dental coverage generally includes the following:
- Preventive exams/cleanings twice a year (every six months, or twice per calendar year)
- X-rays for annual exams
- Cavity Filler
- Root Canals
- Oral Surgery (as dendritic extract)
Some plans are more comprehensive and also include care such as:
- Orthodontics (correcting misplaced markings or misplaced teeth)
- Periodontal medicines (to treat gum disease or dental implants)
- Dentures (eg replacement and restoration of dentures)
Do you need dental insurance in your senior year?
Dental disease doesn’t just affect your teeth. Tooth loss and dentures can affect your nutrient intake, limit your comfort foods, and increase your risk of stroke, heart disease, and diabetes, which are also linked to dementia. In addition, dentists play an important role in the early detection of oral cancer. Proper dental care plays a huge role in your overall health, and your dental needs will only increase with age.
High costs are a barrier to dental care
At a time when the dental needs and costs of seniors or adults of retirement age increase, they tend to lose their employer-provided dental insurance. Consider these statistics from the Centers for Disease Control and Prevention:
- About two-thirds of adults 65 and older have gum disease.
- 1 in 5 adults 65 and older have untreated tooth decay.
- One in five adults 65 and older lose a tooth.
Meanwhile, more than half of seniors (53%) say they have to delay dental care because of high costs, and 23% of Medicare enrollees say they have delayed or No dental care.
Overall, the need for dental care for seniors is clear, but what about dental insurance?
Dental insurance can be a valuable tool in protecting you from expensive dental care. As with any insurance, deciding whether it’s worth the expense depends on your specific needs.
If you only need cleaning and X-rays twice a year, you’ll likely be spending more on your insurance than you’re paying out of pocket. But most seniors are likely to need more care, making dental insurance a viable way to help offset those costs. For example, 19% of Medicare beneficiaries spend more than $1,000 a year on dental care (for those who receive care).
Does Medicare Cover Dental?
However, there are some exceptions:
- X-rays linked to treating fractures, fused bones, or facial bones
- To remove the tooth in preparation for radiation treatment of the tumor
- Oral or dental exams on an inpatient basis as part of exercise before kidney transplant surgery or heart valve replacement
- Dental care is an integral part of another health care procedure covered by medical care, such as but teeth in the treatment of fusion fractures
Therefore, if you have original health insurance (Parts A and B), most routine dental care will not be covered. However, if you have a Medicare Advantage plan (Part C), there’s a good chance your plan includes dental benefits. As of 2020, 88 percent of Medicare Advantage plans offer some type of dental coverage, according to the Kaiser Family Foundation.
What types of dental insurance plans are available for seniors?
If you’re looking for a stand-alone dental insurance plan, you’ll come across many of the same types of plans related to health insurance. There are many different types of dental benefit plans on the market today. Some of the most popular plan types include:
Preferred Supplier Organization (PPO)
A feature of this type of plan is that a network of dentists agrees to provide services for a flat fee. Seeing dentists within these networks may save you money. Out-of-network dentists may charge different fees (high or low), so you’ll have to do your research.
Dental Care Organization (DHMO)
This dental plan pays in-network dentists a flat fee per patient per month. Dentists provide services to patients with low or no fees. Because the plan does not reimburse patients for personal services, patients must remain in-network to use their benefits.
direct repayment plan
You can see any dentist if you have this type of plan. You’ll usually pay the dentist directly, submit a receipt to your plan, and the plan will reimburse you for a percentage of the cost.
These plans are not technically dental insurance plans, but they have become fairly common. The program contracts with dentists who agree to lower fees. Patients use the gap to pay directly to participating dentists. There is no need to file a claim.
Schedule of Allowance Scheme
The plan pays a certain amount for each dental service, and the patient is responsible for paying the difference between that amount and what the dentist charges.
How much coverage does dental insurance provide?
Dental plans require you to pay many of the same out-of-pocket costs as regular health insurance, including monthly premiums, deductibles, co-pays, and coinsurance.
You may pay more for coinsurance than you are used to. For example, Medicare beneficiaries are typically responsible for 20% coinsurance, but it’s not uncommon for dental plans to require 40% coinsurance or more.
Another important factor to consider is that dental insurance plans usually have a cap (the highest annual benefit) and are usually low (usually between $1,000 and $3,000). After reaching the cap, you will pay 100% of the cost of care.
For years, preventive care and fillers were the only services you needed, but they worked well. However, if you need more than very basic dental work, you’ll quickly outpace this benefit. For example, the cost of a tube and a crown together can exceed $3,000.
There are plans with no annual caps, but be aware that even dental coverage with full or comprehensive coverage on the bill itself will almost certainly not cover 100% of your dental care costs.
Dental care is expensive, whether you have insurance or not. Dental insurance plans can help you reduce these costs. You must research the plan you are considering carefully. If you’ve seen a dentist you like, they may be able to recommend a plan to you based on your history and expected future dental needs.