Best Dental Insurance for Seniors on Medicare?
Dental coverage is important to have, oftentimes the cost of it can be offset by the price you would normally pay for routine upkeep and maintenance of your teeth, give or take. Most people aren’t taking proper care of their teeth, however. Cost is definitely a factor, but preventing issues with your dental health can save you from experiencing a lot of pain in the future.
Oral health is something that requires daily work, along with routine visits to a dentist, and the sooner that you address any issues, the less expensive they’ll be to fix, and the less potential there is for them to get worse, causing aches, pains, and other health concerns.
Dental and oral health can help to prevent a number of different issues, even issues that can impact you outside of the mouth. Keeping your teeth in order, professionally cleaned once or twice a year, and dealing with cavities and other issues in a timely way is crucial to this.
Beyond health, there are also cosmetic benefits to staying on top of dental health. Chipped teeth, stains, and other issues can be fixed with dental insurance, and they can help improve self-esteem, confidence, and thus overall quality of life. Granted, you might not care all that much how your teeth look, but if you have coverage that will take care of most of the cost – why not go for?
Here are some options when it comes to the best dental insurance for seniors on Medicare.
What about Medicare’s Dental Coverage?
Unfortunately, Original Medicare doesn’t cover any dental work needed to maintain the health of your teeth. This includes things like routine checkups, dental cleanings, fillings, dentures, or tooth extractions unless deemed necessary to treat an unrelated medical condition. Instead, you will need to choose a Medicare Advantage plan or a standalone dental plan to ensure you get the coverage you need.
Medicare Advantage plans are comprised of Original Medicare (Part A and Part B), a prescription drug plan (otherwise known as Medicare Part D), and additional benefits like vision and dental. The benefit of choosing a Medicare Advantage plan is that all of these services are bundled together so you only pay one monthly premium. The downside is, that dental coverage can be limited to a few select services like cleanings, exams, and dental x-rays so you will still need to pay out-of-pocket for things like dentures, tooth extractions, and fillings.
For comprehensive dental coverage, it might make more sense to look for a standalone dental plan. While you will have to pay a separate monthly premium, the services that are covered might make the extra hassle worth it.
The cost of your dental plan depends on a few factors including your age, the number of people covered through your plan, and the type of dental plan you choose. Most plans cost between $20 to $60 per month, with an average price of around $30.
What is a dental discount plan?
A dental discount plan is not the same thing as dental insurance but it can still be an affordable way to save money on dental services.
Dental discount plans cost around $10 to $20 per month and can be used at participating dental clinics. The discounts can range from 10% to 60% depending on the service received.
What services are covered by a dental plan?
Most dental plans include routine dental care like check-ups and cleanings without having to pay any additional fees. Other services dental plans typically cover include:
- Preventive care
- Root canals
- Tooth extractions
- Prosthodontics (dentures)
Most dental plans offer a coverage structure of 100-80-50. This means the plan will cover 100% of the cost for basic services like routine check-ups and cleanings, 80% of the cost of basic procedures like fillings, and 50% of the cost of major procedures like extractions or crowns. You will be required to pay the remaining cost after your dental plan has covered its portion or if you have exceeded your plan’s annual maximum.
For dental plans, there are three main types to choose from:
- Preferred Provider Organization (PPO)
- Health Management Organization (HMO)
- Exclusive Provider Organization (EPO)
PPOs allow you to choose your own dentist while HMOs require you to choose a dentist within the plan’s network. EPOs are less common but are similar to HMOs with fewer restrictions.
What is an annual maximum?
The annual maximum refers to the maximum amount your insurance plan will cover each year. This amount will depend on your plan, but they are usually capped at between $1000 to $2000 per year. Typically, the higher the annual maximum, the higher the premium you will pay each month.
Can I use my dental plan right away?
Not likely. Dental plans often include a waiting period of up to six months before coverage begins for most services. Major procedures may have a longer waiting period of up to 18 months, so it’s better to get dental coverage before you need it.
How to get started
Once you find a dental insurance plan to suit your needs, enrolment is usually a breeze. Most plans offer online enrolment or you can visit your local private insurance broker for assistance. Most policies are valid once you have been approved but there may be a waiting period for some services. Basic services like cleanings and checkups are usually covered right away. Unlike Medicare, which requires you to be 65 or older, you can apply for dental insurance anytime but you may lose some coverage if you have a preexisting condition.
What to look for in a dental plan?
When it comes to choosing the best dental insurance plan, there isn’t a “one-size-fits-all” answer. You may have to do some shopping to find something that fits both your needs and your budget. Here are some ideas to start with.
- Network type: Monthly premiums and accessibility differ between PPOs, HMOs, and EPOs so it’s important to understand the difference before you commit. HMOs tend to be the less expensive option, but coverage is limited to dentists within your plan’s network. PPOs are more flexible but you often pay for that flexibility with higher monthly premiums.
- Network availability: If you have a dentist already, you might want to consider an insurance plan within your dentist’s network. If you don’t already have a dentist, try to pick a plan with a large local network for the best options.
- Annual maximum: The annual maximum is the most your plan will cover each year. If you can afford it, you should choose a plan with a higher maximum so you don’t run out of dental coverage before the year is over.
- Affordable premiums: Dental insurance plans typically range between $20 to $60 per month but it isn’t uncommon for some providers to charge closer to $100. It’s important to shop around so you get the best deal for the type of services you need the most.
Other important considerations
Before you commit to dental insurance (which is a minimum one-year commitment for most plans!) here are some questions you should ask:
- Is your dentist within the plan’s network?
- Can you choose a dentist or does the plan decide for you?
- What is the annual maximum?
- How long is the waiting period for most services?
- What services are fully covered, partially covered, or not covered at all?
- Is there a deductible you will have to pay before your dental insurance provides coverage?
- Will you be charged for office visits?
- Are treatment options limited to the cheapest available option or can you choose?
Final Thoughts on Choosing Dental Coverage for Seniors on Medicare
Whether you stick to something more basic, or go for a more comprehensive dental plan for seniors, it’s all about striking a balance between what you can afford, and what you realistically need. Routine care is important, but some dentists might also offer you a better price if you pay them in cash for routine maintenance. With an afternoon, and a calculator, you can figure out what will work best for you.