For freedom of choice, there are a few types of plans to consider including PPO dental plans and Indemnity plans. PPO dental plans generally allow members to see any dentist, but they also include a listing of In Network dentists. With PPO’s you typically get more value if you see an In Network provider, but you can still choose to see an Out of Network provider too. Though Out of Network providers can bill for additional charges if they wish.
Find a local dentist, access your insurance cards, or provide your doctor with critical information on the go with the Dental Select Mobile ID app. We provide superior dental insurance for seniors, as well as individuals and families, and our mobile app makes it simple for subscribers and covered family members to get the information they need anytime, anywhere.
Seniors have special dental needs that come with getting older such as root decay, gum disease, tooth loss and more. Even non-dental conditions common to seniors, such as arthritis, can affect dental health. For those coming off of an employee group health plan upon after retiring, coverage may not be extended after you leave your job, leaving you to find your own dental coverage. Most plans have a waiting period for coverage, so this can leave you without coverage for a period of time.
Aetna’s dental discount network includes over 161,000 dentists, and Careington says over 100,000 dentists participate in their plan. We searched for providers from a less populated location in the U.S. and found no dentists from the Aetna plan while the Careington plan had four dentists, although the offices were located 100 miles from the zip we used. If there are no providers available in a reasonable distance from your home, you can nominate dentists, and Careington will contact them to request participation. Dental providers usually join the network within 60-90 days.
Blue Cross Blue Shield has a plan called BlueCare that does not have a waiting period for preventative services and many non-surgical procedures. United Healthcare's United Health One is another. Major surgical treatments and restorative work do require some wait time, though that can be curtailed to some extent if you're coming off another dental plan.
If you don’t floss or brush every day, you will likely run into dental problems that everyone is susceptible to, including cavities, gum disease, tooth decay, and enamel erosion. However, there are some dental issues seniors are more at risk for than any other group of people. Seniors can develop these problems even if they properly take care of their teeth.
My plan covered cavity fillings, but an additional procedure (like a crown or an extraction) would have been costly even with insurance. Multiple appointments also took up a lot of time. I could have spared myself some of those cavities, and long hours in the dentist’s chair, if I’d got regular cleanings in earlier years (and, of course, flossed more often).
DentalPlans.com isn’t an insurance company, but they work with dental service providers to reduce the cost to see an out-of-network dentists. In this way the company gives access to some of the same dental benefits offered by employers through typical group insurance, but more closely resembles a prescription discount card. For example, the estimate we received for a 6-month checkup was only $15. The annual cost for the plans range from $100 – $175 depending on the location and number of people covered.
A PPO, or preferred provider organization, is the most common type of dental insurance. This plan has arranged reduced rates with dentists. These dentists are called in-network because they will work with the insurance company. You can go out of network if you have a PPO plan, but you will not get the benefit of the reduced rates. It’s best to check to see if your preferred dentist is in-network before you buy insurance.
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There are many insurance companies that offer dental services to seniors. Many are part of the group of insurance companies that fall under Medicare part C. While every insurance company under Medicare Part C offers the same medical coverage as Medicare Part A and Part B, they sometimes offer additional services such as dental coverage. Even so, the types of dental coverages that they offer are not identical.
If you go to an out-of-network dentist, then the plan usually pays based on the UCR fee. For example, if the dentist charges $250 for the filling, but the UCR in your area is $150, you could end up paying more. In this case, $130 ($250 – $150 X (.80)). This also introduces the concept of balanced billing, which means paying the dentist the cost difference between their rate ($250 in this case) and the cost-sharing rate ($120).
The cost estimates provided may be different from your actual costs for several reasons, including but not limited to, your unique dental circumstances and the decisions made by you and your dental professionals as to what services you will receive, deviations between the anticipated scope of services and the services actually provided, and the characteristics of your particular plan.