*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Medicare recipients are legally permitted to purchase dental plans on the ACA Marketplace, but the process isn’t easy. As noted in the section above, stand-alone dental plans are not eligible for subsidies. And in the states where the ACA Marketplace is run by the federal government, dental coverage is available only to those who also buy health insurance.
Once you purchase a dental insurance plan and start paying your premiums, most preventive care like cleanings and check-ups are covered immediately. For more serious procedures, after you meet your deductible, you’ll only be responsible to pay your percentage of the cost. And we’ll pay the rest. Also, some dental plans have an out-of-pocket maximum to protect you from high costs throughout the year. On some plans, if you reach this maximum, we’ll pay the full cost of any additional care until your annual maximum benefit is met.
Since buying cheap dental insurance will mean that going to the dentist could cost you more, you might also be less likely to go to the dentist or you could put the visit off if you have a problem. This could lead to bigger issues with your dental health which could lead to more expensive procedures and treatment. For example, if you put off treating a cavity, you could end up needing a root canal.
As time passes, many seniors leave dental coverage (and vision and hearing) behind. Then, when they need it, it is too late. Waiting can be devastating in some cases as many insurances have waiting periods for certain services. For example, a routine filling for a cavity typically requires a 6-month wait. If you can’t wait that long, you will have to pay the cost in full.
While some financial planners suggest dental insurance may not be worth paying for, we did the math to discover that it is usually worth it, provided you attend all of your allowable preventive exams and cleanings. We also learned that if you need any type of work such as a root canal or filling, you will definitely notice a cost savings. However, premiums vary greatly, not only by the type of plan, but by location and age. So you'll want to obtain a few quotes for insurance companies that provide coverage in your area. You'll also want to verify that your dentist accepts your chosen insurance before you sign up with a new provider.
The term “full coverage” can mean different things to different people. For some, “full coverage” means a dental insurance plan that covers basic services like routine checkups, cleaning and X-rays. Others expect a full-coverage plan to reduce the cost of any dental services they may need. The good news is that Humana has a range of dental plans, including both dental insurance and dental discount plans, so you can find the coverage that best fits your needs.