In either case, in our opinion, the purchase of dental insurance can be hard if you don’t do your homework. Why? The premiums aren’t in favor of the benefit. For example, if you are paying $100 per month for dental insurance which has an annual benefit of $1,000, that really isn’t in your best interest. You are paying $1,200 annually for a $1,000 benefit. In this case, it is better to simply negotiate a discount with the dentist or utilize a dental discount plan where appropriate (more on that below).
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.
“Humana” is the brand name for plans, products, and services provided by one or more of the subsidiaries and affiliate companies of Humana Inc. (“Humana Entities”). Plans, products, and services are solely and only provided by one or more Humana Entities specified on the plan, product, or service contract, not Humana Inc. Not all plans, products, and services are available in each state.
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).
Dental savings plans are different than dental insurance. Dental savings plans provide you with a list of dentists who will give you a discount because you’re a member of the savings plan. Usually, these are quite generous discounts and can save you a significant amount of money on your dental care. Sometimes the discount can be well over 50% for things like preventative care, but it tends to be a little less for other types of care.
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.
An example of Delta Dental’s offerings is their Dental for Everyone Gold PPO plan which includes savings that change depending on what year of the plan you're in. When it comes to preventative care, they offer 60% coverage in the first year, 80% in the second year and 100% in the third year and going forward. For basic care, they offer 50% coverage in the first year, 65% of the second year, and 80% in the third year and going forward. For major care, you get 0% coverage in the first year, 30% in the second year, and 50% in the third year.
Some of the benefits of a Carrington dental plan are the low fees, the fact there is no waiting, and that you can choose your own dentist amongst their network. There are also no limits on your coverage and you don't have to fill out any paperwork. Some downsides are that you will likely end up paying more for your procedures than if you had one of the best dental insurance plans.
More than 90 percent of dental insurance policies carry a “missing tooth clause” or a “replacement clause.” Many include at least one of these clauses, but most have both. A missing tooth clause protects the insurance company from paying for the replacement of a tooth that was missing before the policy was in effect. For example, if you lost a tooth before your coverage started and later decided that you would like to have a partial, bridge or implant, the insurance company would not have to pay for that service if they have a missing tooth clause in the plan. A replacement clause is similar except that the insurance company won’t pay to replace procedures such as dentures, partials or bridges until the specified time limit has passed.
Generally, the more complete the coverage that you are buying, the more expensive your monthly premiums will be. Dental savings plans tend to have lower monthly premiums but often not by as much as you would expect. While dental saving plans can cost under $10, there are affordable dental insurance plans that can start for as little as $20 per month and so they might be the better choice. You might have the option of paying your monthly premiums in an annual lump sum. If you can afford to do so, you generally pay a lower amount overall.
You’ll want to go to an in-network dentist as they usually have better, contracted rates. We’ll show an example of that in a minute. Cleaning or preventative care visits are typically covered at 100%. Basic or major services visits are typically covered at 80% and 50%, respectively. What does this mean? If you go to an in-network dentist for a tooth filling (80%) whose contracted rate is $200, you’ll have to pay $40 out of pocket ($200 X (1 – .80)).
*The plan is insured by Delta Dental Insurance Company (Contract 1230) in AK, AL, DC, DE, FL, GA, LA, MD, MS, MT, NV, NY, PA, PR, TN, TX, UT, VI and WV, insured by Dentegra Insurance Company (Contract 1230) in AR, AZ, CA, CO, CT, HI, IA, ID, IL, IN, KS, KY, ME, MI, MN, MO, NC, ND, NE, NH, NJ, NM, OH, OK, OR, RI, SC, SD, VA, VT, WA, WI and WY, and insured by Dentegra Insurance Company of New England (Contract 1230) in MA. The plan is administered by Delta Dental Insurance Company. For Texas residents your Master Policy Form number is TX-AMD-MC-DPO-D-DC(DELTAUSA1-2005). These companies are financially responsible for their own products.
In the United States, Participating Provider Network or PPO, also referred to as Preferred Provider Organization, is an organization governed by medical doctors, hospitals, other health centers, and medical care providers. This organization has an agreement with an insurer or the third party administrator to provide health insurance to the people associated with their client at reduced or low rates. Participating Provider Network plan may work similar to a DHMO while using an In-Network facility. However, a PPO allows Out-of-Network or Non-Participating Providers to be used for service. Any difference of fees will become the financial responsibility of the patient, unless otherwise specified.
Although discount plans are also sold by private companies, they are not insurance plans. There are no copays, coinsurance, or deductible amounts. That also means that there are no pre-negotiated rates or free yearly checkups and cleanings. A participating dentist simply agrees to offer discounts (often a percentage off from the total price) for certain medical services. Then, seniors who choose discount plans will pay their dentist directly for the cost of services (after the discount).
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The cost of not taking care of your oral health could be more. Those without individual dental coverage are less likely to get routine dental care, meaning they seek out a dentist only when they have a problem. By then, more extensive and more expensive measures may be necessary, and major problems linked to poor oral health (like heart disease and diabetes) are more likely to appear.2 Doing nothing now means you might pay more later.