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If you are a senior or are approaching retirement, you may be surprised to find out that Medicare does not provide coverage for routine dental care. Medicare mainly covers medical treatments, but does not provide any assistance for routine dental care such as bi-annual exams, cleanings, or even major services like bridges or dentures. This leaves it to seniors to search for a dental plan that can meet their coverage needs.
The downside of using a dental school is that it can sometimes take a lot more time to get the work done since it’s a learning environment, the hours or days that they practice are limited, and it can be hard to get your insurance coverage to pay for work performed at a dental school if you have insurance. You’ll likely have to pay for your treatment out-of-pocket and get reimbursed later.
However, if your insurance does not cover cleaning and preventative care at 100%, then you will have to pay the remaining costs of your visit. This can cost anywhere from $20 to over $100 depending on the type of care you’re getting and the percentage covered. If you’re getting a PHMO plan, it is easier to estimate your costs since all procedures conducted in their network will have fees, but if you’re going to your own dentist then it will simply be a percentage of whatever they charge.
If you read our article on discount dental plans, you may think we are 100% against dental insurance. We are not. We simply know seniors can get sucked into paying high premiums with equally high out-of-pocket costs with no major insurance advantage. But, affordable dental insurance for seniors is possible that balances the right premiums, out-of-pocket costs, and coverage.
Another option for dental care is Medicaid, which covers some kinds of dental procedures if you meet the requirements. Medicare does not provide dental coverage. The ADA Foundation has provided dental care to 5.5 million children since 2003. They will direct you to a dentist that is near you. Another option is the Children Health Insurance Program (CHIP). It provides health coverage including dental coverage to over 7 million children under 19 years of age.
2Delta Dental PPO is underwritten by Delta Dental Insurance Company in AL, DC, FL, GA, LA, MS, MT, NV and UT and by not-for-profit dental service companies in these states: CA – Delta Dental of California; PA, MD – Delta Dental of Pennsylvania; NY – Delta Dental of New York, Inc.; DE – Delta Dental of Delaware, Inc.; WV – Delta Dental of West Virginia, Inc. In Texas, Delta Dental Insurance Company provides a Dental Provider Organization (DPO) plan.
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.
1DeltaCare USA is underwritten in these states by these entities: AL — Alpha Dental of Alabama, Inc.; AZ — Alpha Dental of Arizona, Inc.; CA — Delta Dental of California; AR, CO, IA, MA, ME, MI, MN, NC, ND, NE, NH, OK, OR, RI, SC, SD, VT, WA, WI, WY — Dentegra Insurance Company; AK, CT, DC, DE, FL, GA, KS, LA, MS, MT, TN, WV — Delta Dental Insurance Company; HI, ID, IL, IN, KY, MD, MO, NJ, OH, TX — Alpha Dental Programs, Inc.; NV — Alpha Dental of Nevada, Inc.; UT — Alpha Dental of Utah, Inc.; NM — Alpha Dental of New Mexico, Inc.; NY — Delta Dental of New York, Inc.; PA — Delta Dental of Pennsylvania; VA – Delta Dental of Virginia. Delta Dental Insurance Company acts as the DeltaCare USA administrator in all these states. These companies are financially responsible for their own products. The plan is a dental HMO in CA and TX.
While we conducted extensive research, we cannot tell you exactly what your new dental plan premium will be or what it will cover. Premiums vary by zip code, age, plan type and other factors. Our reviews can tell you generally what to expect from the dental insurance companies we reviewed, but we cannot predict your exact situation. To calculate average premiums we gathered quotes from numerous areas across the nation; we chose zip codes from large metropolitan areas and from smaller cities of around 150K. We looked for premium rates for one, two and three persons. We made note of the lowest and highest premiums quoted and excluded dental discount plans and preventive-only plans. The sample terms and conditions are common scenarios, but again, these vary depending on the plans available in your area.
If you're struggling to find an affordable dental insurance, your state might offer some programs that could help you. Many states have assistance programs for those who are unable to pay for dental care themselves. To find out whether your state has a program, visit the National Association of Dental and Cranialfacial Research, as well as the Association of State and Territorial Dental Directors. Their websites have links and information about how to get low-cost dental care in your state.
Most full coverage dental insurance plans will cover two preventive maintenance visits per year without requiring a deductible payment. Most require a $50 deductible per person, per year to help cover costs beyond your preventive exams. If you need work done, most plans will cover a part of the costs. We looked at root canals specifically and found that the majority of dental plans will cover about half the cost, which may not seem like a lot, but paying half is better than paying upfront for an $800 root canal. However, keep in mind that most insurance policies, depending on your plan, top out at about $1000 to $1500 per year. Using conservative estimates that might be one or two root canals. If you need extensive work done you might have to pay the remaining amount out of pocket.
MyCigna Dental 1000 is another plan that they offer. It has a $50 individual deductible and a family deductible of $150. The plan provides coverage for preventive care, diagnostic, and restoration care. It provides up to $1,000 worth of benefits annually and you also receive discounts on orthodontic work if you use a dentist in their network – but they don’t provide orthodontic coverage.
(AL – 662369), (AK – 100116668), (AZ – 1039447), (AR – 100108201), (CA – 0I22561), (CO – 419732), (CT – 2424421), (DE – 1326873), (DI – 3041371), (FL – L088857), (GA – 172259), (HI – 423474), (ID – 439793), (IL – 100640719), (ID – 869503), (IA – 1002207278), (KS – 461715304-0), (KY – DOI-805173), (LA – 582580), (ME – AGN213175), (MD – 2112735), (MA – 1930638), (MI – 100259), (MN – 40325516), (MS – 15021382), (MO – 8287507), (MT – 770689), (NE – 100196040), (NV – 876621), (NH – 2268499), (NJ – 1515723), (NM – 100012274), (NY – LA-1375260), (NC – 461715304), (ND – 2000115021), (OH – 985962), (OK – 100151491), (OR – 100213920), (PA – 666488), (SC – 193263),(SD – 10016345), (TN – 2238715), (TX – 1821698), (UT – 436588), (VT – 873256), (VA – 133866), (WA – 828648), (WV – 100149165), (WI – 100196806), (WY – 238959)
Choosing a plan that’s right for you depends on many factors, including the ages and number of people in your family, and whether you or a family member needs orthodontic care. Some dental plans provide low copays, while others provide discounts on services. No matter which plan you select, you’ll have access to a large network of dental providers.