You may have a preexisting oral health condition that is not covered by your current dental policy. Because discount plans are not insurance, they have no waiting periods. You can sign up today and be at the dentist in 30 minutes. If you’ve reached your annual maximum, you can use a discount plan to pay for a procedure you have been reluctant to get because of the out-of-pocket expense.
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.
Dental providers contract with dental savings plans to provide the same quality dental work at reduced prices. The concept is a familiar one – it’s the same model used by discount clubs like Costco and Sam’s. Dentists realize that for many seniors, insurance is not the best option and, in many cases, doesn’t provide all of the coverage they really need. You benefit by gaining access to discounts of up to 60% on routine and major oral healthcare.
As a Medicare beneficiary, you are free to shop for a stand-alone private dental plan for seniors. Some dental plan types are PPO plans* and others are indemnity plans. A PPO stands for preferred provider organization. This is a type of plan that contracts with dental providers to create a network of participating providers. If you want to use a dentist out of network, you usually can for an additional cost. An indemnity plan allows you to visit almost any dentist you like with the plan paying a portion of your total charges. Indemnity plans are also called “fee-for-service” plans.
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.
The short answer here is that there isn’t one. In fact, a better question to ask is “What is the best dental insurance for me?”. One key point that is important for seniors to understand about any type of insurance is the fact that we are all unique and individual. When you consider dental insurance your choice should be 100 percent about you. Even the best plan for your spouse might not be the best plan for you.
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.
Dental plans will usually cover a portion of your costs on different types of dental procedures. Some plans focus more on preventative and basic dental care, but offer less coverage on major dental procedures. It's important to understand what's best for your dental health. If you routinely need a root canal or get cavities, you'll want a plan that provides better coverage on those types of procedures. In contrast, if you have relatively healthy teeth then you might not need to pay for the extra coverage.
Depending on the type of insurance you’re looking at, the network of your dental insurance provider could be crucially important. Check to see how many dentists they have in their network and if your current dentist is in it or if there is a dentist who has an office near you that you would want to go to. Another thing to consider is whether the insurance provider will let you go see dentists outside their network, what the costs will be, and whether you need a referral when you need to see a specialist.
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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)).
Like most kinds of health or ancillary medical insurance, there are deductibles involved in dental insurance. Generally, the deductibles are per individual or per family depending on your plan. Some companies require that you meet the deductible on each member of your family while others have a family amount that you have to hit – no matter who the person receiving the care was. Deductibles can range anywhere from $100 to $500 or more. Obviously, the higher your deductible, the less likely you’ll be to take full advantage of your insurance.
Most people know that they need to visit a dentist regularly. Having dental coverage is strongly associated with how often dental services are used. Americans often say that the cost of dental care and the lack of dental coverage are reasons for not getting needed dental care. Having an individual dental insurance plan from Spirit Dental allows you to get the regular care you need to stay healthy.