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.
Medicare, the largest health insurance provider for adults 65 and older, does NOT provide coverage for routine dental care. Medicare only pays when dental care and medical needs intersect. Medigap, a private insurance plan that supplements Medicare coverage, doesn’t offer dental coverage, but some private Medicare Advantage managed care plans do offer dental benefits.
They have a popular dental PPO plan called MetLife 2-9 Dental. They negotiate fees within their network of dentist which are lower than average and cover over 400 procedures. They offer 100% coverage on preventative care, 80% coverage on basic care, and 50% coverage on major care with a $50 deductible. Their annual maximum coverage amount is between $1,000 and $1,500.
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Each plan will provide dental coverage for a variety of dental needs, but are not always the same. What they might or might not cover includes dental services such as root canals, deep cleanings, and restorative procedures. When they do cover these services they do so only partially and the senior must either pay out of pocket or have a secondary dental insurance plan. Most plans for seniors pay for routine care, such as an annual cleaning, but require a copayment or co-insurance for other services.
Another thing to consider when looking for dental plans for seniors is the waiting period some plans may have for certain services. For example, a plan may set a 3-month waiting period for an extraction. This means that if you get an extraction a week after enrolling in that plan, you usually won’t be covered. Some services may have longer waiting periods, such as 15 months, before the plan covers that service. This is why it is best to not wait until you have a dental emergency to enroll in a dental insurance plan.
Many seniors have dental health issues, and hope that by purchasing a standard insurance plan they will be able to afford to get treatments that they have been delaying due to cost. Unfortunately traditional dental insurance often does not cover preexisting conditions, nor will it pay to replace teeth that were lost prior to purchasing the coverage.
UnitedHealthcare has a large number on in-network preferred providers, over 200,000, so you won’t have any trouble finding a dentist in the plan. Cleanings and X-rays are covered 100 percent. Here are the charges you pay for basic services: exam - $25; root canal - 50 percent; fililngs - 30 percent; extractions - 30 percent. The coverage has no age maximum limitations. Deductible limits are $50 - individual, $150 - family of three with a 6-12 month waiting period for certain services. Cleanings and X-rays are covered with zero co-pay or deductible twice yearly.
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.
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.
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.
Another kind of dental insurance plan is a DPPO which is similar to a health insurance PPO plan. What they do is they work out lower rates with dentists that are in their network who are often referred to as their preferred providers. With this plan, you can visit a dentist outside of your network, but you will not be able to get these low rates and you will likely end up paying more. Many DPPOs provide coverage of preventative care, basic procedures, and major procedures, but they only provide a percentage of this care for each.
Maintaining oral health can be more challenging for seniors and people with certain disabilities. This may be due to an inability to brush their teeth properly, as well as an increased use of medications. Plus, as we grow older, our teeth become less sensitive, so we may not notice a problem until it is too late. All of these factors make it even more important to protect your dental health as you age.1
There can sometimes be significant differences between the dental insurance plans that employers sponsor and those that you obtain as an individual. One big (and obvious) difference is that usually employers pay for part or all of the dental insurance plan, whereas if you're buying a plan by yourself you have to pay for the whole thing. Some employers are also able to get a better deal because they're buying insurance in in bulk for all their employees. But, if you shop around, you could potentially get a plan that is similarly priced or even cheaper.
Another downside of buying your own dental insurance is that you might not be able to afford the same type of coverage, which means that you could potentially have fewer benefits than you would if you had gotten it through your employer. That might mean that you have less access to certain types of treatment or that in order to get an affordable plan with good coverage, you’ll have to choose one where you have to stay within the plan’s network.
These plans, sometimes called "Medigap" plans, are a type of insurance you can get to help cover costs like deductibles and coinsurance. You pay a monthly premium for the supplement, just as you would any kind of insurance. After Medicare pays its part, the supplemental insurance kicks in. You must have both Parts A and B of Original Medicare before purchasing a Medigap plan.
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).
Medicare Advantage plans may offer routine dental care. Medicare Advantage is another way to get you Original Medicare (Part A and Part B) benefits from a private insurance company. A Medicare Advantage plan may offer routine vision as well as prescription drug coverage. If you have a Medicare Advantage plan you have to continue paying your Part B premium. Medicare Advantage plans must cover everything that Original Medicare covers except for hospice care which is still covered by Medicare Part A. The extent of the Medicare Advantage dental coverage may vary from plan to plan.
PPO Plan B has slightly lower premiums and still covers many basic services. The annual deductible is $100 with an annual maximum of $1,000. Keep in mind you are trading in the lower deductible for a higher one but you are also receiving a lower monthly premium. You have 80 percent coverage for three dental cleanings and exams per year and coverage is available for major services including implants, crows, bridges and dentures after one year of continuous coverage. You can visit any licensed dentist but save more by choosing a preferred in-network provider.
If you are on a policy that requires you to go to a participating provider, you should not be charged the difference between these two prices. A contracted dentist generally has an agreement with the insurance company to write off the difference in charges. If the policy allows you to go to a dentist or pediatric dentist of your choice, check the insurance company’s UCR fee guide against the fees that dentist charges. You may be required to pay the difference out of your pocket, however, you cannot put a price tag on quality dental care.
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