It is a far too common situation. You enroll in Medicare and have your medical and health needs covered. You feel good. Finally, you made a decision about Medicare. What about dental coverage? Your teeth matter, right? We all know when our teeth and gums hurt, everything hurts! Yet, Medicare and nearly all Medicare Advantage and supplement plans do not cover dental needs. If they do, coverage is usually limited to preventative care only. What will you do about fillings, bridges, and crowns? Luckily, we at My Family Life Insurance have many coverage solutions when it comes to dental needs. In this article, we discuss dental insurance, plan types, what to look for with affordable dental insurance, and the best dental insurance for seniors on Medicare.
How you define “cost” is important. Generally a single plate – upper or lower- costs between $1,200 and $3,800. So, for a full set of dentures could cost in the $7,500 range. Those higher costs usually include other services such as extractions, mold production, and fittings. Again, the actual cost is dependent upon the senior’s oral health, and the amount of service needed. Don’t be afraid to shop around from one dentist to the next to see if there is a price break.
Since all dental insurance carriers are different, it is important to clarify which dental procedures fall under each specific category. This is important because some insurance plans don't cover major procedures and others have waiting periods for certain procedures. If you know that you will need major dental work that is not covered by a given plan, you should probably look elsewhere to find one that suits all of your needs.
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).
I could have paid the average of $360 a year for a dental policy in my twenties. Or I could have paid out of pocket for two dental exams, including cleanings and X-rays, which, in 2011, cost an average of $370 combined. In that case dental insurance wouldn’t have saved me much money. And if I went to a dental school or clinic for treatment, I could have saved even more on out-of-pocket costs.
The AARP Dental Insurance 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.
Savings plans are NOT insurance and the savings will vary by provider, plan and zip code. These plans are not considered to be qualified health plans under the Affordable Care Act. Please consult with the respective plan detail page for additional plan terms. The discounts are available through participating healthcare providers only. To check that your provider participates, visit our website or call us. Since there is no paperwork or reimbursement, you must pay for the service at the time it’s provided. You will receive the discount off the provider’s usual and customary fees when you pay. We encourage you to check with your participating provider prior to beginning treatment.
For those seniors who enjoy good dental health and are looking mainly for preventive care and basic services, Ameritas Dental may be a good option to consider. For those looking to save money, if you only need one preventive/maintenance checkup per year, you can buy a dental plan through Ameritas that will cost less than plans with more services. The company also offers a dental rewards program where you can roll over unused coverage from one policy term to the next if you did not use dental services during the year.
Dental Preferred Provider Organization (DPPO) plans: DPPO plans offer you more choice when it comes to dentists. PPO networks include a variety of dentists that agree to treat patients with DPPO insurance at lower rates. Typically, patients with DPPO have to pay a deductible. When seeing a dentist in your DPPO network, you will usually pay a percentage of the lower rate for treatment. Your insurance company will pay for the rest.
There are few procedures that most insurance companies will not cover or only provide a discount for. Most individual dental insurance plans do not cover what might be considered cosmetic procedures such as tooth-colored fillings on molar or bicuspid teeth, dental implants or adult cosmetic orthodontics. The majority of dental companies will also limit how often certain appliances can be replaced and, in most cases, will not replace lost items. The limitations are published in the disclosures and contracts for the plan, many of which you can peruse online. Keep in mind that a new dental insurance plan is not going to cover an emergency you are experiencing right now; most have a waiting period of six to 12 months for major work. (However, some will waive the waiting period if you recently had dental insurance.) Dental groups that offer dental discount plans will let you use your benefits right away, but they only provide a discount and not full coverage. Full coverage plans will however cover your initial evaluation so you can start planning your dental procedures.
Unfortunately, Original Medicare (Parts A and B) does not include coverage for services like dental exams, cleanings, fillings, crowns, bridges, plates, or dentures. There are some exceptions, such as when a hospital stay is involved, but otherwise, you would have to pay out of pocket for any routine dental services. For some of us, those expenses could add up quickly.
The reason why so many are uninsured might be because the economy is shifting towards more contract work, consultants, and freelancers. That’s left many people without an employer to pay the bill for things like health insurance and dental insurance. At the same time, many employers are cutting back on the benefits that they’re offering or shifting their benefits. Dental plans, which used to often be paid completely by the employer, might now be optional or require the employee to pay a significant portion of the costs. In that case, it could make more sense for you to shop for a plan that is a better fit for your needs and pay for your insurance yourself.
Our dental insurance plans offer affordable options for dental coverage. The plans have low deductibles to satisfy and multiple options for the maximum amount they pay each year. Our dental insurance plans offer lifetime deductibles (not calendar year), there are no benefit waiting periods, three cleanings are covered per year, adult dental implants are covered, and you can select from various maximum benefit amounts.
No matter which type of plan you choose, we recommend that you carefully review your contract so you know exactly what your insurance will cover. Additionally, in most cases your dentist's office will be familiar with what your insurance may or may not cover. Since many dental offices will require you to pay the estimated uncovered balance upfront, you will need to make sure you know what that is in advance so you can plan your budget. If you cannot cover the remaining balance you may want to ask if your dentist provides financing.
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.
Dental Health Maintenance Organization plans entail dentists contracting with a dental insurance company that dentists agree to accept an insurance fee schedule and give their customers a reduced cost for services as an In-Network Provider. Many DHMO insurance plans have little or no waiting periods and no annual maximum benefit limitations, while covering major dental work near the start of the policy period. This plan is sometimes purchased to help defray the high cost of the dental procedures. Some dental insurance plans offer free semi-annual preventative treatment. Fillings, crowns, implants, and dentures may have various limitations.
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.
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