First, you could enroll in a Medicare Advantage plan. Many Medicare Advantage plans include vision, dental, and prescription drug coverage. All of these benefits are coordinated together, so any premium costs will be included in your low (or non-existent) Medicare Advantage premium. Just be aware that dental benefits are usually limited to cleanings, exams, and bitewing X-rays. If you are looking for more comprehensive coverage, you may want to add on a stand-alone dental plan.
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This is more affordable than dental insurance and there are over 5,400 dentists currently in the Carrington network. The Carrington plan provides a discount that’s usually over 50% on preventative and routine procedures with smaller discounts on other types of procedures. The price for treatment will vary from state to state and affect the percentage of your discount, but some examples of discounts include 51% off a routine check up, 51% off the extraction of a tooth, 50% off a dental cleaning, and just 20% off adolescent braces.
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.
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.
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.
Generally Original Medicare dental coverage is only for limited circumstances involving hospitalization. Original Medicare (Part A and Part B) generally doesn’t cover most dental care, including cleanings, fillings, tooth extractions, dentures, and dental plates. Hospital insurance (Part A) may pay for emergency or complicated dental procedures, for example the reconstruction of the jaw following an accidental injury, according to the Centers for Medicare & Medicaid services (CMS). According to CMS, Congress has not amended the dental exclusion since 1980, when it made an exception for inpatient hospital services when the dental procedure itself made the hospitalization necessary. If you have Original Medicare and want routine dental care, you will generally need to find a plan from a private insurance company.
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.
AARP, Aetna, Blue Cross, Humana, and Delta Dental are a few of the many insurance companies that offer dental plans to seniors. Each company may offer more than one type of dental plan and it is important to pay close attention to more than just the cost of the dental policy. Choosing the best dental plan for a senior is a balancing act between cost, affordability, and need. A good approach is to start by understanding what the senior’s dental needs are and then make a table so that as you begin to compare the different dental plans you can narrow down those plans that are good and remove those plans that are either too costly for the coverage they provide or that do not fit the senior’s dental needs.
No individual applying for health coverage through the individual Marketplace will be discouraged from applying for benefits, turned down for coverage, or charged more premium because of health status, medical condition, mental illness claims experience, medical history, genetic information or health disability. In addition, no individual will be denied coverage based on race, color, religion, national origin, sex, sexual orientation, marital status, personal appearance, political affiliation or source of income.