For the most part, Medicare does not cover dental services with the exception of those services that are required due to another covered medical issue. There are exceptions but seniors should not expect Medicare to cover routine dental care or services such as cleaning, extractions, dentures, or even fillings. If you have an alternative insurance to Medicare B then that policy might cover dental, but again, that only works in certain circumstances, such as if you are not yet retired even though you are age 62 or older.
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.
Many provide as much as 100% coverage preventative services and then less on basic procedures usually 50% to 80%, and usually 50% to 0% on major care or things like crowns. Often there is some fine print with these plans and they do not cover certain procedures. They also have a maximum annual benefit and a deductible that you have to pay before they start coverage. There also can potentially be waiting periods on certain types of procedures but you don’t always have to get a referral to see a specialist.
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.
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.
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.
The cost of not taking care of your oral health could be more. Those without individual dental coverage are less likely to get routine dental care, meaning they seek out a dentist only when they have a problem. By then, more extensive and more expensive measures may be necessary, and major problems linked to poor oral health (like heart disease and diabetes) are more likely to appear.2 Doing nothing now means you might pay more later.