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.
Dental insurance companies divide benefits, services, or procedures into categories and refer to them with American Dental Association (ADA) 3-4 digit code. As an example, Preventative and Diagnostic procedures often include exams (ADA code 0120), x-rays (ADA code 0210), and basic cleanings or prophylaxis (ADA code 1110). Basic procedures often include fillings, periodontics, endodontics, and oral surgery. Major procedures often are crowns, dentures, and implants. Procedures such as periodontics, endodontics, and oral surgery may be considered major, depending on the policy.
My plan covered cavity fillings, but an additional procedure (like a crown or an extraction) would have been costly even with insurance. Multiple appointments also took up a lot of time. I could have spared myself some of those cavities, and long hours in the dentist’s chair, if I’d got regular cleanings in earlier years (and, of course, flossed more often).
But for many, the perceived high cost of dental insurance is one of the key factors that is keeping them from getting a policy. Luckily, there are a number of different options for people at different price points. According to the National Association of Dental Plans, the average annual cost of coverage in 2009 (the most recent year the survey was conducted) for a dental HMO plan was around $225 per year for an individual or $445 per family, the cost of a dental PPO plan averaged around $285 for an individual and $866 per family, and indemnity plans cost an average of $288 for an individual and $666 for a family.
DHMO's are similar to HMOs in that their plans connect you with a network of dentists who give you care for a low monthly premium. With DHMO plans, you are required to go see dentists who are in their network, but in return you have lower costs, and no claim forms to fill out. DHMOs are great for preventative care and basic procedures. Some downsides include that there can be wait times if you need major or restorative dental care and some DHMOs don’t cover this types of treatment. You also need to go see your primary care dentist and get a referral to a specialist in order to get some specialized care.
While some financial planners suggest dental insurance may not be worth paying for, we did the math to discover that it is usually worth it, provided you attend all of your allowable preventive exams and cleanings. We also learned that if you need any type of work such as a root canal or filling, you will definitely notice a cost savings. However, premiums vary greatly, not only by the type of plan, but by location and age. So you'll want to obtain a few quotes for insurance companies that provide coverage in your area. You'll also want to verify that your dentist accepts your chosen insurance before you sign up with a new provider.
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 longer you stay with Spirit Dental, more each plan pays out and the higher your savings. For example, with one plan’s basic dental procedures are covered at 65 percent the first year, 80 percent the second year and 90 percent the third year. Major procedures on that plan follow the same timeline at 25 to 65 percent coverage. All plans cover preventative care at 100 percent. You can bundle EyeMed vision insurance for $7 per month with each plan.
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.
Examples of dental costs with the Careington 500 plan are $15 for an oral exam, $31 for a cleaning, $483 for a crown and 64 percent off of dentures. The prices quoted on the website are in the Fort Worth, Texas area, with savings of 60 to 74 percent off dental services and 20 percent off orthodontia. Cost of procedures may vary depending on your location.
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.
MyCigna Dental 1000 is another plan that they offer. It has a $50 individual deductible and a family deductible of $150. The plan provides coverage for preventive care, diagnostic, and restoration care. It provides up to $1,000 worth of benefits annually and you also receive discounts on orthodontic work if you use a dentist in their network – but they don’t provide orthodontic coverage.
Another benefit is that you have more flexibility when it comes to choosing what type of plan you want. When you work for an employer, they choose which plan they believe would be right for the majority of their workers. But you might not need the same type of coverage as the person who works in the cubicle next to you. By buying an individual plan, you're able to customize and purchase exactly what you need. For that reason, your coverage can actually be less expensive than if you had an employer-sponsored plan – especially if you had to pay for part of your premiums.
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.
Our health benefit plans, dental plans, vision plans, and life insurance plans have exclusions, limitations, and terms under which the coverage may be continued in force or discontinued. Our dental plans, vision plans, and life insurance plans may also have waiting periods. For costs and complete details of coverage, call or write Humana or your Humana insurance agent or broker.