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.
Does this sound good? Maybe. You’ll pay for everything…at a discount. How does this compare to traditional dental insurance? In our opinion, you may end up paying the same or less, generally speaking. While you have to pay for preventative care, it is at a discount. Compare with dental insurance, which the preventative care is free but you generally pay a higher monthly premium.
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.
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Our health benefit plans, dental plans, vision plans, life and supplemental plans, workplace voluntary benefit products, long term disability plans, and short term disability plans have exclusions, limitations, and terms under which the coverage may be continued in force or discontinued. Our dental plans, vision plans, life and supplemental plans, workplace voluntary benefit products, long term disability plans, and short term disability plans may also have waiting periods. For costs and complete details of coverage, call or write Humana or your Humana insurance agent or broker.
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.
One of the biggest downsides of paying for your own plan is that your premiums might not be pre-tax as they would be if you were paying for a plan that your employer and your contribution towards the plan was being taken off your paycheck. But, if you own your own business, you can potentially write off those expenses as a business cost and therefore get the same savings.
*The 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.
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.
As a Medicare beneficiary, you are free to shop for a stand-alone private dental plan for seniors. Some dental plan types are PPO plans* and others are indemnity plans. A PPO stands for preferred provider organization. This is a type of plan that contracts with dental providers to create a network of participating providers. If you want to use a dentist out of network, you usually can for an additional cost. An indemnity plan allows you to visit almost any dentist you like with the plan paying a portion of your total charges. Indemnity plans are also called “fee-for-service” plans.
You may have a preexisting oral health condition that is not covered by your current dental policy. Because discount plans are not insurance, they have no waiting periods. You can sign up today and be at the dentist in 30 minutes. If you’ve reached your annual maximum, you can use a discount plan to pay for a procedure you have been reluctant to get because of the out-of-pocket expense.
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.
After you are approved and sign up for a plan, you can often use it within 24 hours, but it can sometimes take up to 72 hours for it to go into effect. Some plans offer additional savings on things like prescriptions, hearing care, and vision care. Some plans also include discounts on things like cosmetic dentistry, and orthodontics. These plans charge an affordable membership fee that can start as low as $10 per month. In order to get set up, you do have to pay a fee of around $15, but this cost is sometimes offset by giving you a free month on your plan.
Gum Disease. Your gum disease risk increases as you get older. The New York Times notes that in a study of people over 70 years old, 86% had at least moderate gum disease and over a quarter experienced tooth loss. It’s important to properly take care of your teeth, have a healthy diet, reduce stress, and refrain from smoking to reduce your risk of developing gum disease. Systemic diseases and certain medications can also affect the health of your gums.
One example of a Humana insurance plan is their Dental Loyalty Plus package that has a one time deductible of $150 per person or $450 for family. Unlike other plans where the deductible must be paid annually, their deductible lasts as long as you keep the plan. The maximum benefits of the plan in the first year are $1,000, in the second year are $1,250, and in the third year are $1,500. Preventative services are covered at 100%, basic services start with coverage at 40%, but coverage goes up to 70% by the third year, and major services start at 20% coverage and go up to 50% coverage by the third year.
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.
Aetna’s dental discount network includes over 161,000 dentists, and Careington says over 100,000 dentists participate in their plan. We searched for providers from a less populated location in the U.S. and found no dentists from the Aetna plan while the Careington plan had four dentists, although the offices were located 100 miles from the zip we used. If there are no providers available in a reasonable distance from your home, you can nominate dentists, and Careington will contact them to request participation. Dental providers usually join the network within 60-90 days.
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.
The term “full coverage” can mean different things to different people. For some, “full coverage” means a dental insurance plan that covers basic services like routine checkups, cleaning and X-rays. Others expect a full-coverage plan to reduce the cost of any dental services they may need. The good news is that Humana has a range of dental plans, including both dental insurance and dental discount plans, so you can find the coverage that best fits your needs.