Surgery to correct an abscessed tooth is usually considered a health issue and medical insurance covers the cost. Procedures to correct trauma to the mouth are considered medical and not dental, even if lost teeth are involved. Our best advice is to talk to both your medical and dental insurance carriers to determine where coverage falls, so you are prepared for out of pocket costs.
Medicare recipients are legally permitted to purchase dental plans on the ACA Marketplace, but the process isn’t easy. As noted in the section above, stand-alone dental plans are not eligible for subsidies.  And in the states where the ACA Marketplace is run by the federal government, dental coverage is available only to those who also buy health insurance.

Like most kinds of health or ancillary medical insurance, there are deductibles involved in dental insurance. Generally, the deductibles are per individual or per family depending on your plan. Some companies require that you meet the deductible on each member of your family while others have a family amount that you have to hit – no matter who the person receiving the care was. Deductibles can range anywhere from $100 to $500 or more. Obviously, the higher your deductible, the less likely you’ll be to take full advantage of your insurance.
Learn more about:Dental InsuranceDental plans that fit your budget. Get and keep a healthy smile. Find PlansRelatedFinding the Best Dental Insurance in FloridaGetting Low-Cost Dental Insurance as a Self-Employed IndividualFinding Low-Cost Dental Insurance for Your Family as a Self-Employed IndividualFeaturedKey Health Insurance TermsObamacare 101: How Obamacare Health Insurance WorksHealth Insurance Products and Definitions var gf_global = {"gf_currency_config":{"name":"U.S. Dollar","symbol_left":"$","symbol_right":"","symbol_padding":"","thousand_separator":",","decimal_separator":".","decimals":2},"base_url":"https:\/\/www.ehealthinsurance.com\/resources\/wp-content\/plugins\/gravityforms","number_formats":[],"spinnerUrl":"https:\/\/www.ehealthinsurance.com\/resources\/wp-content\/plugins\/gravityforms\/images\/spinner.gif"}; Newsletter Sign up for our eHealth Newsletter email to receive updates that will help you! Email* This iframe contains the logic required to handle Ajax powered Gravity Forms. jQuery(document).ready(function($){gformInitSpinner( 1, 'https://s27829.pcdn.co/resources/wp-content/plugins/gravityforms/images/spinner.gif' );jQuery('#gform_ajax_frame_1').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_1');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_1').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;if(is_form){jQuery('#gform_wrapper_1').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_1').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_1').removeClass('gform_validation_error');}setTimeout( function() { /* delay the scroll by 50 milliseconds to fix a bug in chrome */ jQuery(document).scrollTop(jQuery('#gform_wrapper_1').offset().top); }, 50 );if(window['gformInitDatepicker']) {gformInitDatepicker();}if(window['gformInitPriceFields']) {gformInitPriceFields();}var current_page = jQuery('#gform_source_page_number_1').val();gformInitSpinner( 1, 'https://s27829.pcdn.co/resources/wp-content/plugins/gravityforms/images/spinner.gif' );jQuery(document).trigger('gform_page_loaded', [1, current_page]);window['gf_submitting_1'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}setTimeout(function(){jQuery('#gform_wrapper_1').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_1').offset().top);jQuery(document).trigger('gform_confirmation_loaded', [1]);window['gf_submitting_1'] = false;}, 50);}else{jQuery('#gform_1').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger('gform_post_render', [1, current_page]);} );} );if(typeof gf_global == 'undefined') var gf_global = {"gf_currency_config":{"name":"U.S. Dollar","symbol_left":"$","symbol_right":"","symbol_padding":"","thousand_separator":",","decimal_separator":".","decimals":2},"base_url":"https:\/\/www.ehealthinsurance.com\/resources\/wp-content\/plugins\/gravityforms","number_formats":[],"spinnerUrl":"https:\/\/www.ehealthinsurance.com\/resources\/wp-content\/plugins\/gravityforms\/images\/spinner.gif"};jQuery(document).bind('gform_post_render', function(event, formId, currentPage){if(formId == 1) {if(typeof Placeholders != 'undefined'){
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.
Under the federal law, dental benefits are an optional service for state Medicaid programs. States can include adult dental benefits in their Medicaid programs. Many states do provide dental benefits for adults; however the status and extent of those benefits vary by state and by year, depending on the availability of state funds to support such benefits.

Seniors have special dental needs that come with getting older such as root decay, gum disease, tooth loss and more. Even non-dental conditions common to seniors, such as arthritis, can affect dental health. For those coming off of an employee group health plan upon after retiring, coverage may not be extended after you leave your job, leaving you to find your own dental coverage. Most plans have a waiting period for coverage, so this can leave you without coverage for a period of time.


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.
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Dental insurance companies sort the different types of dental procedures into different classes. There are five different types of classes. Class I is for diagnostic and preventative care which include things like x-rays, exams, and cleanings. Class II is for basic care and other procedures such as fillings. Class III dental care usually refers to major care and procedures such as dentures, bridges, implants, and crowns. Finally, Class IV dental procedures are orthodontics.

If you go to an out-of-network dentist, then the plan usually pays based on the UCR fee. For example, if the dentist charges $250 for the filling, but the UCR in your area is $150, you could end up paying more. In this case, $130 ($250 – $150 X (.80)). This also introduces the concept of balanced billing, which means paying the dentist the cost difference between their rate ($250 in this case) and the cost-sharing rate ($120).


In general the dental insurance companies at the top of our review list provide a range of plan options to numerous areas of the country. We also considered average yearly preventive care costs across numerous zip codes and compared that number to possible yearly premium costs. This helps predict whether the premium costs would, on average, be less than the cost of preventive care paid out of pocket. Keep in mind that co-pays and other small fees might also determine whether you will break even by paying for dental insurance, but our numbers can give you a general idea of what you can expect. It was not surprising to learn that those who charge a higher premium may cover more and those with a lower premium might cover less. This means that if you pay more monthly you might receive more complete coverage, and if you pay less per month you might be expected to pay a bit more during the time of treatment. So you'll need to decide whether you want to pay more per month or make up a bit of the difference when you visit your dentist.
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Like most kinds of health or ancillary medical insurance, there are deductibles involved in dental insurance. Generally, the deductibles are per individual or per family depending on your plan. Some companies require that you meet the deductible on each member of your family while others have a family amount that you have to hit – no matter who the person receiving the care was. Deductibles can range anywhere from $100 to $500 or more. Obviously, the higher your deductible, the less likely you’ll be to take full advantage of your insurance.

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People buying their own dental insurance (as opposed to those covered by an employer's plan) sometimes get a nasty surprise when they sign up: a waiting period. Unlike regular health insurance, in which coverage usually starts immediately or at the beginning of the next month, dental plans often come with a delay between enrollment and the actual onset of coverage for some or all services. It could be six months to a year or more.
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.

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.


These dental schools either offer discounts or provide free dental services in order to get patients they can practice on. While they do all sorts of different procedures, it’s probably best to go to them for more routine care like cleanings, check ups, x-rays, and small cavities. If you have a more complex procedure to get done, you might better off going to an expert instead.

The Dental Care Cost Estimator sometimes groups together, into "treatment categories," services that are often delivered together to address a particular dental problem. The description of different treatment categories, and the inclusion of particular services in a treatment category, is not advice that any particular treatment category is the right treatment for you or that you should not obtain any particular treatment. All of those matters are things that you should decide, in consultation with your dental care professionals. This cost estimator is intended for use in the 50 states, Puerto Rico and other U.S. territories. If you live outside the U.S., you may see information on this cost estimator about products or services that are not available or authorized in your country.
Like most kinds of health or ancillary medical insurance, there are deductibles involved in dental insurance. Generally, the deductibles are per individual or per family depending on your plan. Some companies require that you meet the deductible on each member of your family while others have a family amount that you have to hit – no matter who the person receiving the care was. Deductibles can range anywhere from $100 to $500 or more. Obviously, the higher your deductible, the less likely you’ll be to take full advantage of your insurance.
If you are changing insurance and want to continue with your current dentist, you can visit the websites of insurance companies you are thinking about signing up with and search to see if your dentist accepts the new type of insurance. However, sometimes these search results aren't updated or only show offices seeking new patients, so you'll want to verify by calling your dental office.
DentalPlans.com is one of the leading online marketplaces for finding dental savings plans. The company has been in business since 1999 and is affiliated with more than 30 dental plan companies and has over 100,000 participating dentists around the country. The benefit of using DentalPlans.com is it allows you to access the number of different dental plans to find out which is the best deal for you.
Often, there is no waiting period in a group plan, like one offered by an employer. Of course, if you were eligible for a company-based plan, you probably wouldn't be shopping around on your own. However, the same privilege might be had in a group plan offered through an organization such as AARP.  With their plans, there's no waiting period for preventative services, at least.   
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.
More than 90 percent of dental insurance policies carry a “missing tooth clause” or a “replacement clause.” Many include at least one of these clauses, but most have both. A missing tooth clause protects the insurance company from paying for the replacement of a tooth that was missing before the policy was in effect. For example, if you lost a tooth before your coverage started and later decided that you would like to have a partial, bridge or implant, the insurance company would not have to pay for that service if they have a missing tooth clause in the plan. A replacement clause is similar except that the insurance company won’t pay to replace procedures such as dentures, partials or bridges until the specified time limit has passed.
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.
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 buying cheap dental insurance will mean that going to the dentist could cost you more, you might also be less likely to go to the dentist or you could put the visit off if you have a problem. This could lead to bigger issues with your dental health which could lead to more expensive procedures and treatment. For example, if you put off treating a cavity, you could end up needing a root canal.

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.
Dental health is an important part of your overall wellness, and not having insurance may tempt you to skip regular cleanings and checkups – a decision that could lead to serious dental health problems down the road. Spirit Individual Dental Insurance plans are designed to help fill these types of gaps by offering a variety of plans and price points.
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