If you are a senior or are approaching retirement, you may be surprised to find out that Medicare does not provide coverage for routine dental care. Medicare mainly covers medical treatments, but does not provide any assistance for routine dental care such as bi-annual exams, cleanings, or even major services like bridges or dentures. This leaves it to seniors to search for a dental plan that can meet their coverage needs.
The best way to take care of your teeth is proper maintenance, and Dental Select’s senior dental plans cover 100% of preventative costs. This includes two professional cleanings each year, as well as exams and x-rays. Most of the costs of basic procedures are covered as well, such as fillings, dentures, and even oral surgery. Better yet, there are no waiting periods, meaning that your plan is effective on the first day of the month following your enrollment.
Almost all dental insurance companies use what is called a Usual, Customary, and Reasonable (UCR) fee guide. This means that they set their own price that they will allow for every dental procedure that they cover. This is not based on what a dentist actually charges, but what the dental insurance company wishes to cover. For example, your dentist may charge $78 for a dental cleaning, but your insurance company will only allow $58 because that is the UCR fee that they have set.
AARP and its affiliates are not insurers. AARP does not employ or endorse agents, producers or brokers. AARP Member Advantages is the name for a collection of products, services and insurance programs available to AARP members from trusted third parties. AARP member benefits, including all goods, services and discounts on this site, are provided by third parties, not by AARP and its affiliates. Providers pay a royalty fee to AARP for the use of its intellectual property. These fees are used for the general purposes of AARP. Provider offers are subject to change and may have restrictions. Please contact the provider directly for details.
A carrier recently told us that many seniors expect to carry over their dental coverage from their employer. Yet, that rarely happens. What does happen is that about 90% of seniors on Medicare don’t have proper dental coverage (American Dental Association). After filling out the Medicare paperwork, most seniors put dental insurance on the back burner. (And vision and hearing, too…we’ll get to those later.) And, why not? Your teeth are not hurting yet and they feel pretty good.
Different companies provide various percentages of coverage in these areas. For example, one insurance provider might cover 100% of the cost of Class I services while another might only cover 80%. Yet another plan might not provide Class IV or orthodontic coverage, but provide coverage in all other areas. It’s important that you understand what services are covered before signing up for a plan.
Savings plans are NOT insurance and the savings will vary by provider, plan and zip code. These plans are not considered to be qualified health plans under the Affordable Care Act. Please consult with the respective plan detail page for additional plan terms. The discounts are available through participating healthcare providers only. To check that your provider participates, visit our website or call us. Since there is no paperwork or reimbursement, you must pay for the service at the time it’s provided. You will receive the discount off the provider’s usual and customary fees when you pay. We encourage you to check with your participating provider prior to beginning treatment.
Although discount plans are also sold by private companies, they are not insurance plans. There are no copays, coinsurance, or deductible amounts. That also means that there are no pre-negotiated rates or free yearly checkups and cleanings. A participating dentist simply agrees to offer discounts (often a percentage off from the total price) for certain medical services. Then, seniors who choose discount plans will pay their dentist directly for the cost of services (after the discount).
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.
The key to keeping your teeth healthy as a senior is properly brushing and flossing your teeth, as well as visiting your dentist regularly for checkups and cleanings. You want to make sure to brush your teeth at least twice a day with toothpaste that contains fluoride, according to Colgate. The American Dental Association (ADA) notes that fluoride prevents tooth decay and cavities. It’s also important to floss once a day, says the ADA.
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).
The cost estimates provided may be different from your actual costs for several reasons, including but not limited to, your unique dental circumstances and the decisions made by you and your dental professionals as to what services you will receive, deviations between the anticipated scope of services and the services actually provided, and the characteristics of your particular plan.
Most full coverage dental insurance plans will cover two preventive maintenance visits per year without requiring a deductible payment. Most require a $50 deductible per person, per year to help cover costs beyond your preventive exams. If you need work done, most plans will cover a part of the costs. We looked at root canals specifically and found that the majority of dental plans will cover about half the cost, which may not seem like a lot, but paying half is better than paying upfront for an $800 root canal. However, keep in mind that most insurance policies, depending on your plan, top out at about $1000 to $1500 per year. Using conservative estimates that might be one or two root canals. If you need extensive work done you might have to pay the remaining amount out of pocket.
Preventive care is 100% covered with 2 exams and 3 cleanings free per year. There is a $100 deductible that you only pay once for the life of your plan. After the deductible is met, the plans cover between 80% to 90% of all basic care and 50% to 65% of major work including crowns, bridges, implants, and root canals. Orthodontia is covered at 50% and all plans are highly affordable, with their lowest individual plan often running at less than $115 per month depending on your region. Their highest-tier plan offers a $5,000 maximum benefit per year but isn’t available in every state.
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Dental Preferred Provider Organization (DPPO) plans: DPPO plans offer you more choice when it comes to dentists. PPO networks include a variety of dentists that agree to treat patients with DPPO insurance at lower rates. Typically, patients with DPPO have to pay a deductible. When seeing a dentist in your DPPO network, you will usually pay a percentage of the lower rate for treatment. Your insurance company will pay for the rest.
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.
Medicare Advantage plans may offer routine dental care. Medicare Advantage is another way to get you Original Medicare (Part A and Part B) benefits from a private insurance company. A Medicare Advantage plan may offer routine vision as well as prescription drug coverage. If you have a Medicare Advantage plan you have to continue paying your Part B premium. Medicare Advantage plans must cover everything that Original Medicare covers except for hospice care which is still covered by Medicare Part A. The extent of the Medicare Advantage dental coverage may vary from plan to plan.
Spirit Dental is the online storefront for Direct Benefits, a company started in 2001 by Tom Mayer, who wanted dental coverage to be affordable for all Americans. While Direct Benefits serves as a broker for employee benefits and consultants, Spirit Dental is meant for online consumers who can buy coverage right on the website or talk to one of their many agents and providers nationwide.
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