It’s been said that dental care for seniors may be even more important than dental care when we are children. This, of course, makes dental insurance for seniors a very popular product.
Aging can present a whole host of dental issues ranging from gum disease to attrition or dry mouth. Caring for our teeth is especially important during this period of our lives because poor dental hygiene has been linked to health problems like heart disease, diabetes, and even osteoporosis.
Severity of gum disease in older American is also a concern.
For many individuals turning 65, it comes as a surprise then to find out that Medicare does not include dental coverage for seniors. Why in the world would they think that we don’t need care for our teeth (or eyes and ears too) as we get older? If anything, we might need even more care than we did when we were younger.
The answer lies in history. When Medicare was developed back in the 60’s, it was not common for health insurance plans to include dental, vision and hearing benefits. Also, the American Dental Association actually opposed the inclusion of dental benefits into Medicare coverage.
So here we are sixty years later, and times have changed but Medicare has not. Our national health insurance program for seniors still doesn’t routine dental, vision or hearing care. This is largely because the medical benefits currently included in Medicare are already a challenge for our nation to afford.
It’s not likely that Congress will be adding dental, vision and hearing coverage for nearly 60 million people anytime soon.
What Medicare Does Cover for Dental
While Medicare doesn’t cover routine dental services, it does offer limited coverage for certain situations when the care is considered medically necessary. For example, if you are in an accident and damage your jaw or teeth, Medicare may cover extraction or surgery involving your teeth, gums, mouth.
Likewise, some people who have oral cancer may be able to get limited coverage for dental services related to the treatment for this condition. Sometimes an oncologist may order dental services that are necessary for radiation treatment, etc. It’s also somewhat common for transplant recipients to have an oral examination in a hospital.
Outside of special circumstances like these, pretty much everything else related to dental care will fall on your shoulders.
So how can you cover yourself in the meantime? Fortunately, there are quite a few affordable solutions out there. Before we review options though, let’s first cover some common terms related to how dental plans works.
How Dental Insurance Plans Work
Most dental insurance plans will divide services up into three major categories: preventive, basic and major services. Each insurance company and plan will differ as to which procedures are classified into each category, but here are some fairly common services and how they might fall into categories.
Preventive Care usually includes oral exams, fluoride treatments, sealants, and teeth cleanings. Many dental plans cover preventive care at 100% with no waiting periods and sometimes no deductible either.
Basic services include fillings, extractions, treatments for gum disease and xrays.
Major services are typically the most expensive. Root canals, retainers, crowns, bridges and dentures fall into these categories.
Some dental plans have waiting periods. This is a period, usually from 6 – 12 months, which you may have to wait before work on your teeth can begin. Waiting periods are used by insurance companies to make sure that people don’t purchase the dental coverage immediately before an upcoming and often expensive procedure.
Deductibles, Copays and Coinsurance
Your insurance deductible is the minimum amount that you must pay out-of-pocket before your insurance policy will cover any procedure. It’s common to see deductibles of $50 – $100 on many dental insurance plans. You will pay this entire amount before your insurance pays for anything.
Copays are the fixed dollar amount that you pay to your provider at the time of service.
Coinsurance is similar to a copay but is a percentage. After you meet your deductible, the insurance company commonly pays a percentage, and you pay a percentage. Your percentage is called your coinsurance.
Some dental insurance plans will only cover a certain dollar in benefits to you each years. This is called your annual maximum. After the insurance company has reached this limit, you (the patient) must pay all of the remaining care costs for the year.
Things Not Covered
While dental policies will vary from one insurance company to the next, there are some things which people commonly ask about that are usually not covered. This usually includes any cosmetic, such as teeth whitening, composite (white) fillings, and dental implants. Orthodontics is also usually not a covered service on individual dental plans.
Now that we’ve learned some of the terminology, let’s review some possible options for insuring the health of your teeth. You can check out the video for a quick overview, and read further below for more details.
For people wanting a standalone plan that covers multiple services that Medicare doesn’t, this plan from Central United is a winner.
Over the years our agency has offered a number of dental plans. However, it often seemed like our clients weren’t very happy with them – usually because of the network restrictions. Finally, we found an affordable dental, vision, and hearing insurance alternative from Central United Life Insurance, which is owned by Manhattan Life.
What has made this plan so popular is that you choose your own providers. There are no network restrictions to hassle with. You simply pay your bill and the insurance company will reimburse a percentage of your costs.
Many dental plans out there have waiting periods before you can access any of the benefits. This dental plan, on the other hand, has many benefits right from Day One, and there are no waiting periods for preventive or basic services.
Your benefits also increase over time. The longer you have the policy, the more it will pay out. Applications are short and simple with no health questions.
Some of our favorite features of this plan:
- Anyone age 18 – 85 can enroll
- Economical dental, vision and hearing plans as low as $34.17/month for people age 65+
- Option for up to $1500 per year in benefits (so many other plans are limited to $1000/year)
- Preventive and basic dental services available from DayOne
- Families can enroll together if they choose to do so
- Immediate coverage for eye exams
- Immediate coverage for hearing exams
- No Networks! See any provider you like
- Guaranteed Acceptance -No underwriting or health questions.
- Renewable up to age 85
- EZ online applicationwith coverage available the very next day
- Use your coverage right away
- 30-day free look period in many states – you can return the policy with no questions asked for a full refund (even shorter in some states)
The reason we feel this is one of the best dental insurance plans is that you have some coverage for both preventive and basic services. No waiting if you need a filling. It’s unhealthy to leave dental issues like that unresolved, so this plan provides an easy solution to help you pay for those costs.
Benefits for Vision Care
It’s not that easy to find standalone vision plans, so it makes sense to bundle these benefits with dental. This policy will cover your basic eye exams or refractions as well as eyeglasses or contact lenses. There is no waiting period for eye exams either, and you can choose your own optometrist.
Benefits for Hearing Care
Taking care of our hearing is easy to overlook, but as we get older, we don’t hear quite as well as we did in our younger years. With this insurance, you can take advantage of a regular hearing exam. Furthermore, this plan also provides benefits toward the purchase of hearing aids, which can be very expensive without help.
A number of insurance carriers offer private dental plans as a standalone product, not combined with vision or hearing.
Typically these plans are either network-based or are indemnity coverage.
In the network-based plans, the insurance company contracts with dental providers to form a network or participating providers. PPO networks are common, where you get the best pricing for seeing dentists in the network, but still have some benefits if you seek treatment outside the network.
Indemnity plans, on the other hand, will usually allow you to choose your own dentist. You will pay a fee for each type of service that you obtain through the network. The insurance company will then contribute a portion of the total charges while you pay the rest.
Reimbursement rates are often based on the “usual, customary and reasonable” charges that are typical in a certain geographical area. The insurance company assesses what they feel is an average of the rates being charged by dentists in your area, and then pays you a certain percentage of that average rate for each service.
Although the UCR charges may be called “usual, they may or may not accurately judge the fees that dentists actually charge you, so be prepared for a balance bill from time to time.
Common Features and Costs
Both network and indemnity plans typically have an annual maximum limit to your benefits. This might be $1000 – $2500 in total coverage depending on the plan.
Because this a true insurance plan where the carrier contributes toward the cost of your care, you will often find that plans have waiting periods. This protects the insurance company from people who might wait until they need a major service before purchasing the coverage.
Preventive care is generally provided right away, while more of the basic and major services will incur the waiting period. Because of this waiting period, it’s best to enroll in this coverage when you don’t have an immediate need for major dental work.
Dental insuance plans will typically charge you a monthly premium for the plan itself. There may also be a deductible, which is the amount you can expect to pay out of pocket before your benefits kick-in.
You’ll also find that you may owe a copay or coinsurance for certain procedures as they occur. For example, a visit to your primary dentist might require you pay a copay of $30. Check the plan’s schedule of benefits to review what expenses you will be responsible for as you use the insurance.
While Original Medicare doesn’t include coverage for routine dental services, Medicare Advantage plans sometimes do. Advantage plans – commonly called Part C of Medicare – are a form of private coverage. You can opt to get your Part A and B benefits from a private insurance carrier.
Medicare pays that carrier to roll out your benefits. These insurance companies are allowed to include “extras” that you would not get from Medicare or a Medigap plan.
These ancillary benefits often include preventive and/or basic dental care, vision care, hearing care and even wellness or fitness memberships. Dental benefits like these are usually preventive in nature, and you may need to get your care from the plan’s network of dentists.
All Medicare Advantage plan application kits come with a Summary of Benefits. Review the benefit with your agent to see exactly which services might be included for you.
Remember that your Medicare Advantage plan also covers your regular medical care. You want to always be sure that your doctors are in the plan’s network before you join. You might find a plan with a great dental benefit, but if your primary care physician isn’t a provider on the network, it may not be a good fit for you.
Annual Changes to Medicare Advantage Plans
Also, be aware that Medicare Advantage plans can and do change their benefits, premiums, copays, coinsurance, network and drug formularies from year to year. It’s possible that the dental benefit you sign up for the first year will change in the second year. Make it a habit to review your Annual Notice of Change document from the Medicare Advantage insurance company every September.
This ANOC letter will come in a packet that includes a side by side comparison of any benefits that are changing from this year to the next. If you are unhappy with any of the coming changes for next year, you can use the Annual Election Period (AEP) in the fall to switch to another plan that suits you better for the next year.
The AEP runs from October 15th – December 7th every year.
Many insurance companies offer discount plans for dental services. These are sometimes called dental savings plans. This is a sort of “club” if you will. You join the club and all members of the club get access to network dentists at discounted rates. Just by being a member and using the network dentist, you qualify for deep discounts on a variety of services.
Sometimes you will see these plans offered with a limited HMO network. There is no coverage outside the network.
The upside is that there are no claims to file. These plans also often have no annual maximum because there is not actual benefit being paid by an insurance company. It’s also common to have no waiting periods. Discounts plans can be a great option if you have an immediate need for serious dental work.
The downside to these plans might be that your preferred dentist isn’t in the network. However, if you are open to seeing another dentist for your care, you’ll save a bundle. The plan can provide you with a fee schedule, so you can see ahead of time exactly what you’ll spend on everything from an oral exam to a root canal.
Though dental discounts plans are not actual insurance for seniors, they can be a terrific way to get lower rates when you need immediate care.
In a pre-paid dental plan, the dentists who accept the plan get paid a flat fee per member every month. You select the dentist you want at the time of enrollment. When it’s time for care, you schedule an appointment with that dentist and seek all of your treatment through his or her office. Changing dentists may be allowed, but there might be certain time allowances for how quickly the plan will accept and implement your provider change.
You will show your ID card at the time of service, and you’ll usually pay a set copay based on the service being performed. Some procedures which are more expensive may require pre-approval with your insurance carrier. Unlike PPO plans, however, DHMO plans generally do not have a waiting period. You are generally covered for any treatment as soon your enrollment in the plan is processed. Most plans also do not limit he amount of care you can receive in one year.
Another plus to pre-paid dental plans is that premiums are often lower than a traditional standalone dental insurance PPO plan.
If you are married and your spouse is still working, ask the employer whether your spouse can continue to carry you on their dental insurance plan. Sometimes companies will allow this, and because that is group coverage you may have access to better networks than what you can find in the individual plans.
How to Compare Dental Insurance Options
We hope this list of options was helpful to you! We know that selecting the right plan for yourself can be tricky. Here are some things to consider:
- Do you have a need for immediate care for a dental concern? If so, pre-paid or discounts plans are a good choice because there are no waiting peirods
- Do you have a specific dentist that you’d like to see? You might start by asking that provider which plans he or she recommends or participates in.
- Is there a history of dental problems in your family? If your parents have had issues with their dental health, sometimes a full-coverage insurance plan is the best way to go to make sure that you’ll have adequate contribution from your insurance company in the event of expensive procedures like root canals and crowns.
Do you have a question or comment about finding dental insurance? If so, we’d love to hear from you in the comments below.