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Does Medicare Offer Dental Coverage?
Medicare is our government’s medical insurance program established in 1966 for senior citizens age 65 or older. Some individuals under retirement-age may also qualify for Medicare, including those with permanent, severe medical conditions or long-term disabilities. Original Medicare contains Part A, which is hospitalization insurance, and Part B, which is insurance for doctor’s visits. Part D is prescription drug coverage. Most people easily recognize the familiar red, white and blue cards seniors use for discounts at stores and on public transportation. Original Medicare does not offer dental coverage. Dental coverage is only available in situations when it is medically necessary. Medically necessary dental care is rare. One example of medically necessary care is having an oral exam before a kidney transplant because it is required to clear you for the surgery.
In fact, 6 million more seniors sought dental services in 2016 than in 2006. In 2016 alone, seniors spent nearly $29 billion on dental services, representing the highest growth in spending of any demographics. Seniors who haven’t retired yet may still get insurance through their employer, however, retired persons are less likely to visit a dentist. Employers are the large source of dental benefits, yet retirees often lose them just when they need the benefits the most. Some people are caught unaware, assuming Original Medicare includes dental benefits. There are the individuals scrambling to find coverage when they can’t put off seeing a dentist any longer. Seniors who are looking for dental benefits in New Haven should consider Medicare Advantage (Medicare Part C), dental insurance from an insurance company or a discount dental plan.
Checkups and Cleanings:
- Basic exam–$50 to $100
- Dental X-ray–$20 to $250
- Standard cleaning–$70 to $200
- Silver amalgam–$50 to $300
- Composite–$90 to $450
- Simple extraction–$75 to $450
- Surgical extraction–$150 to $650
- Wisdom tooth extraction–$75 to $3,000 based on the number and complexity of the extractions
The cost of a crown can range from $500 to $3,000 based on the type of material used.
The cost of a root canal can range from $300 to $2,000 based on the location of the tooth and the complexity of the procedure.
What Is Medicare Advantage?
According to the Kaiser Family Foundation, 34 percent of Americans chose a Medicare Advantage plan in 2019. Medicare Advantage plans are administered by private insurers who contract with Medicare to provide coverage. These companies generally also offer supplemental coverage for dental, hearing and vision. Most also offer prescription drug coverage. Depending on the plan you select, you may pay no premium beyond the premium you already pay for Medicare Part B. Leading insurance companies offering Medicare Advantage plans include Aetna Group, Humana, UnitedHealth Group and Blue Cross Blue Shield affiliates.
It’s rare for a plan to offer enough dental benefits in New Haven for seniors. Most cover oral exams and other preventative care, although some also cover fillings, root canals, extractions, crowns and dentures. Plans with more comprehensive coverage will generally have higher premiums than plans with basic coverage, although not always. People over 65 are keeping their natural teeth longer, but years of wear cause the enamel to become thin. Gums also naturally recede, making seniors more prone to crown and root cavities. Also, two out of three seniors have gum disease, making comprehensive benefits essential. Even seniors who no longer have their natural teeth should have dental benefits for exams to check for signs of oral cancer and to replace dentures which no longer fit correctly.
Is Standalone Dental Insurance a Good Option for Seniors?
Even senior citizens who enjoy good dental health can benefit from dental insurance which is separate from a health insurance policy. Most policies have 100-80-50 coverage, which means preventative care, including six-month exams, x-rays and teeth cleanings, are covered 100 percent. Basic restorations, such as fillings, are typically covered 80 percent and major restorations, such as crowns, have 50 percent coverage.
Companies offering plans popular with senior citizens include Aetna, Cigna, Delta and UnitedHealthcare. The standalone dental insurance will affect the dentist you can see. Seniors should make sure the insurance company’s network of dentists includes one which is convenient and one they will enjoy visiting. Typically, a senior’s choices will include Dental Health Maintenance Organizations and Dental Preferred Provider Organizations. You’ll have to use a dentist in the plan’s network to receive coverage if you select an HMO Medicare Advantage plan. PPO plans offer you a choice of using a network provider or one that isn’t in the network, although there is less coverage if you use an out-of-network provider.
Important points to consider when choosing a plan include coverage for anticipated dental needs, waiting periods, restrictions on pre-existing conditions, deductibles and yearly caps on benefits. Many insurance companies limit coverage for major dental work for six months or more. This is to prevent people from buying insurance until they need it. Restrictions on treating pre-existing conditions are also common. Many policies have missing teeth clauses. You won’t be covered for replacing a tooth that you lost prior to buying insurance. Deductibles are what you have to pay out of pocket before you have coverage. Preventative care costs usually are not part of the deductible. Many policies also have caps on the dollar amount of benefits you can claim in a given year.
Are Dental Discount Plans Like Insurance?
Discount dental plans may not be insurance, but they are an affordable alternative for dental benefits in New Haven. Private companies sell the plans and charge members a monthly or annual fee. Members receive a card which they show to dentists in the plan and they receive a discount on the dentist’s normal fee. According to the National Association of Dental Plans. only five percent of Americans choose discount dental plans to save money. Typically, members pay discounted prices for a wide range of dental care services, including:
- Preventative care, such as exams, x-rays and teeth cleanings
- Fillings, onlays and overlays
- Dental crowns
- Certain cosmetic procedures, such as teeth whitening
Discount dental plans have many advantages over insurance, including:
- There’s no waiting period for major procedures
- There are no pre-existing conditions exclusions, such as a missing teeth clause in many insurance policies
- You can visit any dentist in the network and change dentists anytime
- There’s no paperwork or claim forms to fill out
- There’s no cap on your discounts – use the card as much as you wish
Many discount dental plans, such as DentRite®, have other benefits as well. For example, DentRite® offers discounts on eye exams, glasses and contact lenses, LASIK and prescriptions at participating pharmacies nationwide.
Are There Options for Paying for Out-of-pocket Dental Expenses?
AARP and other local and national senior organizations often have information on senior discounts available for insurance and professional services. Professional and trade groups are also good sources of finding group rate insurance. Group plans are nearly always less expensive than individual plans and there is generally more coverage.
Dentists may offer payments plans; ask our office staff. Dentists may offer financing through CareCredit. CareCredit is a medical credit which you have to apply for over the phone. If you’re accepted, CareCredit can finance tooth repair, crowns, fillings, gum disease treatment and more. There are usually promotions, ranging from six to 24 months, with 0 percent interest, but if the balance isn’t paid in full before the promotion ends, you’ll pay their normal interest rate. Since almost all dentists accept credit cards, senior citizens with good credit can take advantage of those 0 percent interest credit card offers they receive in the mail and sign up before visiting the dentist if they know they need work.
Contact our office in New Haven for more information on standalone dental insurance, Medicare Advantage and more.