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What Choices Do Senior Citizens Have for Dental Insurance?
When a person turns 65 and applies for Social security, he or she is automatically enrolled in Original Medicare (Part A and B). In certain cases, younger individuals with permanent disabilities also qualify for Medicare if they receive Social Security Disability Insurance. Medicare is the federal government’s insurance program for hospital stays and doctor’s visits. It was created in 1965 so seniors could have an affordable medical insurance option. Medicare does not offer any dental coverage except for rare instances of medically necessary dental care. For example, Medicare will pay for an oral examination for a person about to undergo a kidney transplant if the exam is required to clear them for surgery.
Poor adult oral hygiene can lead to heart disease, diabetes and pneumonia. For people over age 65, taking care of their teeth and gums is important for their general health. However, seniors cannot count on Medicare for dental benefits in Atlanta. Instead, they must find a Medicare Advantage plan, buy standalone dental insurance or enroll in a discount dental plan. When you’re on a fixed income, choosing the best way to get dental benefits is important, especially considering the sometimes high costs of care.
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.
Is Medicare Advantage Part of Medicare?
Medicare Advantage is called Medicare Part C; however, private insurers contracted by Medicare offer Medicare Advantage plans. The plans offer the same coverage as Original Medicare, but they may also include Medicare Part D (prescription drug coverage) and dental, vision and hearing coverage. About one in three retirees choose an Medicare Advantage plan, most likely because of the supplemental benefits. In some cases, dental benefits are limited to preventative care only. Other plans include common procedures, such as fillings, root canals and extractions. Generally, the more dental coverage available, the higher the monthly premium. Some Medicare Advantage companies choose to allow participants to choose extra dental coverage by paying an insurance rider so people won’t have to pay for it if they don’t need it.
Nearly all doctors and hospitals accept Medicare, but private insurers offering HMO or PPO Medicare Advantage plans will have a limited network of providers to keep their costs down. The nation’s most popular providers include Aetna, Anthem, Humana and UnitedHealthCare. According to the Kaiser Family Foundation, 43 percent of individuals with Medicare Advantage plans have a plan with either UnitedHealthcare or Humana.
Medicare Advantage plans include Health Maintenance Organization plans, Preferred Provider Organization plans and Private Fee-for-Service plans. With HMO plans, you’ll have to see a doctor in their network. PPO plans let you see out-of-network doctors, although you won’t have the same level of coverage as you would if you saw an in-network doctor. Some Medicare Advantage plans have no monthly premium; however, individuals still have to pay their Medicare Part B premium.
Is Standalone Dental Insurance a Good Option for Seniors?
Standalone plans are independent of a health insurance policy. There are Preferred Provider Organizations which typically operate on a 100-80-50 principle. They usually pay 100 percent of your preventative care, 80 percent of basic restorations, like fillings, and 50 percent of major restorations. like crowns. Health Maintenance Organization plans usually pay a fixed rate for services as opposed to a percentage.
When you first get dental insurance, preventative care is usually covered right away. There may be a waiting period before you have coverage for other procedures. This is to keep people from buying insurance knowing they need a root canal very soon. Most plans have a deductible which is the amount you have to pay before your coverage kicks in. Preventative care usually is covered even if you haven’t met your deductible. Plans may also have benefit caps which limit the amount of benefits your insurance will pay each year. Typically, insurance companies cap annual benefits at $1500 to $2,000. While this may seem like a lot of coverage compared to your cost for the insurance, if you need a root canal and a crown or dentures, it is very easy to reach your benefit cap and have to pay out-of-pocket costs.
For retirees on a fixed income, the cost of insurance is important, but other factors also matter. If you need a specific procedure and there is a waiting period, your condition may worsen. Additionally, if the insurance does not cover care you’re likely to need, the policy probably isn’t worth purchasing.
Will Dental Discount Plans Offer Enough Coverage for Seniors?
Seniors who belong to a discount dental plan enjoy saving money each time they visit a dentist. The plans require a small enrollment fee and an annual membership fee in order to pay discounted rates from the plan’s network of dentists. Membership fees are significantly less than insurance premiums. Dental care included in many of the plans include:
- Exams, teeth cleanings and x-rays
- Dental fillings
- Root canals
Plans usually allow members to save on nearly all common dental procedures, including some cosmetic procedures, such as teeth whitening.
Discount dental plans are not insurance; however, they enjoy distinct advantages over insurance including:
- No membership restrictions – everyone is accepted
- No waiting periods for major procedures
- No clauses excluding pre-existing conditions
- No limits on the plans use
- No deductible to meet
Plans like DentRite® offer dental benefits in Atlanta, along with benefits for vision and hearing care. These benefits are almost always included at no extra charge.
How Can Retirement-age Individuals Get Help with Dental Expenses?
Being on a fixed income can make paying out-of-pocket dental costs challenging. Seniors faced with a large bill can ask their dentist if payment options are an option. Many dentists offer their patients financing through CareCredit, a credit card company specializing in financing dental and medical care. You can apply over the phone while you’re at your dentist’s office if your dentist has CareCredit.
Dental benefits improve senior’s access to oral care which in turn improves their oral health. Given the increasing body of research which connects oral health and overall health, it’s essential for seniors to have dental benefits. Seniors having trouble paying dental costs can ask their dentist about lower-cost treatment options. Veterans can ask the Department of Veterans Affairs as they may have dental benefits available. AARP and other organization for seniors may have information about discounted insurance, discount dental plans for seniors and other dental benefits in Atlanta.