Trying to decide if dental insurance for seniors is worth the cost? Read this overview to help you decide, especially if it’s not covered by your Medicare plan.
Seniors often find themselves shopping for dental insurance for the very first time.
That’s because Original Medicare doesn’t cover the majority of dental procedures (unless they’re part of a hospitalization).
Medicare Part C plans (a.k.a. Medicare Advantage Plans) are delivered by private insurance companies, and will sometimes include dental coverage.
If your Medicare plan does not include dental insurance, you have a few options:
- Pay full price for dental cleanings and procedures.
- Find a low-cost clinic or dental school.
- Purchase a separate dental insurance plan.
Before you decide, let’s take a look at how dental insurance works.
How Dental Insurance for Senior Works
Just like health insurance, dental insurance companies collect premiums from their customers. They generally have a list of in-network dentists who will complete work for discounted rates, and the insurance company will pay for all or a portion of those charges.
Preventive care is usually 100% covered. These services include cleanings and x-rays.
From there, they often cover 80% of basic services like fillings, extractions and heavy cleaning services. And major dental procedures, like dentures, bridges, root canals and crowns…you can expect them to cover 50% of the expense.
Some dental procedures are covered by some plans and not by others—braces, missing teeth, cosmetic treatments and implants, for instance. That’s why it’s important to read the fine print for any dental plan you’re considering.
You may not have these problems now, but if you would in the future, is there room in your budget? Or would you be better off if they were covered?
There are other variables too, including copays, yearly maximum payouts and waiting periods.
Let’s go through what those terms, and more, mean:
- Premium: This is the monthly payment made to the insurance company to purchase coverage.
- Annual Maximum: This is the insurance company’s ceiling for payments. If your annual maximum is $5000, the plan provider will only pay that much within a calendar year. Anything above that, you will be responsible for. Or you can put the procedure off until after the new year.
- Deductible: Before your dental coverage kicks in, you will be responsible for paying 100% of fees up to a predetermined amount. If the dental plan has a deductible, and it’s $500, you will have to pay $500 to the dentist before coverage starts.
- Coinsurance: Coinsurance is always a percentage, not a flat rate. It’s the portion that you’re responsible for paying.
- Copay: You are also responsible for a copay; however, it’s a flat rate rather than a percentage.
- In-Network: These providers have a contract with the dental insurance company and offer reduced rates to patients who have purchased a plan from that company.
- Waiting Period: This is the amount of time that must pass between the purchase of a dental insurance plan and having dental work done. This is to deter patients from buying insurance just to have one costly procedure completed.
- Pre-Existing Condition: This is a dental problem or complication diagnosed before purchasing the dental insurance plan. Waiting periods exist to protect dental insurance companies from the costs associated with pre-existing conditions.
That’s a quick overview of how dental insurance works.
Now let’s look at whether or not it’s a worthwhile investment for you.
Is it worth it for You?
As we discussed earlier, every dental plan is different, and your time will be well-spent when you research what each option covers.
Dental Plans offers a helpful graphics that shows the coverage for preventive care, basic procedures, major procedures, orthodontics, cosmetic services and dental implants as well as annual maximums, deductibles, waiting periods and more for major dental insurance providers.
A great place to start as you learn more about dental insurance for seniors, dental plans, dental insurance companies is DentalPlans.com. You’ll also find out how all of this comes together to ensure that you get the best possible dental care during retirement.
- Medicare 101: The Basics and Other Things You Should Know
- Mind the Medigap: Filling the Coverage Holes Medicare Leaves Behind