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The senior demographic is defined as anyone who is 65 years or older, and they comprise almost 20% of the U.S. population. That number will increase steadily because every day, more than 10,000 Americans reach that age. Seniors are also the least likely to have affordable dental care because of a lack of insurance. When they were employed, most of them had insurance coverage through their employers. Upon retirement, however, many were left without the means to provide adequate insurance for themselves and their families. Approximately 65% of seniors have no dental insurance and the result is that they forego needed dental treatment.
Even without insurance, seniors spent $28 billion in 2016 to pay for needed dental care, resulting in the highest expenditures for dentistry of any demographic. A study conducted by the Kaiser Family Foundation found that half of all Medicare recipients hadn’t seen a dentist in the preceding year, and almost 20% of those who did, spent more than $1,000 on out-of-pocket expenses for routine dental work. The reason for these somewhat alarming statistics may be the cost of dental procedures.
Do Seniors Have Options for Dental Insurance?
When an individual reaches the age of 65, they are automatically enrolled in Medicare. However, traditional Medicare provides no coverage for dental procedures unless they are necessary for a surgical procedure. As an example, Medicare may cover a dental exam if it’s required for a specific surgery. As a result, Medicare beneficiaries must seek alternative sources to pay for their dental procedures. Approximately 25% of seniors enroll in a Medicare Advantage plan and another 10% use private insurers to cover their dental costs.
What Are Medicare Advantage Plans?
Advantage plans are supplemental insurance plans that provide a spectrum of benefits that aren’t included in the traditional Medicare plan. Advantage plans have a network of providers that provide lower out-of-pocket limits, lower deductibles, and lower rates overall for covered procedures. In a traditional Medicare plan, the provider must be reimbursed by the government for services rendered to Medicare patients, which can take months. Under the Medicare Advantage plans, the insurer pays the healthcare provider directly, which means that the provider is paid in a more timely manner. Advantage plans often include hearing, vision, and prescription drug coverages, and they have a separate identification card. Aetna, Humana, and UHC are the most popular and well-known providers of Advantage plans, and they endeavor to keep the premiums affordable so that seniors can obtain the healthcare services that they need. The scope of dental coverage they provide is usually limited to cleanings, basic checkups, and standard x-rays.
Are Standalone Dental Insurance Plans Worthwhile?
If you need more comprehensive coverage, then a standalone dental insurance plan may be a cost-effective option for you. Standalone plans are available at different price points, with the most comprehensive coverage provided at the highest price point. Plans are available as follows:
A basic plan generally covers annual exams, cleanings and diagnostic x-rays.
The mid-range plan will include some expanded services for emergency treatments, dentures, fillings, inhalation anesthesia, orthodontics and specialty x-rays.
Premium plans are the most costly, but they provide the most comprehensive coverage. They’re probably the best option for those who require a significant amount of dental procedures, and the covered services usually include:
- Full dentures
- Endodontic procedures
- Partial dentures
- Onlays and inlays
- Oral surgery
- Periodontal procedures
The coverage from a private plan is usually tiered, which means that the patient is responsible for partial payment of many procedures. Usually, the tiered rate is 100-80-50, which means that 100% of the cost of routine procedures is covered, 80% of the cost of basic procedures is covered, and 50% of the cost of complex procedures is covered by the provider. The remaining balances are the patient’s responsibility. Private dental plans may be lower in cost than a Medicare Advantage plan, but it probably won’t include hearing, vision or prescription medication benefits that may be included with an Advantage plan.
Are Dental Discount Plans a Better Option Than Insurance?
Discount dental plans are not insurance plans. They’re provided by private companies as a membership service that a dentist agrees to accept. The members pay an enrollment fee and a monthly membership fee and then pay the dental provider directly. The private companies negotiate with various dentists to provide discounted dental procedures to their members. They’re usually very affordable and have some advantages over insurance plans. For example, discount dental plans are free from waiting periods for dental benefits, complex forms, annual limitations on the number of office visits, exclusions for age or pre-existing conditions, coinsurance obligations, copays or deductibles and restrictions on changing dentists.
Generally, a discount plan will provide a substantial reduction in the cost of:
- Root canals
DentRite and other similar providers usually include hearing, prescription, and vision discounts, so they may be a viable option for those who are generally in good health but need basic routine maintenance. Those who require more dental benefits in their area, however, might be better served with a standalone insurance plan.
How Can I Manage Out-of-pocket Dental Expenses?
Many dental offices offer flexible financing plans and payment options, so if you need dental treatment, they may be able to provide you with the treatment you need at a rate that you can afford. CareCredit is a popular medical financing option that’s accepted by more than 200,000 healthcare providers throughout the nation. There’s an application to be completed, and an approval process, so not everyone will qualify for financing.
Some senior organizations such as AMAC and AARP provide senior discounts on goods and services, so you may save some additional money by checking their websites.
If you need dental treatment in the Aventura area, then call Dental Specialty Center of Aventura at (305) 677-4779 and let us help you. Don’t forego needed dental procedures because of financial constraints. Call us today and let us help you restore your good oral health. We’d love to help you maximize your dental benefits in our office. We look forward to working with you.