What Every Retirement-Age American Should Know About Dental Insurance
As we grow, so do our concerns about our health. A lot of attention ends up being paid to health insurance plans and programs for senior citizens. Unfortunately, dental insurance for seniors is often easily overlooked.
Although people tend to deprioritize treatment for dental care, oral hygiene is among the most common health concerns for people over the age of 65. It’s also where a lot of money is being spent. A study from the Pew Center on the States predicts that total annual spending on dental care will surge from $101.9 billion in 2010 to $161.4 billion in 2018.
At the root of the problem is the fact that dental insurance is often not included in employer-sponsored health insurance plans. In 2012, 70 percent of American employees in private sectors were offered health insurance through their employer but only 45 percent were provided dental coverage.
To make matters worse, dental coverage is not included in Original Medicare, which in 2013 saw over 43 million senior enrollees. And while the Affordable Care Act has impacted healthcare coverage, it only guarantees dental coverage for children.
So what are seniors left to do? Without employer- or government-funded dental insurance, seniors with fixed incomes are left to hunt down affordable dental plans on the open market.
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If you’d like more information first, just keep reading. We’ll break down everything you need to know about dental insurance.
Types of Dental Insurance Plans
Dental insurance plans are structured similarly to health insurance plans. Here are a few of the different types of dental plans:
DHMO, or Dental Health Maintenance Organization plans, typically require you to choose one dentist or dental office to coordinate all of your dental services. This office will perform all your basic dental work and will refer you to a specialist if needed.
As long as you stick with your chosen dentist and their referred specialists, your plan will usually provide extensive coverage. But should you stray from that dentist and visit another dental office without their referral, expect to pay the full amount of the visit out of your own pocket. These plans are the dental equivalent of an HMO health insurance plan.
A Preferred Provider Organization differs slightly from an HMO in that you may not need to choose just one dentist or dental facility. The plan will consist of a network of selected dentist offices and you are free to visit any dentist within this network.
If you go outside of the selected network with a PPO, you can still expect to have your services at least partially covered by the plan.
Similar to a PPO, a fee-for-service plan (also called an “indemnity” plan) breaks down the percentage covered by the plan based on the type of service. So a routine cleaning might be covered at 90 percent while something like a root canal might only be covered at 50 percent.
How do Dental Insurance Plans Work?
Dental insurance plans are similar to normal health insurance plans. A good measuring stick to use when looking at plans is the “100-80-50” rule. This means the insurance will cover 100 percent of routine care such as checkups and cleanings, 80 percent of the cost of fillings, root canals and other such procedures and 50 percent of the cost of more advanced services such as bridges or crowns.
While “100-80-50” is a good rule of thumb, there are a number of variables that may differ from one plan to the next. It’s important to carefully consider each of these variables and identify the ones that are most or least important to you, your budget, and your dental needs.
A network is a group of selected dentists that have all agreed to contract with the insurance company. The level of your coverage can depend on whether you use a dentist inside or outside of the plan’s network.
The monthly premium is the amount you must pay each month to remain enrolled in the plan.
A deductible is the amount you must first pay out of pocket before the insurance (or a certain percentage of the insurance) kicks in.
Copay and coinsurance are both forms of out-of-pocket expenses you’re likely to incur when you visit the dentist. A copay is a flat fee (such as $15 for a teeth cleaning visit) while coinsurance is a percentage of the total amount of the service (such as 20 percent of the cost of the teeth cleaning).
An out-of-pocket maximum is the most you will pay out of pocket for all dental services in a given year. Once you reach this limit, the insurance will cover the remainder of all dental costs for the rest of the year.
Most dental insurance plans will come with a waiting period where certain procedures may not be covered for a specific amount of time. For example, coverage for a root canal might not be available until you have had your plan for six to twelve months.
While it’s true that not all dental insurance plans require a waiting period, such a restriction is a way for the insurance company to protect itself from a customer who signs up for the plan, has a root canal performed and then drops the plan after the procedure.
What Does Dental Insurance Cover?
Most dental insurance plans cover a few basic and major services. These can include things like:
- Cleanings and exams. It’s not uncommon for a dental insurance plan to entitle you to one or two free cleanings and/or exams each year.
- X-rays. Basic x-rays, called “bitewing” x-rays, are often covered by insurance while more advanced x-rays may require a greater out-of-pocket expense.
- Fillings and extractions. Having a cavity filled or a tooth pulled can often be done with just a copay or coinsurance.
- Standard repairs. Procedures such as root canals, bridges and crowns are at least partially covered by many dental insurance plans.
Some dental insurance plans might extend coverage or partial coverage for more advanced services such as endodontics, dentures, implants, cosmetic procedures and more. It’s important when shopping for dental insurance to consider each plan’s coverage details for any anticipated procedures.
Many plans categorize orthodontic treatment as a Class IV service, which are frequently covered from 25 percent to 50 percent. Supplemental dental insurance plans for braces may also involve a separate lifetime maximum that applies to the entire course of orthodontic treatment and is not part of your annual dollar maximum.
Dental Discount Plans and How They’re Different
You may have heard of dental discount plans. Is that the same as insurance?
The answer is not exactly, although the core concept remains much the same. With a discount plan, you pay an annual fee for access to discounted dental services. Think of a discount plan as a membership. The annual fee provides access to a network of dentists that offer various services at a reduced rate for discount plan holders.
A dental discount plan may operate with the same network restrictions as many dental insurance plans.
Dental Hygiene and Seniors
Seniors have somewhat of a unique relationship with dental health. They tend to have specific oral hygiene complications due to medications, nutrition, and good old wear and tear. And some of those dental problems are known to cause health complications in other areas of the body.
For example, many medications seniors rely on—such as those used for treating high blood pressure or Parkinson’s disease—may cause dry mouth, which in turn may cause cavities.
The Impact of Dental Insurance
With all these premiums, copays, and deductibles, how does dental insurance save you money? Well despite these expenses, a dental insurance plan is still likely to save you money on the overall cost of your dental care. This is especially true for seniors who are more likely to experience oral health complications.
Here’s a look at some average costs for various dental procedures for somebody without insurance, as provided by Member Benefits.
- Checkups. A checkup consisting of an exam, cleaning, and x-rays will run about $288 in most places.
- Fillings. Depending on the location of the tooth (hard-to-reach teeth usually cost more), fillings can cost up to $150 for a silver, amalgam filling, up to $250 for a tooth-colored composite filling, and over $4,000 for a cast-gold or porcelain filling.
- Tooth extractions. The cost of pulling a tooth can run up to $200 for a wisdom tooth, $300 for a non-surgical, gum-erupted tooth, $600 for a soft-tissue, surgical extraction, and $650 for a surgical extraction requiring anesthesia.
- Crowns. Crowns can cost up to $328 for a resin crown, $776 for a full-cast metal, and $821 for a porcelain-fused one.
- Root canals. A root canal for an exposed root can set you back $120 while a residual tooth can fetch up to $185.
The costs of dental care without insurance coverage have led to the dental divide: Those who can afford dental care go to the dentist and have good dental health, and those who cannot afford dental care avoid seeing a dentist and thus have poor oral hygiene. But dental hygiene doesn’t have to break the bank, especially if you have insurance.
Tips for Buying Dental Insurance
There are a number of things to keep in mind when shopping for dental insurance. Here are five tips for every senior who is looking to insure their smile.
- Anticipate your dental needs. How often do you find yourself visiting the dentist? And when you do, what services are typically needed? Has your dentist warned you about any developing problems with your teeth? Are you taking any medications that may affect your oral health? Don’t just think of the services you need now, but think of the care you may need in the future.
- Determine your budget. How much can you set aside every month to pay premiums? And how much room do you have for out-of-pocket costs? Would a discount plan be better suited for your financial situation?
- Get quotes. It takes just a few minutes to request dental insurance quotes, and doing so can give you a great starting point in your quest to find the best dental insurance.
- Know the details. Read the details of each plan that appeals to you. Look for things like waiting periods, deductibles, prescription drug coverage and so on.
- Get coverage before you need it. Because of waiting periods and plans that may not cover pre-existing dental problems, it’s wise not to wait until you’re in pain to enroll in dental coverage.
As a bonus tip, ask questions. Research customer satisfaction ratings for various plans. Check with the Better Business Bureau. Talk to people you know about their dental insurance plans and what they do and don’t like.
Even better, call HealthMarkets at (800) 360-1402 and speak to one of our licensed agents. We’re happy to go over your dental insurance options with you and send you on your way to a happy, healthy smile you can afford.
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