If you’re a Medicare beneficiary, you’ve likely got your health insurance covered. But what about your teeth?
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Many seniors assume dental insurance is health insurance for your teeth. While dental insurance does share some similarities with health insurance, there are some major differences between the two that you should understand.
Like health insurance hospital coverage, dental insurance does cover emergencies, such as breaking a tooth or getting an infection. Also, like medical coverage, most dental plans cover preventive care.
The big difference between health insurance and dental insurance is how much coverage the policies provide, and how that coverage works.
The dental insurance coverage you receive will depend on your individual plan, but dental plans generally cover the following care:
Some plans are more comprehensive, also covering care such as:
Dental disease doesn’t only affect your teeth. Tooth loss and dentures can affect your nutrition intake, limiting the types of foods you’re comfortable eating. Gum disease can also increase your risk of stroke, heart attack and diabetes, and it is also linked with dementia. Plus, dentists play an important role in the early detection of oral cancer. Proper dental care plays a huge role in your overall health, and your dental needs will only increase with age.
Seniors — or retirement-age adults — often lose their employer-provided dental insurance at a time when their dental needs and costs are increasing. Consider these statistics from the Centers for Disease Control and Prevention (CDC):
At the same time, more than half of seniors (53%) say they’ve had to delay dental care due to the high cost, and 23% of Medicare enrollees say they’ve delayed or gone without dental care, according to statistics from the Kaiser Family Foundation.
Overall, the need for senior dental care is clear, but what about dental insurance?
Dental insurance can be a valuable tool to protect you from the high cost of dental care. Like any insurance, deciding whether it’s worth the cost or not depends on your specific needs.
If you only need twice yearly cleanings and X-rays, you’d probably spend more on an insurance premium than you would if you paid out of pocket. But most seniors are likely to need more care than that, making dental insurance a viable way to help offset those costs. For example, 19% of Medicare beneficiaries spend over $1,000 a year on dental care (for those that actually receive care at all).
No. However, there are some exceptions:
So, if you have Original Medicare (Parts A and B), most regular dental care will not be covered. However, if you have a Medicare Advantage plan (Part C), there’s a good chance that your plan includes dental benefits. As of 2020, 88% of Medicare Advantage plans offer some type of dental coverage, according to the Kaiser Family Foundation.
f you’re searching for a stand-alone dental insurance plan, you’ll run into many of the same types of plans that pertain to health insurance. There are many different types of dental benefit plans on the market today. Some of the most popular plan types include:
This type of plan features a network of dentists who have agreed to provide their services for a set fee. Seeing these in-network dentists may save you money. Out-of-network dentists could charge different fees (higher or lower), so you’ll have to do your research.
This dental plan pays in-network dentists a set fee per patient, per month. The dentists provide services to patients at low or no cost. Because the plan doesn’t reimburse patients for individual services, patients must stay in-network to use their benefits.
If you have this type of plan, you can see any dentist. You’d typically pay the dentist directly, submit a receipt to your plan, and the plan will reimburse you for a percentage of the cost.
These plans technically aren’t dental insurance plans, but they’ve become quite popular. The plan contracts with dentists who agree to reduce their fees. The patient pays participating dentists directly, using the discount. There’s no need to file a claim.
This plan pays a set amount for each type of dental service. The patient is responsible for paying the difference between that amount and what the dentist actually charges.
Dental plans require you to pay many of the same out-of-pocket costs as regular health insurance, including a monthly premium, a deductible, copays and coinsurance.
The coinsurance you pay will likely be more than you’re used to paying. For example, Medicare beneficiaries are typically responsible for 20% coinsurance, but it’s not unusual for dental plans to require 40% coinsurance or higher.
Another important factor to consider is that dental insurance plans often have a cap (a maximum annual benefit), and it’s usually very low (typically between $1,000 and $3,000). After you meet the maximum, you’ll pay for 100% of the cost of your care.
For years when preventive care and a filling or two are the only services you need, that works just fine. But if you need more than very basic dental work, you will quickly exceed that benefit. For example, the cost of a root canal and crown together can be upward of $3,000.
There are plans that have no annual limit, but be aware that even dental insurance that bills itself as “comprehensive” or “full coverage” almost certainly will not cover 100% of the cost of your dental care.
To get a feel for the types of dental coverage you can get at a particular cost, take a look at these popular dental plans:
Diagnostic/
preventive
Coinsurance:
Basic services
Coinsurance:
Major services
Note: Some plans require an annual commitment, which means that even if you don’t like the plan, you still have to commit to paying 12 months of premiums.
Dental care is expensive, whether you have insurance or not. A dental insurance plan can help you reduce those costs. It is important that you research plans you are considering carefully. If you already see a dentist you like, they may be able to recommend a plan to you based on your history and future anticipated dental needs.
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