Dental Insurance for Seniors

Dental insurance is not covered by Medicare but a few crowns and a root canal can be a $5,000 out of pocket expense. Dental insurance might help you cover some of those expenses. But is it worth the premiums? Find out.

Dental insurance or dental plans for seniors is nothing more than a marketing term. The same plan you can buy when you are 40 you can still purchase when you are 80. There are no special discounts and no special features.

Now that we got that out of the way you are ready to learn a little bit about dental insurance. Just enough to be able to make an informed decision on what you might want or need.

You might already know these facts, but I will repeat them anyway.

  1. Medicare does not cover dental bills. The exception would be if you were in an accident and needed reconstructive surgery that included your teeth. But cleanings, fillings, root canal, crowns, etc. are not covered by traditional Medicare.
  2. Medicare supplements do not cover dental except as previously mentioned.
  3. Medicare advantage plans sometimes have a very limited dental plan. The plans suck. I do not know any other way to say it. Sorry.
  4. Unless you have serious health problems dental expenses can dwarf other medical costs and put a real dent in your retirement savings.
  5. Poor dental hygiene can lead to several serious medical issues. You cannot wait for a toothache to see a dentist.

I am going to really try and not get you caught up in a lot of insurance jargon. If I need to use an insurance term I will explain it carefully first.

The first thing you need to know is that there are Dental Plans and Dental Insurance. They are not the same thing.

Dental Plans

Dental plans are essentially discount plans.

There is a network of dentists that participate in the plan. When you go to see them, they will discount their services according to a schedule of discounts that they have agreed upon with the dental plan network.

Sometimes these discounts can offer you significant savings. More than enough to warrant the plan’s relatively low cost.

There are hybrid plans where major work is discounted and basic work like cleanings and fillings are covered by a copay of $20 or so.

The important thing to understand is that with a discount plan you MUST use a dentist that is part of the network. If you do find a network dentist you like, these are great plans.

Fortunately, there are a lot of dental plans to choose from. There is some overlap with their networks but some well known companies offer dental plans like CIGNA and Aetna as well as others.

The unfortunate part is that more and more dentists do not take any insurance at all. They will tell you something along the lines of “but any PPO plan and we will accept it”.

What that means is that if you have PPO dental insurance they will submit a claim for you. They will not discount according to the PPO network and you will have to pay them up-front while you wait to get paid.

For example, if a crown costs $800 with a network dentist and $1400 with your dentist, and the plan pays 50%, you will get reimbursed $400 not $700.

But there are some good reasons to get a PPO plan and we will discuss them next.

PPO Dental Insurance Plans

A true PPO dental insurance plan works like this:

You pick a dentist within the PPO network. By doing so you are entitled to the discounted rate that the dentist will charge all members of the network. They are contractually obligated to do so.

Your plan might have a deductible which must be met before the plan starts to pay anything. Generally, the deductibles are dental insurance run between $50 and $150 per person.

After the deductible the plan will pay a percentage of the bill. Preventative work is usually paid at 100%. Basic work like a filling is often paid at 80% and major work like crowns or root canals at 50%. These vary from plan to plan.

The catch is that major work, the expenses that you were hoping to get help on, are often not covered for the first 12 months on the plan. There are some plans that will cover major work immediately but at a much-reduced rate such as 10% to 20% of the cost.

Should I But a Dental Plan or PPO Dental Insurance?

I can have you read twenty pages of information on dental coverage, but you might be no further along in making a decision. You need some help. Okay, I will give you my two-cents on which plan is better.

If you can find a dentist that you really like in a Dental Plan it might be a good choice. However, even with a good dentist it might also depend on how much work you need done.

Some of us can look at a candy bar and feel the holes forming in our teeth. The dentist is putting his children through college on your crowns, root canals and implants. So, if you want real coverage that will not only reduce the bill but pay for some of the cost of the work, then this might not be the best choice.

I have group dental at this time but in the past I had a Dental Plan for many years. It was inexpensive, I had a great dentist and the discounts were substantial. Plus, I did not blow my retirement fund on dental bills. I go to the dentist for every 3 or 4 months to avoid the big bills.

You really need to look at the plans and decide. Of course you can call me with questions or for my general dental insurance wisdom.

Use the following links. They will take you to dedicated web pages for each of the plans. You can apply directly online since nobody has paper applications anymore.

For Dental Plans try Clicking one of these links:

 

A Great PPO with a 12 Month Wait for Major Work.