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More than 16 percent of Americans are 65 years or older, but they’re the demographic with the least access to adequate dental care despite being those who need it the most. Most Americans are insured through their employer, but when they retire, they must either self-insure or obtain insurance on their own through private insurance. This can be expensive, so many seniors go without insurance due to financial constraints. Since more than 10,000 Americans turn 65 years old every day, the number of seniors without insurance is going to increase dramatically over the next few decades.
Even though they were uninsured or under-insured, seniors spent more than $28 billion in 2016 for dental services for seniors. In the last decade, there was an increase of 6 million seniors who sought dental care even though they didn’t have insurance, and that trend is expected to continue. A study by the Kaiser Foundation concluded that almost half of all Medicare recipients hadn’t been to the dentist in the preceding year, and of those who had, almost 20% incurred more than $1,000 in out-of-pocket costs. The following examples of common dental costs can explain these statistics:
Checkups and Cleanings:
- Basic exam–$50 to $100
- Dental X-ray–$20 to $250
- Standard cleaning–$70 to $200
- Silver amalgam–$50 to $300
- Composite–$90 to $450
- Simple extraction–$75 to $450
- Surgical extraction–$150 to $650
- Wisdom tooth extraction–$75 to $3,000 based on the number and complexity of the extractions
The cost of a crown can range from $500 to $3,000 based on the type of material used.
The cost of a root canal can range from $300 to $2,000 based on the location of the tooth and the complexity of the procedure. If you need more information on dental benefits in Orlando, then call our office and we can help you.
Do Seniors Have Options for Dental Insurance?
Once an individual reaches the age of 65, they’re automatically enrolled in traditional Medicare. Those who are disabled, regardless of their age, are also enrolled in Medicare. Typically, Medicare doesn’t provide for dental procedures unless they’re an adjunct to a surgical procedure, in which case they’re covered under Part A for hospital benefits. However, routine dental procedures that are necessary for good health, such as fillings, extractions, and dental cleanings aren’t covered, so seniors must seek private insurance companies for their dental needs. Approximately 10% of seniors pay out-of-pocket for their dental plan insurance, and approximately 25% enroll in a Medicare Advantage plan.
How Does a Medicare Advantage Plan Work?
Medicare Advantage plans are supplemental insurance plans that provide the coverages that traditional Medicare doesn’t. They’re optional, but they can be cost-effective for many people and unlike traditional Medicare, the healthcare provider is reimbursed directly by the insurance company rather than by the government. Advantage plans often provide for dental, vision, and prescription drugs as well as traditional healthcare. Aetna, Humana, and UHC are popular Advantage providers and if you enroll in one of their plans, you’ll receive an identification card that’s separate from your red, white, and blue traditional Medicare card.
Although they try to keep their premiums at a low cost, an Advantage plan has a separate premium for which you’ll be liable. Dental benefits, however, are usually limited to a basic exam, tooth cleaning, and standard X-rays.
Should I Purchase an Independent Dental Plan?
If you want more dental coverage than your Advantage plan provides, then it might be more cost-effective to purchase an individual dental policy. Most plan providers offer a variety of plans at varying price points, so you should be able to purchase a plan that will fit both your needs and your budget. The following are some examples of standalone dental insurance plans.
Usually, a basic plan will cover exams, annual cleanings and diagnostic x-rays.
A mid-range dental plan will usually cover emergency treatment, orthodontics, standard and specialized x-rays, dentures, fillings, and inhalation anesthesia. There may also be a discounted rate for services that aren’t covered.
Premium dental plans usually cover:
- Endodontic procedures
- Inlays and onlays
- Oral surgery
- Periodontal procedures
Most private insurance providers stipulate 100-80-50 tiered coverage, which translates to 100% coverage for routine exams, 80% coverage for basic procedures such as fillings, and 50% for complex procedures such as crowns and dentures. Although your private plan will likely cost less than an Advantage plan, there are no benefits for vision or hearing or prescription drugs.
Is a Dental Discount Plan Better Than an Insurance Plan?
A discount dental plan is different than a dental insurance plan. When a dentist agrees to accept insurance, they’re being reimbursed for the regular price of their services, whereas with a discount plan, they agree to accept a reduced rate for their services. Both discount plans and insurance plans usually require either an annual or a monthly payment or membership fee, but with an insurance plan, the provider pays the dentist. With a discount plan, the patient pays the dentist directly albeit at a reduced rate.
Additional benefits of a dental discount plan include:
- No deductibles, copays or coinsurance payments
- No waiting periods, full benefits begin immediately
- No annual limitations on office visits
- No claim forms or paperwork
- No restrictions on changing dentists
- No pre-existing conditions or age limit exclusions
Although dental discount plans may provide less coverage than traditional insurance plans, they can lower the out-of-pocket costs for common procedures such as:
- Prophylactic procedures
- Root canals
Some discounts plans offer additional options for hearing, prescription, and vision discounts. For those who have overall good health and don’t require extensive and expensive dental procedures, then a dental discount plan may be the prudent choice. However, if you anticipate the need for extensive or expensive dental work, then a standalone dental insurance plan may be more advisable and more cost-effective over time. If you’d like help in determining your dental benefits in Orlando, then call our office and we’ll be happy to help you.
What Are My Options for Managing My Out-of-pocket Expenses?
Even with an insurance plan and a dental discount plan, dental expenses can be substantial. Many dentists offer flexible financing options to their patients, and CareCredit, which is accepted at more than 200,000 nationwide providers, can enable you to manage your out-of-pocket expenses more easily. Medical credit companies are now available that offer same-as-cash financing for up to 24 months if the balance is paid in full before the promotion period. Some offer interest-paid financing for up to 60 months for more costly procedures, and all are contingent on approved credit. However, dental financing has some caveats:
- Not everyone will qualify when they complete an application
- Interest rates are usually 15% to 20%, so the final cost can be substantially higher than the initial cost of the procedure.
Keep in mind that AMAC and AARP provide senior discounts as do other organizations such as AAA, so if you need a discount dental plan or an insurance plan, then do an internet search for senior discounts for these types of services.
If you’d like to learn more about Medicare Advantage or your dental benefits in Orlando, then call Orange Avenue Dentistry at (407) 278-5356 and we’ll be happy to answer all of your questions.