It is a far too common situation. You enroll in Medicare and have your medical and health needs covered. You feel good. Finally, you made a decision about Medicare. What about dental coverage? Your teeth matter, right? We all know when our teeth and gums hurt, everything hurts! Yet, Medicare and nearly all Medicare Advantage and supplement plans do not cover dental needs. If they do, coverage is usually limited to preventative care only. What will you do about fillings, bridges, and crowns? Luckily, we at My Family Life Insurance have many coverage solutions when it comes to dental needs. In this article, we discuss senior dental insurance, plan types, what to look for with affordable dental insurance, and the best dental insurance for seniors on Medicare.
A carrier recently told us that many seniors expect to carry over their dental insurance coverage from their employer. Yet, that rarely happens. What does happen is that about 90% of seniors on Medicare don’t have proper dental insurance coverage (American Dental Association). After filling out the Medicare paperwork, most seniors put dental insurance on the back burner. (And vision and hearing, too…we’ll get to those later.) And, why not? Your teeth are not hurting yet and they feel pretty good.
As time passes, many seniors leave dental coverage (and vision and hearing) behind. Then, when they need it, it is too late. Waiting can be devastating in some cases as many insurances have waiting periods for certain services. For example, a routine filling for a cavity typically requires a 6-month wait. If you can’t wait that long, you will have to pay the cost in full.
How Does Dental Insurance For Seniors Work?
Many seniors don’t know how dental insurance works. Individual dental insurance works just like employer-sponsored (i.e. group) dental insurance. Here are the characteristics of dental insurance for seniors.
Premium – how much you pay
Waiting Period – usually, preventative services are covered at day 1, basic services (fillings, for example) at 6 months, and major services (bridges & crowns) at 12 months
Annual Benefit – how much the plan will pay each year
Deductible – the amount you need to pay first, excludes preventative costs usually
UCR – means Usual, Customary, and Reasonable. This pertains to how dentists in your area charge for a certain procedure. The insurance company looks at the UCR fees in your area and bases their cost sharing or reimbursement off this fee. UCR is usually with out-of-network coverage and with indemnity plans
In-Network / Out-Of-Network – you should be familiar with this as likely your health insurance had in and out-of-network coverage. Same with dentist coverage
UCR cost-sharing really confuses people. We at My Family Life Insurance call it a “black hole”. Maybe that is unfair. However, most insurance companies don’t share their UCR computations. You typically find out the UCR fee when receiving your EOB (explanation of benefits) and your out-of-pocket costs.
Next, we show a simple example of how UCR fees work.
Example of In And Out Of Network And UCR Fees
You’ll want to go to an in-network dentist as they usually have better, contracted rates. We’ll show an example of that in a minute. Cleaning or preventative care visits are typically covered at 100%. Basic or major services visits are typically covered at 80% and 50%, respectively. What does this mean? If you go to an in-network dentist for a tooth filling (80%) whose contracted rate is $200, you’ll have to pay $40 out of pocket ($200 X (1 – .80)). That sounds very good, right?
If you go to an out-of-network dentist, then the plan usually pays based on the UCR fee. For example, if the dentist charges $250 for the filling, but the UCR in your area is $150, you could end up paying more. In this case, $130 ($250 – $150 X (.80)). The insurance cost sharing is based on the UCR fee. In this case, the insurance carrier pays $120 ($150 X .80). This also introduces the concept of balanced billing, which means paying the dentist the cost difference between their rate ($250 in this case) and the cost-sharing rate ($120).
This is why, most times, it is more advantageous to go to an in-network dentist.
Types Of Dental Insurance For Seniors
There are really three types of dental coverage. They have many similar attributes, yet differences which we describe throughout this article.
The three types include:
(1) traditional dental insurance with in and out-of-network coverages, cost sharing, deductible, and copays. Traditional insurance can either be an in-network plan or both in and out-of-network (PPO)
(2) indemnity insurance plans which will pay a benefit directly to you or the dentist. It doesn’t usually matter which dentist you go to
(3) discount dental plans which you pay out-of-pocket costs at a discount off the dentist’s rate, per a contracted fee schedule
We touch base on all of these coverage types throughout the article.
How To Find An Affordable Dental Insurance Plan
If you are coming off of group coverage, and you like your dentist, you will want to ask what plans he or she accepts. Otherwise, you have the freedom to choose any plan.
In either case, in our opinion, the purchase of dental insurance can be hard if you don’t do your homework. Why? The premiums aren’t in favor of the benefit. For example, if you are paying $100 per month for dental insurance which has an annual benefit of $1,000, that really isn’t in your best interest. You are paying $1,200 annually for a $1,000 benefit. In this case, it is better to simply negotiate a discount with the dentist or utilize a dental discount plan where appropriate (more on that below).
However, you can obtain affordable dental insurance. You just need to understand how to go about doing so. We discuss that next.
Affordable Dental Insurance For Seniors – Pick Your Dentist
If you read our article on discount dental plans, you may think we are 100% against dental insurance. We are not. We simply know seniors can get sucked into paying high premiums with equally high out-of-pocket costs with no major insurance advantage. But, affordable dental insurance for seniors is possible that balances the right premiums, out-of-pocket costs, and coverage.
There are a couple of ways to go about this. If you like your dentist or if that doesn’t matter to you.
If you like your dentist, you’ll want to find out from the office staff which insurances they accept. Don’t ask them what insurances they like – they could like an insurance that pays them a nice benefit but has high premiums to you – just ask what they accept. With that list, start your research. We discuss that next.
If you don’t like your dentist or the dentist doesn’t matter to you, then you’ll want to contact someone like My Family Life Insurance that can search for plans in your area.
Affordable Dental Insurance For Seniors – Research
The next step is to find dental insurance that fits your needs and budget. The dental insurance you choose will depend on the following:
(1) premiums – how much it costs
(2) deductible – is there a deductible? If so, is it applies to basic and/or major services only? Or, does it include preventative care? All things being equal, you want no deductibles or only a deductible on basic and/or major services. Of course, you need to consider your premium, too
(3) waiting periods – preventative care usually has day 1 coverage. Basic and major services usually have waiting periods of 6 months and 1 year, respectively. Obviously and ideally a plan with no waiting period would be great, but generally comes at a higher cost
(4) insurance cost-sharing – preventative care usually pays 100% of the cost. However, basic services might pay 80% of the cost, and major might pay 50%. Many plans start cost sharing low and then increase sharing each year the longer you stay with the plan. We describe one below
(5) annual benefit – the most the insurance will pay for its share annually, usually $1,000 but many plans now offer $1,500 or more.
(6) in-network / PPO or indemnity plans – if you have an in-network dentist, you will pay a lower cost share than someone who goes to an out-of-network dentist. Most insurances nowadays allow you to pick either, and they operate like a PPO. There are many indemnity plans now which will pay the benefit directly to you
That is really it. Simple, isn’t it? Unfortunately, it sounds easy, but we know it is not. You really need to find that balance among premiums, out-of-pocket costs, coverage, and benefits.
Luckily, we have done that for you already. However, before we do that, first we wanted to briefly discuss another type of dental coverage, discount dental plans.
What Are Discount Dental Plans?
There is another type of dental coverage that is available. These are discount dental plans. If you read our article on discount dental plans, then you know we tend to favor them. The reason why is that the balance between premiums and out of pocket costs just seems right. Here are discount dental plans in more detail.
These are not insurance. They are discount plans. Just like a Costco membership, these plans allow you to receive a discount on services from participating dentists. Here are the characteristics of a dental discount plan.
(1) relatively low premiums – usually cost $8 to $15 dollars per month depending on the plan and additional services.
(2) fee schedule – one of the advantages, we feel, is that you will pay for services per a predetermined and contracted fee schedule. Need a filling, you may pay $150. A crown might cost $900. The fee schedule is based on the ADA dental codes
(3) preventative services – unlike traditional dental insurance, you need to pay for preventative services
(4) no waiting periods – if you need a crown, you can get it done the next day. It is day 1 coverage
(5) you need to confirm the network – if there is a plan you like, you will need to confirm the dentist is in your network.
Does this sound good? Maybe. You’ll pay for everything…at a discount. How does this compare to traditional dental insurance for seniors? Well, in our opinion, you may end up paying the same or less, generally speaking. While you have to pay for preventative care, it is at a discount. Compare with dental insurance, which the preventative care is free but you generally pay a higher monthly premium.
Best Dental Insurance For Seniors On Medicare
Traditional Dental Insurance
If you have a dentist you like, we can find you an affordable plan. Going to an in-network dentist saves you a considerable amount of money. We recommend this where needed. In fact, going to an in-network dentist is really the only way traditional dental insurance makes sense. As a senior, you are likely on a fixed income. It is important that seniors select the dental insurance that meets their needs and budget.
An independent agency, like My Family Life Insurance, can help seniors find the right dental insurance plan. We aren’t beholden to one or two carriers. We represent you and your best interests.
What if your dentist does not take insurance or the insurance does not matter? There are a couple of plans we like. We describe them below.
The first plan we like is an indemnity plan. Remember, indemnity plans pay directly to you (or the provider, but we recommend to you).
Because this is an indemnity plan, you will pay for everything out of pocket first. Is this a bad thing? Maybe not as we explain below.
First, people age up to 85 can apply. It is guaranteed issue – so no underwriting or pre-existing exclusions.
You can select an annual benefit of either $1,000 or $1,500. Think of it as a pot of money that gets used throughout the year and then filled up again every January 1.
The plan pays based on the UCR fee in your area per the percentages below:
Since this plan bases reimbursement on UCR fees, you will pay less if your dentist charges less than the UCR fee in your area. For example, if the dentist charges $200 for cleanings and x-rays, and the UCR fee is $150, you will be reimbursed $90 for a net cost of $110. However, if the dentist charges $100, your net cost is $10. See how that works?
Since this is an indemnity plan, you can use other insurances or coverage. A dental discount plan can work well here. Using the above example, if the dentist routinely charges $200 for cleaning, but per the discount plan contract, charges you $100, you will have a net cost of $10. Remember, most discount dental plans charge between $8 and $15 per month depending on other features.
For a 65-year-old person entering Medicare, the indemnity plan starts at around $35 and $45 per month for the $1,000 annual benefit and the $1,500 annual benefit, respectively.
If that doesn’t seem worth the squeeze, consider this plan also allows vision and hearing benefit as well. You would draw from the same annual benefit and use a discount card the same way. Reimbursements are as follows:
How great is that? You have dental, vision, and hearing coverage all into one!
And, we didn’t mention before. There are low waiting periods for the coverage compared to other types of dental insurance.
The disadvantage: this plan is offered in most states, but is not offered in every state.
Traditional Dental Insurance For Seniors
If the indemnity plan doesn’t work for you, we work with many plans that are available in all 50 states. Premiums vary by the state.
One plan in particular has over 450,000 dentists in its network.
You can go to any dentist, but if you use an in-network dentist rather than an out-of-network, your out-of-pocket costs are based on negotiated insurance rates rather than UCR fees.
The carrier offers two plans. A basic plan and a more rich plan. The basic plan has an annual benefit of $1,000 while the richer plan has a benefit of $2,000. Some states allow a network option within the basic plan in which you must go to an in-network dentist.
The carrier covers preventative care at 100% with day 1 coverage for both plans. The basic plan incorporates both basic and major services into one group, with coverage at 15% day 1 and 50% after 1 year and no orthodontia covered. The richer plan is as follows:
As mentioned, you can go to any dentist. You will pay less if you use an in-network dentist. We gave examples of UCR and in-network rates before.
As we mentioned, premiums vary by state. The rates start in the mid $30s. Rates for the in-network plan, where available, start in the mid $20s.
The plan also has a vision insurance component for an extra fee. You can choose from two vision insurance providers based on your needs and budget.
Other Types Of Dental Insurance For Seniors
If the indemnity plan or the traditional dental insurance plan do not work for you, we work with several other carriers that can fit your needs and budget. We also use discount dental plans where they make sense.
How To Enroll
It is easy to enroll. Enrollment takes place online through a secured application process. The benefit of online enrollment is that there is no need to meet face-to-face, thus saving you time and money.
We hoped you learned more about dental insurance for seniors. You have many affordable options. Need assistance or want to learn more? Feel free to contact us or use the form below. We would be happy to help you find an affordable insurance plan for you. Remember, we work in your best interests only. This is the only way we know how to work with our clients. If there is a better plan available that we can’t offer you, we would be happy to help you obtain or recommend that plan to you.