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Finding affordable healthcare coverage – including dental benefits in Baltimore – can be challenging for many seniors. Adults over 65 often require dental services to improve their overall health, but they’re also the segment of the population with the least access to affordable dentistry. Once seniors leave the workforce and lose employer-based coverage, they often lose their dental insurance as well. Today, nearly two-thirds of seniors have no dental benefits, and with 10,000 people reaching age 65 daily, this number is likely to increase.
Despite the rising number of uninsured seniors, overall spending on dental services is still rising. In 2016, seniors spent over $28 billion on dental services, and they represent the highest growth rate in dentistry spending across all age groups. According to the American Dental Association Health Policy Institute, 6 million more seniors visited their dentist than in 2006. However, seniors are still facing challenges when it comes to seeing a dentist – nearly half of all seniors on Medicare did not see a dentist in the past year. Those who did see the dentist – about 19% — spent $1,000 themselves. The list below outlines some of the typical costs of dental procedures:
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.
What Options Do Seniors Have for Dental Insurance?
A nationally funded health insurance program in the United States, Medicare is available for seniors over 65 or anyone who is deemed permanently disabled. Every senior is automatically enrolled after reaching age 65, and they are given a red, white, and blue ID card to present when receiving medical services. Despite Medicare covering many medical procedures, it does not offer coverage for routine dentistry nor common procedures like crowns and root canals. There are exceptions, such as when a dental exam may be covered by Medicare Part A if it’s necessary to clear a patient for surgery.
With Medicare providing limited options for dental benefits in Baltimore, many seniors search for affordable alternatives. Ten percent of seniors turn to private insurance to manage dental expenses while 25% enroll in Medicare Advantage plans.
What Is a Medicare Advantage Plan?
Provided by private companies, Medicare Advantage supplements are optional plans that seniors can purchase to enhance the benefits offered by Medicare. When you choose an Advantage plan, you’ll be able to select a qualified provider from a larger network, and you’ll also receive some price protection through out-of-pocket spending limits, lower deductibles, and cost-sharing programs. With traditional Medicare, the government reimburses health care providers for services. However, any treatment covered by a Medicare Advantage plan is reimbursed directly by the insurance company.
In addition to dental benefits, Advantage plans may include vision care, prescription drug coverage and other services. Some of the most popular Advantage plan providers include Aetna, Humana, and UHC. When you enroll in a plan, the provider will give you an ID card similar to a typical health insurance card. Medicare Advantage plans are usually quite affordable for seniors, with low premium costs. Last year, the average cost of an Advantage plan was about $420 annually. Keep in mind, however, that most of the dental benefits are limited to preventive care like oral examinations and cleanings. More extensive dental work such as surgeries and restorations may not be covered, making a standalone insurance plan an option to consider.
Do I Need a Standalone Dental Plan?
Seniors desiring more comprehensive dental benefits in Baltimore may wish to enroll in a standalone dental plan. These are also provided by insurance companies, who offer different levels at different prices. Your premiums as well as any copay or coinsurance costs will depend on what level of coverage you choose. The following are a few examples of the types of plans offered:
Basic Plans: Most basic plans offer coverage for preventive care, including professional cleanings, X-rays, dental exams, and other diagnostic treatment.
Mid-Level Plans: A mid-level plan provides more enhanced coverage, such as braces and orthodontic treatment, emergency dental care, specialized X-ray screening, nitrous oxide, and restorations like dentures and fillings.
Premium Plans: The highest level of coverage, a premium plan offers partial to full coverage for advanced dental treatment, including surgeries and more complicated restorations. A premium plan is ideal if you require extensive dental work. Some of the services covered under premium plans include:
- Dental inlays and onlays
- Tooth crowns
- Endodontic care
- Oral surgeries
- Periodontal treatment
Private dental benefits often use a “100-80-50” tiered system for coverage, meaning that most routine services are covered at 100%, basic procedures receive 80% coverage, and more extensive procedures receive 50% coverage. Recent research from Bankrate revealed the average annual cost of a private dental plan is about $350. While this may be slightly lower in cost than an Medicare supplement, private plans usually do not offer additional vision, hearing, or medication benefits.
Can I Use a Dental Discount Plan Instead of Standalone Dental Insurance?
Dental discount plans are provided by private companies much like standalone plans, but it’s important to note that they are not insurance. Instead of charging regular premiums, discount plans involve a monthly membership fee and an enrollment fee upon signup. Discount plan providers negotiate lower rates with dental care providers and pass the savings on to members. With a discount plan, you’ll pay the dentist directly at the time of service.
Seniors hoping to save money on dental services may wish to consider a discount plan, which offers several advantages over standalone dental insurance:
- No coinsurance obligations, copays, or deductibles to pay.
- You won’t have to wait before receiving care.
- There are no limits on how frequently you can see a dentist.
- You can switch dentists at any time.
- There are no cumbersome claim forms or paperwork to fill out.
- Discount plans typically do not have age limits or exclusions for preexisting health conditions.
Discount plans generally do not cover as much as a traditional insurance plan, but they can make routine services more affordable. Some of the discounted services include:
- Routine dental exams and cleanings
- X-ray diagnostics
- Tooth extractions
- Dental crowns
- Root canal therapy
- Tooth fillings
- Dental crowns
Many popular discount plans, including those from DentRite®, also offer discounts at eye centers, hearing aid suppliers, and more. If you are in generally good dental health and will only need regular checkups and cleanings, a discount plan could be a good option for you. However, a traditional insurance plan may be a better option if you have ongoing dental needs.
What Options Are There for Managing Out-of-pocket Dental Costs?
When budget is a concern, financing options and flexible payment agreements can make dental costs more manageable. One option is financing via CareCredit, which is available at more than 200,000 providers nationwide. These payment agreements often come with interest-free, short-term financing if the balance is paid off during a promotional period, and long-term financing up to 60 months for larger purchases. While payment plans can help make dental services more affordable, they do have some disadvantages, including:
- An application and approval process – as with any line of credit, not everyone will qualify for financing.
- Many payment plans have interest rates between 15-20%, increasing the overall treatment cost.
If you have questions about Medicare, supplement plans, discount options or other ways seniors can receive affordable dentistry, we recommend speaking with the AARP or your local senior organizations. These valuable resources can help you navigate the Medicare and insurance process.