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Anyone over the age of 65 is considered a senior, and although seniors comprise almost one-fifth of the U.S. population, they have the least access to affordable dental insurance. This statistic is projected to worsen since more than 10,000 Americans reach the age of 65 years every day. When they were employed, most obtained dental and medical insurance coverage through their employers. Once retired, however, they no longer had insurance coverage for themselves and their families. The result is that many seniors simply do without the dental treatments that they need, largely because they can’t afford the dental expenses. This can result in adverse medical conditions, since dental health and medical health are closely connected.
Even though seniors are largely uninsured, in 2016, they spent more than $28 billion on dental treatments and had the largest increase in dental spending of any demographic. The American Dental Association reports that in 2016, dentists saw 6 million more senior patients than in 2006, and this number is projected to increase due to the number of people who are turning 65. Despite the billions spent on dental treatments, the Kaiser Family Foundation reported that about half of all Medicare recipients stated that they hadn’t been to a dentist in more than a year. Those who had sought dental treatment reported spending more than $1,000 for out-of-pocket expenses. The high cost of dental procedures may be a major factor in seniors’ reluctance to seek treatment, as is evidenced by the following examples of the costs for routine 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.
Is Dental Insurance Available for Seniors?
When an individual reaches the age of 65, they’re automatically enrolled in Medicare Part A and have the option to enroll in Part B for a monthly premium. However, Part A doesn’t cover dental treatment unless a specific dental procedure is required before surgery. For example, Medicare may cover a basic examination if it’s required for a surgical clearance. This means that Medicare beneficiaries must seek alternative methods for obtaining dental coverage. About 25% enroll in a Medicare Advantage plan, and another 10% use private insurance companies that provide dental benefits. If you have questions about your dental benefits in Arlington, call our office and we’ll be glad to answer them.
Are Medicare Advantage Plans Worthwhile?
Medicare Advantage plans are optional insurance plans that expand the benefits for Medicare beneficiaries. They usually have low monthly premiums, reduced out-of-pocket costs, and low deductibles. However, the Advantage plans reimburse the dental provider directly and often include hearing, vision, and prescription drug costs. Under Medicare Part A, the provider must wait for the government to reimburse them, which can take months. Aetna, United Healthcare, and Humana are some of the most popular Advantage plan providers. Members will receive a Medicare Advantage ID card when they enroll, in addition to the Medicare ID card they received.
Dental benefits for Advantage plans are usually limited to an annual exam, cleaning, and standard x-rays. According to MedicareAdvantage.com, Advantage plan subscribers paid about $420 annually for their plan, which is about $35 monthly. Those who need more comprehensive dental coverage may need yet another plan to meet their needs. If you have questions on your Advantage plan or dental benefits in Arlington or need to schedule an appointment, call our Arlington office and we’ll be happy to help you.
Will a Standalone Dental Insurance Plan Meet My Needs?
A standalone dental insurance plan may help you complete your dental care needs. Standalone plans are offered in different price ranges and the number of covered procedures will increase as the premium increases. The following examples of standalone tiers can help you determine which will best suit your needs.
Usually, a basic plan will cover only exams, annual cleanings, and diagnostic x-rays.
A mid-range dental plan will usually cover emergency treatments, dentures, fillings, inhalation anesthesia, orthodontics, and standard and specialized x-rays. There may also be a discounted rate for services that aren’t covered.
Premium dental plans usually cover:
- Endodontic procedures
- Onlays and inlays
- Oral surgery
- Periodontal procedures
Most private insurance plans have 100-80-50 tiered coverage. This means that they’ll pay 100% of the cost of routine examinations, 80% of the cost for basic procedures such as fillings, and 50% of the cost for complex procedures such as crowns and dentures. You’ll be responsible for payment of the balance of each procedure, which can be costly, depending on the procedure you need. Keep in mind that standalone plans provide no benefits for vision or hearing or prescription drugs.
Will a Dental Discount Plan Replace My Insurance?
Dental discount plans aren’t insurance and won’t take the place of an insurance plan. When a dentist agrees to accept a discount dental plan, they agree to accept less for a procedure than they would normally charge. A discount dental plan is a membership plan rather than an insurance plan. Rather than monthly or annual premiums, the member pays an enrollment fee and a membership fee to the plan provider and then pays the dentist directly at the preset rate.
Discount plans are usually very affordable, and they have some advantages over insurance, such as:
- They have no copays, coinsurance payments or deductibles
- There are no waiting periods, you’ll receive full benefits immediately
- There are no annual limitations on appointments
- There are no tedious claim forms or paperwork to complete
- There are no restrictions on changing to another dentist
- There are no exclusions for age or pre-existing conditions
Discount plans may cover fewer procedures than traditional insurance plans, but they’re usually less expensive when it comes to out-of-pocket costs for the following procedures:
- Prophylactic procedures
- Root canals
Some discount plans such as DentRite offer options for hearing, prescription, and vision discounts, and for those whose overall health is good, then a dental discount plan may be an excellent option for you. However, for those who need more intensive dental procedures, a standalone plan may be a more cost-effective and prudent choice.
What’s the Best Way to Manage Out-of-pocket Dental Costs?
If you need dental procedures but don’t have cash on hand to pay for your part of the cost, then ask your dentist about flexible financing or payment options. CareCredit is one option that’s accepted by more than 200,000 providers throughout the nation. They have an application process and an approval process, so not everyone will qualify for financing.
Many senior organizations such as AMAC and AARP provide discounts for all types of goods and services including insurance, so be sure to check those organizations for additional discounts on your dental needs. If you have questions about dental benefits in Arlington, then call our office and we’ll be happy to help you.
If you need dental care in Arlington, the call Ballston Dental Arts at (703) 291-3111 and let us help you. We’ll make sure you receive the dental procedures that you need at a price that fits into your budget. If you need dental procedures, call us to schedule an appointment or if you need more information. We’re looking forward to helping you regain your good oral health.