Medicare Advantage Dental Benefits in [GEOID]

Seniors over the age of 65 are perhaps the segment of the population most in need of dental care, yet they also have the least access to affordable dental services because of a lack of insurance coverage. Since most Americans receive their dental insurance through employer-sponsored plans, seniors are forced to look for other options once they leave the workforce. Unfortunately, approximately 65% of seniors end up going without dental coverage, and the percentage is only going to increase since more than 10,000 Americans turn 65 every day.

Despite a lack of insurance options, seniors spent more than $28 billion on dental services in 2016 and had the highest growth rate in dental spending of any segment of the population. According to the American Dental Association Health Policy Institute, 6 million more seniors visited a dentist in 2016 than in 2006, and the growth is expected to continue. Despite the growth in dental spending among seniors, a study by the Kaiser Family Foundation found that nearly half of all Medicare recipients had not visited a dentist in the past year and that 19% of those who did visit a dentist spent more than $1,000 out of pocket. The following are examples of typical costs for common dental procedures:

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What Options Do Seniors Have for Dental Insurance?

Adults over the age of 65 or who are permanently disabled receive health care coverage through Medicare. All seniors are automatically enrolled in traditional Medicare when they turn 65. Traditional Medicare comes with the familiar red, white, and blue ID card and does not provide benefits for routine dental care, such as cleanings, extractions, and fillings. Under certain circumstances, dental services may be covered under Part A hospital benefits if they are necessary as part of another covered procedure. For example, Medicare may cover a basic oral examination if needed for presurgical clearance. This leaves Medicare beneficiaries looking for alternative ways of paying for dental expenses. Approximately 10% of seniors turn to private insurers for dental benefits. Another 25% enroll in a Medicare Advantage plan.

How Do Medicare Advantage Plans Work?

Medicare Advantage supplements are optional plans that you can purchase that expand on the benefits offered by traditional Medicare. Medicare Advantage plans provide you with access to a network of qualified providers while offering some price protection in the form of out-of-pocket spending limits, low deductibles, and cost-sharing measures. Unlike traditional Medicare in which the government reimburses health care providers, benefits offered under Medicare Advantage plans are reimbursed directly by the insurer. These plans are offered by private insurance companies and often include dental benefits as well as vision and prescription drug coverage. Humana, Aetna, and UHC are among the most popular providers of Medicare Advantage plans. If you enroll in a Medicare Advantage plan, you will likely receive a separate ID card from your insurer. Medicare Advantage plans typically come with low premiums, so they are affordable for many seniors; however, the dental benefits are normally limited to basic exams, cleanings, and standard X-rays. According to MedicareAdvantage.com, the average premium for a Medicare Advantage plan in 2018 was approximately $420 per year.

Should I Consider Standalone Dental Insurance?

If you want more comprehensive dental coverage, you may want to consider purchasing a standalone dental plan. Most insurance companies offer several levels of coverage at different price points. Premiums, as well as the percentage of cost covered and the types of services included, vary based on the type of plan chosen.

Basic Plans:

Most basic plans cover oral evaluations, cleanings and other prophylactic services, and diagnostic X-rays.

Mid-level Plans:

Mid-level plans normally offer expanded services, such as orthodontics, emergency treatment, panoramic and other specialized X-rays, inhalation anesthesia, dentures, and fillings.

Premium Plans:

Premium plans offer at least partial coverage for advanced dental procedures and are ideal for individuals with significant dental care needs. Examples of services offered in premium plans include:

• inlays and onlays
• crowns
• endodontic procedures
• oral surgery
• complete and partial dentures, and
• periodontic procedures

Most private dental insurance plans offer “100-80-50” tiered coverage. This means that routine exams are covered at 100%, fillings and other basic procedures at 80%, and complicated procedures, such as crowns, at 50%. According to Bankrate, the average cost of a private dental plan is approximately $350 per year. While this may be somewhat lower than the cost associated with a Medicare Advantage plan, you do not have the additional vision, hearing, and prescription drug benefits.

Are Dental Discount Plans a Good Alternative to Insurance?

Dental discount plans are sold by private companies; however, they are not insurance. Dentists that accept dental discount plans agree to accept discounted rates for basic services. Instead of an annual or monthly premium, the patient pays an enrollment fee and a small monthly membership fee to the plan provider and pays the dentist directly for the service at a pre-negotiated discounted rate.

Dental discount plans tend to be very affordable and offer some advantages over insurance:

• There are no deductibles, coinsurance obligations, or copays
• There are no waiting periods before receiving full benefits
• There are no limits on the number of office visits per year
• You can change your dentist at any time
• You don’t have to spend time filling out claim forms or paperwork
• Unlike private insurance plans, most dental discount plans do not have age limits or exclusions for pre-existing conditions

While discount plans may not cover quite as much as traditional insurance, they do substantially lower the cost of common services, such as:

• checkups
• cleanings
• X-rays
• extractions
• crowns
• root canals
• fillings, and
• dentures

DentRite and other popular discount plans also include discounts for vision and hearing services as well as prescriptions. A discount plan may be a viable option if you are in good oral health and only require basic cleanings and maintenance. If you require extensive dental work, however, a standalone dental insurance plan may save you money in the long run.

Are There Options for Managing Out-of-Pocket Dental Expenses?

Many dental providers offer flexible payment options and financing options. One popular financing option is CareCredit, which is accepted by more than 200,000 health and wellness providers across the country. Medical credit companies typically offer short-term financing of up to 24 months with no interest if the balance is paid in full by the end of the promotional period as well as long-term financing of up to 60 months for larger expenses. Of course, financing comes with some drawbacks:

• Like any other form of credit, there is an application and approval process, so not everyone qualifies
• Interest rates can run anywhere from 15% to more than 20%, which adds significantly to the overall cost of care

AARP and other senior organizations are also a valuable resource for information regarding discounts on everything from professional services to various types of insurance.

If you are looking for a dentist office in [GEOID] that takes Medicare Advantage contact us today.

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