Learn About Dental Plans for Seniors
- Why Buy a Dental Plan or Dental Insurance?
- What's the Best Dental Plan for Seniors?
- PPO Dental Plans: Good Coverage at a Premium Price
- HMO Dental Plans: Affordability with Limited Flexibility
- Dental Indemnity: Traditional Dental Coverage
- Dental Savings Plan: Not Insurance, Discount Dental Care!
Shop & Compare Dental Insurance in Your State
Medicare Does Not Cover Dental… Period!
Seniors across the U.S. are seeking coverage to help cut their dental care costs. Currently, minimal government assistance is available for seniors who need regular dental care and can't afford to pay out of pocket.
Medicare and Medicaid do not include oral health coverage for most people. Even those programs that do include coverage only contain provisions for extractions of teeth, and exclude the common oral procedures we all need as we age.
Basically, no help is available through Medicare for obtaining primary tooth repair or for having missing teeth replaced. There's virtually no aid for just about any type of oral care seniors require except as medically necessary in the care of a serious health problem, such as cancer.
In other words, we're on our own!
We have three choices:
- Pay full price 100% out-of-pocket each time we see the dentist.
- Buy a restrictive dental insurance (PPO, HMO or Indemnity) policy.
- Join a Dental Savings Plans to save 40-60%.
What's the Best Dental Plan for Seniors?
You wouldn't believe how often we're asked this question. The simple answer is that it depends on these two factors:
- Your budget.
- How badly you need serious dental work right now.
As with all types of insurance, it’s a good idea to have a dental plan before you’re facing a crisis. By enrolling in a dental plan before problems arise, you’ll generally get a better rate.
If you already suspect or know that you need serious dental work, it still makes sense to apply. That’s because once you’re approved, the plan may potentially save you some money by allowing you to purchase the dental services you need at the insurance company’s lower, negotiated rates.WARNING: You may pay much higher premiums or be rejected outright if dental problems have already manifest themselves. Dental insurance is not included in the Affordable Care Act law, so there are no guaranteed issue rights.
For most of us, reaching retirement age means "fixed budget". That can really put a damper on making healthcare decisions. When considering your budget, think about both the monthly or annual cost of the plan AND how much you’ll need to pay out-of-pocket.
With dental insurance, such as an HMO or PPO, you’ll pay less when you see the dentist, but you pay for the policy every month, even when you don’t need it. Plus, almost all dental insurance plans have a 3-year graded maximum benefit (e.g., $500|$750|$1,000). Meaning, your maximum benefit in year one is just $500, year two $750, and year three $1,000. And many policies have a life-time maximum benefit.
Do the Math!
If you do the math, basic dental insurance may not be such a great deal. Basic plans are $29 to $45 per month ($540 per year, on average), plus you’ll pay 20 to 60% co-insurance. And that’s just a basic plan. Premium plans are in the $60 to $75 per month range… and up!
The alternative is a dental saving plan (DSP), also known as discount dental. This isn’t insurance, it’s a pre-negotiated rate plan with dentists that’s an alternative to costly, restrictive insurance.
With a DSP you pay one low annual fee to join (around $120 to $140 for an individual) and pay the discounted amount when you see your dentist.
Wondering how much you can save? In a word… plenty! The typical savings is 40-60%. That really adds up fast if you need restoration work.
How Badly You Need Dental Work
Budget is the first decision, and it’s important. But it may get trumped by your need for serious dental work right now.
Above I mentioned that most dental insurance policies, particularly those with a monthly premium less that $50, have a graded benefit period. Others have a waiting period for just about everything except cleanings. That means you could end up paying your monthly premiums for 6-12 months before the policy will pay for any kind of restorative work, oral surgery, etc.
If you find yourself in this situation, a dental savings plan is a must. There’s no waiting period, no deductibles, and no on-going monthly premiums. Simply show your card and save 40-60%.
A Third Option
Here’s another thought, and it’s an option you may want to consider. Buy both a DSP and dental insurance. Here’s why.
If insurance is what you really want, but you don’t have the budget for a premium policy, get a DSP for discounts now while the waiting period on your basic dental insurance policy tics down. This way, you can start getting your teeth fixed now, at a discount. Then, in 6-12 month, when your insurance kicks in, you can get even more savings.
Ready to go price compare? For dental savings plans we have two recommendations:
- DentalPlans.com - A quality provider of dozens of DSPs nationwide.
- Careington Dental - founded in 1979 and a leader in discount programs.
Click here to shop dental insurance in your state.
PPO Dental Insurance Plans for Seniors: Good Coverage, High Price
PPO dental plans are a popular option for senior citizens due to the freedom they allow plan members in selecting their own dentist. Typically PPO plans are touted for their flexibility compared to HMO plans, and their low cost compared to traditional indemnity plans.
Businesses use them to provide a valuable option to employees, although the annual payments are typically more expensive than other options. PPO plans are available to individuals and families as well.
Preferred provider organizations are managed care organizations with networks of dentists under contract with an insurance carrier. They offer the greatest savings to plan members who select a dentist within the network, but members have the freedom to choose a provider outside of the network.
When seeing a dentist, you the member pay the dentist directly for the services rendered as well as the copay, and are reimbursed at a later date by the insurance carrier. Occasionally, PPO organizations will pay the dentist directly.
Though dental PPO plans have definite dental benefits for the elderly, be aware this flexibility comes at a price: PPO annual premiums are typically much more costly than other types of dental insurance for seniors. In addition to higher premiums, patients must pay their deductibles before coverage actually begins.
Many seniors looking for coverage on a limited income may find the monthly payments quite cumbersome.
There are also tedious claim forms to be filled out, and patients usually have a lengthy wait to receive reimbursements. In addition, since most PPO insurance plans only cover a portion of the dental fee, patients must make a copay out of pocket. Many choose this type of plan due to the flexibility it offers in selecting a dentist.
HMO Dental Insurance Plans for Seniors: Affordable, Limited Flexibility
HMO dental plans, also known as dental health maintenance organizations (DHMO) are usually much cheaper than PPO plans and indemnity plans. Similar to PPO plans, a network of dental providers is under contract with the dental insurance company to provide select services at predetermined prices.
Low cost dental insurance for seniors such as HMO plans are most popular with businesses who use them to insure their employees at affordable rates. But if you are not insured by an employer, you can easily access an HMO policy.
The main advantage of HMO dental insurance for seniors is the low cost compared to DPPO or indemnity plans. Unfortunately, DHMOs impose strict requirements and restrictions on insured members. For example, the dental HMO will not pay for oral health care unless it is rendered by an in-network provider.
Different than PPO or indemnity plans, HMOs assign a member to a panel of dentists and oral health specialists from whom they must choose. You do not have the option of selecting a provider out of network. In fact, if you need to see a specialist, the HMO carrier will only pay for services from a specialist referred by your dentist.
The most unique feature of DHMO companies is the method by which they pay their dental providers. They are paid based on the number of patients they treat and are expected to see a certain number per year. Occasionally you will hear patients complain of being rushed through the process or receiving substandard care.
DPPOs, in comparison, allow providers to spend more time with each patient. Despite obvious restrictions and cumbersome guidelines, many people choose HMO insurance plans due to their low cost in relation to other insurance options.
Dental Indemnity Insurance for Seniors: Traditional Dental Coverage
Dental indemnity insurance, also known as traditional insurance, is a type of plan in which the policyholder chooses any dentist he or she wishes. The patient pays the dentist directly for services, and is then reimbursed by the insurance carrier by means of a claims process.
Typically these plans cover 50%-80% of the cost of dental work, and the remaining amount is paid by the patient. Members of indemnity insurance plans often must wait a long time after they file their claim forms to receive reimbursement for services paid out-of-pocket.
For these reasons, this type of dental insurance, for seniors, is simply not the best option.
Group members and employees have the flexibility to choose their dentist, change dentists and see a specialist without a referral.
Despite these freedoms, these plans are less popular today due to their expensive annual premiums, higher deductibles and tiring claims procedures. Indemnity insurance is typically structured to appeal to groups and businesses, so it is not the best option for individuals and families.
Dental Savings Plans: Not Insurance, Low Cost Dental Care for Seniors!
Dental Savings Plans (DSP) are alternatives to traditional dental insurance. Since they are not insurance, these plans charge very low annual fees – some starting as low as $9.95 per month – require no copay or deductible and carry no annual maximum limits.
Again, to be clear, a DSP is not insurance, it’s a discount dental plan designed to save you a serious amount of money when you go to the dentist.
It's important to keep in mind you will be responsible for paying the dentist the discounted fee when you use a DSP. There's no payment reimbursement by the plan provider. Their role is to get you the best discount possible.
No Claims, No Waiting!
Dental discount plans do not require claim forms because there's nothing to process – as a plan member you pay the dentist directly, and that’s it. No other payments required. No waiting for reimbursement checks to come in the mail.
Many seniors who do not have access to employer plans or who cannot afford expensive premiums are turning to discount dental plans. Even if you do have dental coverage but are caught in a long waiting period, this type of plan can easily operate in conjunction with an existing policy.
Can't Be Turned Down.
You may have a preexisting oral health condition that is not covered by your current dental policy. Because discount plans are not insurance, they have no waiting periods. You can sign up today and be at the dentist in 30 minutes. If you’ve reached your annual maximum, you can use a discount plan to pay for a procedure you have been reluctant to get because of the out-of-pocket expense.
Works Like Your CostCo or Sam's Club Membership.
Dental providers contract with dental savings plans to provide the same quality dental work at reduced prices. The concept is a familiar one – it’s the same model used by discount clubs like Costco and Sam’s. Dentists realize that for many seniors, insurance is not the best option and, in many cases, doesn’t provide all of the coverage they really need. You benefit by gaining access to discounts of up to 60% on routine and major oral healthcare.
Works with Regular Dental Insurance.
Because of their low cost, many people choose to carry this type of plan in addition to regular dental insurance, in case of dental emergencies.
There are many DSPs available. After our extensive research, MedicareWire recommends only two DSP programs:
- DentalPlans.com - A quality provider of dozens of DSPs nationwide.
- Careington Dental - Founded in 1979, Careington is a leader in the DSP industry.
It's worth your time comparing what they offer.
The dental insurance and dental plan data on MedicareWire.com comes directly from public and private sources and is subject to change. The MedicareWire.com website is available for educational purposes. Our goal is to present information accurately and without bias, based on our interpretation of factual information. However, this site is not intended as a substitute for legal, health, or financial advice from a licensed professional.
MedicareWire.com is an independent research, technology and publishing organization. We are not affiliated with Medicare, Medicare plans, insurance carriers, or healthcare providers, nor are we compensated for Medicare plan enrollments. We are affiliate with the dental savings plans mentioned on this page and may receive compensation if you join a plan. For more information, see our disclosure page.
Savings plans are NOT insurance and the savings will vary by provider, plan and zip code. These plans are not considered to be qualified health plans under the Affordable Care Act. Please consult with the respective plan detail page for additional plan terms. The discounts are available through participating healthcare providers only. To check that your provider participates, visit our website or call us. Since there is no paperwork or reimbursement, you must pay for the service at the time it's provided. You will receive the discount off the provider's usual and customary fees when you pay. We encourage you to check with your participating provider prior to beginning treatment. Note-not all plans and offers available in all markets. Special promotions including, but not limited to, additional months free are not available to California residents.
The logos and brand names used on MedicareWire.com legal U.S. trademarks. We make no claim to the marks whatsoever, nor do we claim to represent the brands, products or services presented. We use brand names and logos on this page for editorial purposes only, as permitted by U.S. Trademark Fair Use Law.
The dental plan information on MedicareWire.com is maintained by David Bynon and was last updated on .