Learn About Dental Insurance for Seniors on Medicare
More than 48-million Medicare beneficiaries want and need help paying for their dental and oral health care. However, as far as Medicare is concerned, our teeth and gums are not part of our major medical coverage. For this reason, minimal government assistance is available for seniors who need dental care and can't afford to pay for it out-of-pocket.
For most of us, the cold, hard fact is this: The government will not help us maintain good oral health, repair our teeth, or replace our missing teeth. This includes dentures. In fact, there's no coverage through Original Medicare for any type of dental work unless it’s deemed medically necessary. Even Medigap policies, purchased to supplement Original Medicare, do not offer dental coverage. By law, they can’t.
In other words, seniors, we're on our own.
The goal of this guide is to help you understand your choices so you can make the best coverage decisions for your personal situation. Whether you're looking for low-cost dental care, supplemental dental insurance, or the best dental insurance available, this guide has you covered. I’ll go over all options available to you, explain the pros and cons, link you to online resources, and use my own situation as a real-world example.
What's the Best Dental Plan for Seniors?
Most people want to get right into it, so let's address the question that's probably on your mind, what's the best dental plan or insurance for seniors? I’m sorry to say, there’s no single “best” solution. What’s best for you depends on two individual and equally important factors:
- Your budget; and
- How badly you need dental work right now.
I want to help you save as much money as possible and get some peace-of-mind. So, let’s discuss your options.
For most seniors, there are four basic choices:
- Pay full price out-of-pocket each time you go to the dentist.
- Join a Dental Savings Plan and pay 20-60% less on most procedures.
- Buy individual dental insurance that limits your coverage.
- Enroll in a Medicare Advantage plan with limited dental benefits (at an additional monthly cost).
If you are a low-income senior and qualify for Medicaid, you may have additional options that will help you get low-cost or no-cost dental care. The availability of this care is all based on where you live. More on this later.
For obvious reasons, paying full price for your dental care isn’t a smart thing to do. Even if you don’t believe you can afford dental insurance, and you don’t qualify for low-income assistance, you can get a very hefty discount for a small, annual fee, by enrolling in a Dental Savings Plan (DSP).
If you can afford dental insurance, it’s important to take the time to understand the limitations. Unlike Medicare and private health insurance, which covers you completely to the limits of the policy on day one, most dental insurance policies don’t. Dental insurance is one of those things that people like to buy, use, and then cancel. Wise to this, most plans have annual limits.
Most dental insurance plans use a 3-year graduated benefit model. For example, with a $500|$750|$1,000 plan, your maximum benefit in year one is $500, year two $750, and year three $1,000. After year three, if you stay with the plan, your annual maximum remains $1,000 per year.
In addition to the annual maximum benefit, many policies have a lifetime maximum benefit. The insurance company’s goal is a long-term relationship with clients who maintain their oral health through regular checkups and cleanings. Plans are intentionally designed to prevent high claims for dental restoration work by people with serious dental issues.
I’ll be discussing both dental insurance and dental savings plans in this guide. Both offer valuable benefits. What’s best for you depends on your personal situation. It pays to explore and put some facts and figures on paper.
WARNING: You may pay much higher premiums or be rejected for dental insurance outright if dental problems have already manifested themselves. Dental insurance is not included in the Affordable Care Act law, so there are no guaranteed issue rights like you have with Medicare.
IMPORTANT: A dental savings plan (DSP) is not insurance. It’s a discount program that offers discounts directly to you when you use participating providers. Unlike insurance, there are no deductibles, annual maximums, waiting periods or medical claims forms. However, you pay for your discounted services out-of-pocket.
For most of us, reaching retirement age means "fixed budget". That can really put a damper on making healthcare decisions. When considering your dental care budget, think about both the:
- monthly or annual cost of a plan, and
- how much you’ll pay out-of-pocket with a plan.
With dental insurance, you might pay less when you see the dentist, but you pay for the policy every month, even when you don’t need it. I say you might pay less because some dental policies have co-insurance as high as 75% in the first year.
If you do the math, basic dental insurance may not be such a great deal. Basic plans cost an average of $29 to $45 per month ($480 per year, on average), plus you’ll pay 20 to 75% co-insurance. And that’s just a basic plan. Premium plans are in the $60 to $75 per month range, and up, and you still have co-insurance!
The alternative to dental insurance is a DSP, also known as discount dental. This isn’t insurance, it’s a pre-negotiated rate plan with dentists. It’s an alternative to costly, restrictive insurance that is worth considering.
You pay a low annual fee to join a DSP. Most plans are in the range of $120 to $150 for an individual and $170 to $200 for a family. Once enrolled, you pay the discounted amount when you see your dentist.
Wondering how much you can save? In a word… plenty! The typical savings is 20-60%. That really adds up fast if you need restoration work.
While thinking about your budget, it’s important to do your research on the type and amount of dental procedures you think you’ll need. This is the only way to come up with the right answer for your situation.
Let’s say you know you need to have a deep cleaning, five fillings replaced, and a new crown. This is the work I needed as I was putting this guide together, so I priced it out in my local area. Then I ran the numbers through the discount claimed by my DSP of choice.
Here’s what I found:
|Full Mouth X-Rays||$128.00||$128.00||45%||$70.40|
|Perio Scaling and Root Planing (Per Quadrant)||$260.00||$1,040.00||55%||$468.00|
|1 Surface Silver Filling for Primary or Permanent Tooth||$149.00||$596.00||64%||$214.56|
|Single Crown - Porcelain on Noble Metal||$960.00||$960.00||43%||$547.20|
When you add in the annual cost of the DSP, $149.99, the total cost for the work I need is about $1,450. That’s a 47% savings!
I worked the exact same math to compare a basic $1,200/$2,500/$3,500 dental insurance policy, at about $40 per month, with co-insurance ranging from 20% to 75%. With this plan, the co-insurance decreases after year one and two until it reaches its minimum level in year three.
As I discovered, you really need to look at the fine print of dental insurance before making your decision. When they use graduated annual coverage limits and co-insurance, it makes it more challenging to figure out your costs. If you don’t think you’ll be needing restoration work right away, it’s not such a big deal. However, in my case, it is.
Due to the graduated rates, the exact same procedures I need would cost $2,491 when you include the policy’s $40 monthly premium for the first year. However, this exceeds the $1,200 maximum for the first year. So, I’d either be forced to pay the amount over $1,200 ($1,524) completely out-of-pocket or wait until year two to have my fillings or crown work done. If you don’t mind spacing out your restoration work, it’s no big deal. In fact, the cost goes down a bit in year two because the plan pays more.
Here's what it would cost me to have the exact same work done using a basic dental insurance plan:
|Full Mouth X-Rays||$128.00||$128.00||50%||$64.00|
|Perio Scaling and Root Planing (Per Quadrant)||$260.00||$1,040.00||75%||$780.00|
|1 Surface Silver Filling for Primary or Permanent Tooth||$149.00||$596.00||75%||$447.00|
|Single Crown - Porcelain on Noble Metal||$960.00||$960.00||75%||$720.00|
If the co-insurance rates in my example seem high, it’s because they are. Basically, the plan wants you to have cleanings and checkups in the first two years. And that’s fine because this plan offers three free cleanings per year, which average $140 to $180 (full price). That means if you use all three cleanings and have an annual checkup with full mouth x-rays, you’re breaking even on the monthly dental plan premiums.
How Badly You Need Dental Work
Budget is the first decision, and it’s important. However, it may get trumped by your need for immediate dental care.
Above I mentioned that most dental insurance policies, particularly those with a monthly premium less than $60, 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 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 are no waiting periods, no deductibles, and no on-going monthly premiums. Simply show your card and save 20-60%. Let me tell you, in my personal experience, the savings really add up fast on restoration work.
If your oral health is good, basic dental insurance that offers a free annual checkup, two or more cleanings per year, and $1,000 or more of restoration work per year is a good decision. In most cases, you’ll get the full value of your monthly premiums when you take advantage of the preventative care features in the plan. Then, when you do need restoration work or oral surgery, you have the insurance to help pay the costs.
A Third Option
Here’s another thought, and it’s an option you may want to consider if you need work now and want insurance for the long-term. Buy both a DSP and insurance. This is what I decided to do because of my situation.
If insurance is what you really want, but you don’t have the budget for a premium policy with no waiting periods, good coverage on day one, and low co-insurance, then get a DSP for discounts now while the waiting period on your basic dental insurance policy tics down (if it has one) or the coverage level moves up to a reasonable level. This way, you can start getting your teeth fixed now, at a discount. Then, down the road, you can get even more savings with the insurance.
This is exactly what I did for myself. I simply could not wait any longer to have my dental work done. I had already waited over five years from when my dentist first x-rayed my teeth and showed me the issues. For me, it was critical to have the work done this year, or I’d be at risk of losing some teeth.
Choosing a Dental Savings Plan
At last count, there were more than 45 different dental savings plans on the market. None of them are available nationwide, but some of the best plans cover 40 or so states.
Some states have as many as 22 plans, while others have only two or three. Plus, many plans offer discounts on more than just dental. Some of the plans I like the most offer vision and hearing discount benefits, too.
If you’re thinking that it will take some time to find the best DSP, here’s some good news. I’ve done the research for you. After hours comparing features and reputation, the plans I recommend include:
- CIGNAPlus Savings Dental Network Access Plan
- Careington POS Dental Plan
- Aetna Vital Savings Plan
- :DP SmartHealth Plan
Here’s a brief overview of each of these plans:
CIGNAPlus Savings Dental Network Access Plan – CIGNA is one of the biggest names in healthcare, including dental. They offer two plans, but for just a little more, the CIGNAPlus plan offers vision, hearing, and wellness services. CIGNA claims average savings of 37% on most dental services including braces, cleanings, x-rays, root canals, crowns, dentures, implants and more. The discount plan network includes general dentists, endodontist, orthodontist, oral surgeons, and other specialists. The list price is $149.95/year for individuals and $199.95/year for families. Browse to http://medicarewire.com/discount-dental-plans/ to see if the CIGNAPlus Savings Dental Network Access Plan is available in your area.
Careington POS Dental Plan – Careington is a pioneer in the dental industry, delivering discount dental plans to more than 15 million members. They have the largest network of providers and a reputation for excellent customer service. I like this plan because of its discounts, including FREE added benefits for vision/LASIK, hearing, prescriptions and specialty healthcare (not available in Florida). Careington claims their plan offers up to 20-50% at more than 62,000 participating dental locations, including orthodontics and implant specialists. The list price is $149.95/year for individuals and $199.95/year for families. Browse to http://medicarewire.com/discount-dental-plans/ to see if this Careington plan is available in your area.
Aetna Vital Savings Plan – No doubt you already know that Aetna is one of the biggest names in Medicare. They offer Medigap plan, Medicare Advantage plans, Part D for prescriptions and regular dental insurance, too. With their large provider network, it's really no surprise that they offer a DSP. What is a surprise is the value. The list price is $139.95/year for individuals and $179.95/year for families, making it a very good buy if you don't care about a lot of extras. Aetna claims an average 15-50% savings on most dental services including cleanings, X-rays, root canals, crowns, dentures, implants, braces and more! Browse to http://medicarewire.com/discount-dental-plans/ to see if the Aetna Vital Savings plan is available in your area.
:DP SmartHealth Plan – DentalPlans.com is the #1 name in discount dental. For more than 15 years, they've been committed to making care more accessible and more affordable for seniors. While they offer all leading DSP brands, they also have two plans of their own. I'm particularly impressed with the :DP SmartHealth Plan based on how much value it offers for the price. In addition to great dental discounts, you get discounts on:
- Telemedicine via eDocAmerica
- Emergency Medical Travel Assistance
- Vision Care and LASIK
- Hearing Care
It offers specialty health care and prescription discounts, too. These can help seniors who often go into the Medicare Part D "donut hole" on their prescription coverage and those who like to use alternative medicine, like acupuncture, that Medicare won't cover.
If you're not familiar with the concept of telemedicine, I assure you that you soon will be. Medicare is beginning to study how this new technology can both save money and make it easier for seniors to see the doctor for minor issues. While waiting for Medicare to figure it out, which will likely be another three or four years, you can start seeing a doctor from the comfort of your home, saving time and money. The list price on this plan is $199.95/year for individuals and $299.95/year for families. Browse to http://medicarewire.com/discount-dental-plans/ to see if the :DP SmartHealth Plan is available in your area.
Are you ready to see which DSPs are available where you live? Browse to http://medicarewire.com/discount-dental-plans/ to use the plan comparison tool.
Choosing a Dental Insurance Plan
Unfortunately, dental insurance is not as straight forward and clear cut as dental savings plans. Dental insurance may have annual limits, lifetime limits, class-of-work limits, time limits, and co-insurances.
No dental plans that I found and researched cover all possible costs. That said, if you value your teeth and your overall oral health, the rising cost of getting your teeth fixed makes a good dental insurance policy important.
Due to the restrictions that most insurers put on dental insurance, it's critical to understand what you’re getting into before jumping in and buying a policy. A little knowledge early on can save you a serious amount of money, not to mention a lot of pain and frustration.
Finding the perfect dental plan for your specific needs takes some time and research, but it doesn’t have to be difficult. It starts by understand the different classes of dental insurance.
Most dental insurance plans cover a yearly checkup, basic cleaning, and $1,000 or more for basics, like fillings. As I mentioned above, the full charge for a yearly checkup and one cleaning about what you’ll pay for a year of basic dental insurance.
If your mouth is already healthy, basic dental insurance will help you keep it that way. If your oral health has declined, a basic dental plan will help you get it back to where it should be over a period of a few years, so you can smile, laugh and eat with confidence again.
It won’t take you long to realize that not all dental insurance is created equal. Even two policies that make similar claims like “Up to $3,000 in coverage!” have different meanings. You need to read the terms and conditions. That’s one of the reasons I’ve gone out of my way to collect all coverage pamphlets for all major dental insurance plans.
Dental Insurance Work Classifications
Most dental plans divide their coverage into several different classes. This makes it easier to see what’s covered and what isn’t. The common classes of coverage are:
- Class 1: This is your preventative dental care. This includes basic exams, X-rays, and cleanings. Most good plans cover 100% of these costs.
- Class 2: This is basic restoration dentistry. It includes fillings, root canals, and periodontal work. In this class, most commonly 80% of your expenses are covered by insurance.
- Class 3: This is your major restorative dental care, which most seniors need. This includes crowns, bridges, and dentures. Some plans that don’t cover this at all, while others cover up to 50%.
- Class 4: This is your orthodontic services like braces, implants, and teeth pulling. Some plans will cover Class 4 work up to a certain amount per year (usually capped around $1,000) while many dental programs won’t cover it at all.
Now that you know the different classifications of dental work, you should have a good understanding of what to look for. Again, what’s best for you is based on your personal situation. That said, this is the most vital information to know before shopping for dental insurance. This will help you see which plans cover the work that you need. It also helps you weed out plans that don’t support more serious dental work.
Compare Prices and Coverage
You might be tempted to compare plans based on monthly premiums or on coverage. If you want the best plan, you’ll need to look at coverage and cost together. When you do this, you’ll discover that one plan offering $2,000 in coverage only takes care of fillings, x-rays, and general cleanings while a different plan, that costs a little more for the same annual coverage, includes root canals, crowns, and bridges.
Therefore, the first step is to use the dental work you already know you need or anticipate needing in the future to eliminate the plans that don’t provide the coverage you need. You’ll be really upset if you buy a plan that won’t pay for that crown you just broke or a root canal to get rid of a bad toothache.
Research Your Local Networks
After you have narrowed your plan choices, it’s time to verify that your dentist will accept them. Unfortunately, dental insurance, like health insurance, is not universal. Just because you have insurance doesn’t mean your dentist will accept it.
Even if you don’t currently have a dentist, do your research. Read some online reviews. For this, I prefer Yelp.com. Call a few top-rated dentists and ask them about the insurance policies they accept. You need to make sure you can find a good, local provider who accepts the coverage that you want.
Read the Fine Print
All dental insurance plans are different. They’re not standardized like Medicare. For this reason, it’s super important to read the fine print to make sure you fully understand the coverage. It’s important to understand the limitations that any policy has. Some insurance policies have more than one limit listed.
There’s often a yearly limit to what insurance will cover from the first three classes of dental care. It’s also common for insurers to put a lifetime limit on what they're willing to cover from the fourth class, such as oral surgery. If the limits are annual, that’s good. Policies with lifetime limits are bad. Be sure to read about waiting periods, too.
The fine print doesn’t just reveal limits and the type of dental work covered, it also explains the amounts you pay and coverage changes based on how long you’ve had the policy. You’ll also want to know if your coverage is based on a calendar year or a 12-month span starting when you first get your policy.
A good plan is discovered in the fine print. It’s something you can’t ignore, so take the time to figure it out.
Top Recommendation for Seniors: Spirit Dental
After evaluating more than 50 plans from 15 different insurance companies, I concluded that Spirit Dental has an ideal plan for most seniors.
Most dentistry is preventative. Dentists want to prevent cavities and tooth decay. If those problems are already present, they want to prevent it from spreading. If you have severely damaged teeth they want to remove them to prevent them from infecting your overall health.
Spirit Dental’s $1,200/$2,500/$3,500 plans are designed to meet your preventative oral health needs and restoration dentistry over time. Coming in at an average of $42 per month (higher in some areas, lower in others), these plans offer excellent value in the long-term. Sure, the co-insurance is higher at the beginning, but you’re rewarded in year three and beyond.
Here are the reasons I purchased a Spirit Dental $1,200/$2,500/$3,500 plan myself and made it my recommended choice:
- It costs an average of $42 per month in most areas (as high as $55 per month in high cost of living areas).
- It's a PPO, so you have more choices in the dentists you use.
- There are no waiting periods.
- No lifetime maximums on any covered services.
- Two FREE exams per year.
- Three FREE cleanings per year.
- For $7 more per month, you can add vision benefits.
- There's a 30-day Customer Satisfaction Guarantee. You can cancel for any reason in the first 30 days.
The sooner you have solid dental coverage, the better off you’ll be. This isn’t just for the health of your teeth, but studies have shown that extended periods of gum disease and poor oral hygiene have negative effects on a person’s overall health, including their heart.
Browse to http://medicarewire.com/go/spiritdental/ to compare and price shop Spirit Dental plans in your area.
Medicare Advantage Plan Dental Options
There are a few national Medicare Advantage plans and a growing number of regional plans that offer dental coverage. It's most commonly found in HMO and PPO plans as an option, with a corresponding uplift in your monthly premium.
In general, I found that most Medicare Advantage dental options are very modest, however, there are no waiting periods. Medicare Advantage rules don't allow insurers to use waiting periods, as this would force seniors to stay in a plan for more than a year in order to receive services.
The most common coverage level is $1,500 per year with full coverage on basic procedures and partial coverage on major services. For example, Humana offers the most plans with a dental coverage option. Their Medicare Advantage HMO dental plan, called MyOption Dental Advantage HMO, has a $1,500 annual cap and offers:
- 100% In-Network Coverage on:
- Up to two routine exams per year
- One set of X-rays per year*
- Up to two routine cleanings per year
- Up to one filling per year
- 75% In-Network Coverage on:
- Minor procedures including scaling and root planing
- 30% In-Network Coverage on:
- Major services like root canals, crowns and denture adjustments and realignments
- Zero Out-of-Network Coverage
The cost is highly dependent on where you live but ranges from about $26 to $40 per month. Humana offers a slightly different PPO dental plan, that's available with their Medicare Advantage PPO plans, that's less expensive, but offers far less in benefits. The big difference is that you can get a 30% discount when you go out-of-network, whereas the HMO plan has no coverage out-of-network.
For me, the big issue with bundling dental with a Medicare Advantage plan is trying to get everything to line up. It's difficult enough finding a Medicare Advantage plan that offers the healthcare coverage you want, that your primary care doctor and specialists accept, and also covers your medications at a good price. Now try adding your dentist into the mix.
For this reason, I generally recommend keeping health and dental coverage separate. That said, it's worth doing a little phone work to see if your dentist accepts a plan if it offers the coverage you need at a good rate. After all, it's all about saving money.
What Other Resources Are Available?
If you need dental services, and you can't afford to pay, there are resources available. Here's what my research found:
Medicaid: In some states, Medicaid covers limited dental services. You may qualify for Medicaid if you have income below the poverty level and limited assets. Check with your local Medicaid office.
Reduced-Cost and Free Clinics: Dental clinics are available in many states, but their availability is spotty in rural areas. You can research what's available near you by visiting NeedyMeds, healthcare.gov, freeclinics.com, and hhs.gov.
Federally Qualified Health Centers (FQHCs) sometimes offer dental care. These are health clinics located in under-served areas. Anyone with Medicare benefits is eligible to receive services from an FQHC, including some services that Medicare does not cover.
Community Health Centers, funded by the Health Resources and Services Administration (HRSA), offer free or reduced-cost health services, including dental care. You can find centers near you on the hrsa.gov website.
Dental Schools sometimes offer low-cost dental care using students under the supervision of licensed dentists.
Thank You... and Please Share with Your Friends
I hope that my research and information has helped you. If so, would you please share it with your family and friends on Facebook or other social media? Thank you, I greatly appreciate it!
To Your Health,
Compare the Best Dental Insurance for Seniors on Medicare
The dental plan information on MedicareWire is maintained by David Bynon and was last updated on .