Transitioning to life as a senior can feel like a brave new world. Your insurance options change. You have new streams of income from Social Security and retirement accounts. You may even have more time to spend with friends and family.
- What to know about Medicare and dental coverage
- When to buy dental insurance
- What to look for in dental plans
In Part Two, we'll go over what Best Company's top dental insurance providers offer seniors.
What to know about Medicare and dental coverage
Original Medicare (Part A and Part B) does not cover dentistry. If you have Original Medicare and want dental coverage, you’ll need to purchase a separate policy.
Some Medicare Advantage plans offer some dental coverage, but it’s important to understand what services this additional feature offers.
“Medicare Advantage plans rarely offer dental services. If they do, the offered services are limited, usually to preventative care only. Preventative care usually comprises two cleanings and office visits each year with x-rays. Moreover, more often that not, the Medicare Advantage plan requires you to go to an in-network dentist. If your dentist is not in the network, the Medicare Advantage plan won't pay,” says John Barnes of My Family Life Insurance.
If you’re considering a Medicare Advantage plan, check to make sure that your dentist takes your plan. If you want more than preventive care covered, you may be able to add coverage to your Advantage plan.
“Most plans allow policyowners to buy-up and get more comprehensive coverage. These plans might cost around $25 more a month, but will cover basic services like cavities — as well as larger items like crowns, root canals, and extractions. Most will have a limit of $1,000 in benefits for the insured for the year, but they don't usually have waiting periods — which is nice,” says Adam M. Hyers, Hyers and Associates, Inc. insurance agent.
It’s getting easier to find Medicare Advantage plans with decent dental benefits.
“Many, if not all, competitive plans are offering dental benefits included in their Medicare Advantage plan offerings. Benefits are going to cover annual cleaning, x-rays, oral exams, and other basic services like fillings and extractions. Many plans are moving towards including root canals and crowns into their benefits, but the amount of benefit you receive will cover a portion of these expenses,” says John Norce, MedicarePortal president.
However, if you’re still deciding between Original Medicare and Medicare Advantage plans, you’ll want to carefully compare the health coverage and assess your needs.
“I do caution my clients not to purchase Advantage plans just for ancillary benefits like dental and vision insurance. Consumers should really pay attention to the health insurance benefits associated with Advantage plans and how they compare to Medicare supplements,” says Hyers.
There are situations where you may be better off purchasing a separate dental insurance policy. Fenella Stevens, owner of the SCR Insurance Company, offers a few examples:
1. They need to buydown to qualify for Medi-Cal or Medicaid.
2. They want or need richer dental coverage.
3. Their preferred dentist isn’t in-network.
When to buy dental insurance
Experts fell into two camps when it came to buying dental insurance. Some thought it was worth buying, others did not.
Travis Price, Licensed Income Protection Agent, highlights a few possible issues with dental insurance:
1) Deductible — Before the insurance pays a dime, there's usually a deductible of around $100.
2) Tiered co-insurance — The co-insurance usually starts out around 60 percent and increases to 90 percent in year three.
As an example, let's say it's your first year with a dental policy and they cover 60 percent, you cover 40 percent and the deductible.
Your bill is $1,500. You pay $100+$560 in co-insurance. The insurance company picks up $840. You're paying the insurance company $45 a month. You're only getting $300 in benefit if all your costs for the year.
3) Exclusion periods — Finally, depending on the type of procedure, routine, minor, or major surgery there's usually an exclusion period for three to six months, except for cleanings.
4) Most of the lower-cost plans are reimbursement plans. So you pay, then request your money back.
If you’re a disciplined budgeter, it can be just as effective to set money aside in advance of receiving treatment you may need. Indemnity plans can give you access to lower rates and allow you to only pay for the dental treatment you receive.
“Instead, I suggest that seniors talk to their dentists about a 'cash payment' amount or ask how much the insurance company pays the dentist and find out if they'd accept that,” says Price.
Whether or not you purchase dental insurance, you should consider your dental needs.
“As seniors age, generally speaking their dental needs increase. I would say they want to make sure major services are covered well, including partial bridges, crowns, and implants,” says Barnes.
If you’re buying dental insurance, it can be smart to buy it before you need services like fillings or root canals.
“I always recommend a senior purchase dental insurance now and not wait until dental trouble arises. The reason is that seniors will meet any waiting periods now. Sure, they have to pay the monthly premiums, but that more than offsets your out-of-pocket cost of a major service. Far too often, seniors wait until they have pain and need dental insurance. Then, they are surprised to learn that if they bought the policy a year ago, the dental insurance would cover the service,” advises Barnes.
Aside from having the coverage you need, some plans have an increasing annual benefit maximum.
“There are many robust dental insurance plans that offer high annual benefits, such as $5,000 annually. However, these plans usually start out at $1,000 or $1,200 annual benefit in the first year. The annual benefit increases each year the longer the senior holds onto the plan. If the senior needs a root canal done and has had the plan for awhile, the plan likely will pay a nice benefit to the dentist, minimizing the senior's out-of-pocket costs,” says Barnes.
What to look for in dental plans
When evaluating dental plans, look at the following:
If you’ve established care with a dentist and trust them, you should understand how your dentist works with insurance companies and check to see if they’re in-network.
Some dentists contract with insurance companies to provide services at discounted rates. If your dentist does this, you’ll want to see which insurers and companies they accept.
“When searching for a plan, it helps to start with your dentist and identify the plans and networks they participate in. Network-based plans, whether DMO or PPO, will provide higher benefits for in-network providers,” says Norce.
Other dentists do not contract with insurance companies. Instead, they do balance billing. When this happens, dentists have set rates for services. The dentist will bill the insurance company first. The insurance company will pay what it covers, then you’ll be billed for the rest. In these cases, you’ll want to have a plan that offers out-of-network coverage. If your plan only offers network coverage, you’ll be responsible for the full cost when you receive care out-of-network.
Finding a good network goes beyond your general dentist.
“It's important that the carrier has a robust dental network of professionals you can see, including oral surgeons,” says Barnes.
The more complete a dental network is, the easier it will be to find an in-network provider when larger dental needs arise.
In the past, you may have only used dental insurance for preventive care and minor services like fillings. However, your needs will change as you age.
“Generally speaking, as seniors age, their dental needs increase. They will want to protect that need now as waiting until they need dental insurance proves costly. The reason it proves costly is that many dental insurances have waiting periods on basic and major services. These waiting periods are usually 6 and 12 months, respectively.
Seniors will want to consider plans that cover implants and any pre-existing missing teeth, in addition to preventative care, basic services, and other major services,” says Barnes.
Plans with more robust coverage tend to be more expensive. So, think about the kind of care you’ll need.
One distinguishing feature of dental insurance is the waiting periods for some services. Waiting periods mean that the plan won’t cover the service until you’ve been on the plan for a set amount of time. Waiting periods are designed to prevent people from only purchasing insurance when they need costly care. If everyone only purchased coverage when they needed an expensive service, insurance companies would go out of business.
If you anticipate needing major services in the future, talk with your dentist about their pricing. Then, determine if it makes the most sense to save money on your own for these services or purchase a dental insurance policy.
Consider dental plans as you make your choice. Some plans will increase the annual maximum benefit the longer you have the plan, so purchasing one of these early can be beneficial. The annual maximum benefit is the total amount the insurer will pay towards covered services for the year.
As you evaluate plans, also pay attention to what services are covered and what services are not.
“Nearly all plans don't cover cosmetic needs. Additionally, and many seniors are not aware of this, many insurance plans do not cover the replacement of pre-existing missing teeth. If seniors have any missing teeth they want repaired, it is important they call the carrier and find out if the carrier will cover the repair/replacement of any missing teeth (once the waiting period is met, of course),” says Barnes.
Insurance costs include the monthly premium, out-of-pocket expenses, and the annual maximum benefit.
“In choosing a dental plan it is important to compare plans based on how they pay out for comprehensive services like crowns or implants. You should enroll in a plan that offers comprehensive coverage, but also has a premium that is affordable for the long haul because many dental plans have an increased level of coverage after having the policy for a year,” says Troy Baccus, Medicare Life Group owner.
It’s easy to focus on the monthly premium because it’s a consistent part of your budget. However, it may be worth paying a higher premium that still works for your budget for better cost-sharing and a higher annual maximum benefit.
You first need to understand how your plan handles claims.
“You want to see if the plan is an insurance plan or reimbursement plan. Insurance will pay a percentage of the claims where reimbursement plan will pay you based on a standard cost of a procedure in your area,” says Norce.
If you have a reimbursement plan, you need to know what the standard costs are in your area and what your dentist charges. Once you know these numbers, you can estimate what your out-of-pocket expenses will look like.
If your plan is an insurance plan, you’ll want to look at the coverage rates. Most plans fully cover preventive services. Some plans also fully cover diagnostic services. Plans have different cost-sharing strategies for basic and major services. Compare the percentages across plans. If your plan offers in-network and out-of-network coverage, see how the coverage rates change. It’s likely that out-of-network care will cost you more than in-network care.
As you consider the premiums and out-of-pocket expenses for your dental plan, you also need to consider the annual maximum benefit.
“Your maximum benefit for the year is important to understand. Should you need a root canal or crown, you want the maximum available benefits to offset the cost of these higher procedures,” says Norce.
Understanding what to expect from Medicare, when to buy dental insurance, and what to look for in dental plans will help you make the best choice for your personal finances while taking care of your oral health. Continue reading Part Two to learn more about what top-ranked dental insurers offer seniors.