Medicare advantage dental benefits in Dalton (Seniors 65+)

When an individual reaches the age of 65, they’re automatically enrolled in Medicare Part A, which is primarily hospitalization insurance and doesn’t cover dental procedures unless they are necessary for a surgical procedure. Traditional Medicare is provided at no charge to seniors, most of whom had dental and medical insurance through their employers, but when they retired, they were no longer able to maintain their insurance. Almost two-thirds of seniors have no dental benefits in their local area, so they usually do without the dental treatments they need. This dilemma will only increase since the number of seniors is increasing at the rate of about 10,000 people per day.

In spite of a dearth of dental coverage, in 2016 seniors spent in excess of $28 billion on dental procedures, which was the largest increase in dental expenditures of any demographic. The American Dental Association reports an increase of 6 million seniors visiting the dentist in 2016 compared to 2006, and this trend is expected to continue to grow. Despite this projection, a study reported by the Kaiser Family Foundation found that almost half of Medicare recipients hadn’t seen a dentist in the previous year and of those who had, almost 20% reported spending more than $1,000 for out-of-pocket dental expenses. The high cost of dental procedures may be, in part, responsible for the number of seniors who don’t seek the dental services they need, as is evidenced by the following average costs for routine dental procedures:

Checkups and Cleanings:

• Basic exam–$50 to $100
• Dental X-ray–$20 to $250
• Standard cleaning–$70 to $200

Fillings:

• Silver amalgam–$50 to $300
• Composite–$90 to $450

Extractions:

• 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

Crowns:

The cost of a crown can range from $500 to $3,000 based on the type of material used.

Root Canals:

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.

Do Seniors Have Any Options for Dental Coverage?

Although traditional Medicare doesn’t pay for dental procedures, unless they’re necessary for a surgical procedure, seniors have several options for dental benefits in their area. Medicare Advantage plans provide supplemental coverage for procedures that aren’t covered by traditional Medicare, and they’re typically available with low monthly premiums, reduced out-of-pocket costs and low deductibles. Approximately 25% of seniors opt for a Medicare Advantage plan to supplement their traditional Medicare plan. Another 10% use private insurers to supplement their Medicare, and about two-thirds simply have no additional dental insurance and usually forego needed dental services.

What Benefits Do Medicare Advantage Plans Provide?

Advantage plans are purchased through private insurance companies and many offer hearing, vision and prescription drug coverages that traditional Medicare doesn’t provide. Unlike traditional Medicare, Medicare Advantage providers reimburse the dentist directly. Those dentists who accept Medicare must wait for the government to reimburse them, which can take months. Advantage plans are offered by private insurance companies such as Aetna, Humana, and UHC and frequently include vision, hearing and prescription drug benefits. Advantage plans have low monthly premiums, which makes them affordable for seniors, but the dental benefits they provide are usually limited to basic examinations, standard x-rays and prophylactic services. According to MedicareAdvantage.com, Advantage premiums for 2018 averaged about $35 per month or $420 per year.

Would a Standalone Dental Insurance Plan Be More Advisable?

More comprehensive dental coverage can be obtained through a variety of standalone dental insurance plans obtained through an insurance company. Various pricing levels are available, and the list of benefits increases as the premiums increase. The following examples of pricing plans illustrate this.

Basic Plans

Usually, a basic plan will cover basic exams, an annual cleaning and a limited number of diagnostic x-rays.

Mid-Range Plans

A mid-range dental plan will usually cover a specified number of emergency treatments, orthodontics, dentures, fillings, standard and specialized x-rays and inhalation anesthesia. There may also be a discounted rate for services that aren’t covered.

Premium Plans

In addition to the above benefits, premium dental plans usually cover:

• Crowns
• Dentures
• Endodontic procedures
• Inlays and onlays
• Oral surgery
• Periodontal procedures

Most private insurance providers cover procedures on a 100-80-50 tiered coverage, which means they’ll provide 100% coverage for routine exams, 80% coverage for basic procedures, and finally 50% for complex procedures. You’ll be responsible for paying the balance of these procedures. Your private dental plan is probably less than your Advantage plan, but there won’t be benefits for vision or hearing or prescription drugs.

Would a Dental Discount Plan Be More Advisable Than a Dental Insurance Plan?

Discount dental plans are not insurance plans and they don’t function like them. When a dentist agrees to accept a dental discount plan, they agree to accept a rate that’s negotiated by the discount plan provider. Rather than pay a monthly premium, discount plan providers charge members an annual enrollment fee and a monthly membership fee. The patient pays the provider directly at the rate that’s been preset by the discount plan provider. Discount dental plans tend to be very affordable and offer some advantages over insurance. There are:

• No copays, deductibles or coinsurance payments
• No waiting period, you receive full benefits immediately
• No annual limits on office appointments
• No claim forms or paperwork to complete
• No restrictions on changing your dentist
• No exclusions for pre-existing conditions or age

Dental discount plans may provide less coverage than traditional insurance plans, but they have lower out-of-pocket costs for routine procedures such as:

• Checkups
• Crowns
• Dentures
• Extractions
• Fillings
• Prophylactic procedures
• Root canals
• X-rays

Discount plans such as Smile Alliance Club may offer additional options for hearing, prescription, and vision benefits, and if you have overall good health and don’t require extensive dental treatments, then a dental discount plan may be the best for you. However, if you anticipate the need for extensive and expensive dental work, then a standalone insurance plan may be a more cost-effective option for you. If you’d like us to help you determine your dental benefits in Dalton, then call our office and we’ll be happy to help you.

How Do I Pay Out-of-pocket Dental Costs?

If you need dental work but can’t afford the out-of-pocket expenditures, then ask your dentist about their flexible financing options and payment options. CareCredit is a very popular financing tool that’s accepted at more than 200,000 providers nationwide. There is an application and an approval process, so not everyone will qualify for financing. Many senior organizations such as AMAC and AARP offer senior discounts on goods and services, including professional services and insurance, so check with those two organizations for additional discounts that can reduce your out-of-pocket expenditures.

If you need dental procedures in Dalton but are concerned about your out-of-pocket costs, then call Drs. Grant and Conger at (706) 847-4165 and we can help you. We’re known in the Dalton area for providing quality senior dentistry and we’d love to help you regain your oral health, so call us today.