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What Every Senior Needs to Know About Dental Coverage and Medicare Advantage in Florida
Once adults reach the age of 65 or leave the workforce, they are often left without dental insurance. Even though seniors often have an increased need for dental services, approximately 65% end up paying out of pocket or going without the dental services that they need. Since more than 10,000 Americans turn 65 every day, the percentage of seniors without dental coverage is likely to increase significantly in the coming years.
Why Should I Consider Getting Dental Benefits in Florida?
The American Dental Association Health Policy Institute estimates that 6 million more seniors visited a dentist in 2016 than a decade earlier. The growth rate of dental spending among seniors is higher than any other segment of the population with seniors spending approximately $28 billion on dental services during 2016. Although this growth trend is expected to continue for the foreseeable future, a Kaiser Family Foundation report found that nearly half of seniors on Medicare had not seen a dentist during the past year.
What Is the Average Cost for Different Types of Dental Care?
According to the Kaiser Family Foundation, 19% of Medicare recipients who visited the dentist had out-of-pocket expenses in excess of $1,000. The following is an overview of what you might expect to pay for common dental procedures. Of course, costs can vary based on your location.
Checkups and Cleanings:
- Basic exam–$50 to $100
- Dental X-ray–$20 to $250
- Standard cleaning–$70 to $200
- Silver amalgam–$50 to $300
- Composite–$90 to $450
- 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
The cost of a crown can range from $500 to $3,000 based on the type of material used.
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.
What Are My Options for Dental Benefits in Florida?
Adults who are permanently disabled or who are over the age of 65 receive health care coverage through Medicare. The traditional Medicare plan that comes with the red, white, and blue ID card does not include benefits for dental services, such as exams, cleanings, fillings, or extractions. In general, Medicare only covers dental services if they are required for another procedure covered under Medicare Part A hospital benefits. For example, a basic oral examination may be covered if it is required as part of clearance for a covered surgical procedure. In general, Medicare beneficiaries must look to Medicare supplement plans, standalone insurance, discount plans, and financing options to help pay for dental services.
What Are Medicare Advantage Plans?
Medicare Advantage plans are optional and expand on the coverage offered by traditional Medicare. Unlike basic Medicare, which is sponsored and subsidized by the government, Medicare Advantage supplements are offered and reimbursed by private insurers. These plans normally require beneficiaries to utilize network providers and tend to have low deductibles, low premiums, out-of-pocket spending limits, and other cost-sharing and price protection measures. Many of the most popular plans, such as Aetna, UHC, and Humana, include dental, vision, and prescription drug benefits. Since these plans are separate from traditional Medicare, beneficiaries normally receive a separate ID card from the insurer. Since the average annual premium for a Medicare Advantage supplement is usually very low, they are within reach for many seniors. The benefits, however, are normally limited to basic preventative services, such as exams, standard X-rays, and cleanings. Even with a Medicare supplement, you could still face significant out-of-pocket expenses if you need extensive dental work or a more complex procedure.
What Are the Advantages of Standalone Dental Insurance?
Private dental insurance plans offer comprehensive coverage for many dental services and come in a variety of coverage levels and price points, so they can be customized to your needs and budget. Most private dental plans provide tiered coverage. For example, routine cleanings and exams may be covered at 100%, fillings and other basic procedures at 80%, and complex procedures at 50%. The average cost for a private dental plan will differ, depending on your coverage selection.
Which Type of Standalone Dental Insurance Is Best?
When choosing a standalone dental plan, you should consider the type of services that you are likely to need as well as your budget. Most dental insurers offer basic, mid-level, and premium plans.
This type of plan has the lowest price point and includes coverage for basic exams, cleanings, X-rays, and other prophylactic services and is a good option for individuals who generally are in good oral health.
Mid-level dental plans include a wider range of services than basic plans, including fillings, dentures, specialized X-rays, inhalation anesthesia, orthodontics, and emergency treatment.
Premium dental plans come with the highest premiums, offer at least partial coverage for complex procedures, and are designed for individuals with significant oral health issues. For example, most premium plans offer at least some coverage for oral surgery, crowns, periodontic and endodontic procedures, dentures, and inlays and onlays.
What Are Dental Discount Plans?
A number of private companies offer discount plans that allow consumers to pay a discounted rate for basic dental services. These plans are different than traditional insurance. Instead of paying a monthly or annual premium, you pay a low enrollment and membership fee. You still pay the dentist directly for the service but at a pre-negotiated, discounted rate.
In addition to their low cost, discount plans offer several other advantages over traditional insurance:
- Most plans do not have age limits or exclusions for pre-existing conditions.
- You receive full benefits immediately.
- You don’t have to worry about paperwork, deductibles, copays, or coinsurance obligations.
- You are free to change dentists at any point.
- You are not limited to a certain number of office visits per year.
Discount plans may not cover as much as traditional insurance when it comes to complex procedures, so standalone insurance may be a better option if you need extensive dental work. Discount plans are, however, a good option for individuals who are in good oral health and who only need basic preventative care or basic services, including: X-rays, exams, cleanings, fillings, root canals, extractions, dentures, and crowns.
Many popular discount plans, such as DentRite, also offer discounts for prescriptions as well as vision, hearing, and other wellness services.
What Happens If I Have Out-of-Pocket Dental Expenses?
If you don’t have dental benefits in Florida, your dental provider may allow you to spread out the cost of your dental care with a payment or financing plan. CareCredit is a popular financing option that is accepted by approximately 200,000 different health and wellness providers and facilities across the country. Most financing plans are offered through medical credit companies and allow individuals to spread payments over 24 to 60 months depending on the amount of the expense.
Senior organizations, such as AARP, typically offer discounts on various types of services as well as information on various types of insurance geared toward seniors.
If you’d like more information about Medicare Advantage or have questions about financing and dental care for seniors, please give us a call today.