Good dental health is an important part of your overall health. This is especially true as you age – seniors are more likely to experience gum disease and other conditions.
Regular dental care can help you prevent and address these issues. But dental care can be expensive for seniors, because Medicare doesn’t typically cover many oral health services.
Below, learn more about different dental insurance options for seniors, which services these plans typically cover and what kind of coverage will work best for you.
What does dental insurance typically cover for seniors?
What or how much your dental plan covers depends on what kind of plan you have and what kind of care you need.
Dental care is organized into different types, ranging from simple procedures to more extensive work. Most dental plans will typically cover preventive, basic and major restorative dental care.
Preventive dental care
Preventive dental services are designed to prevent and diagnose future oral health issues. They include oral checkups and screenings, X-rays, cleanings, and more. With regular preventive care, you can maintain better oral health and avoid future problems.
Basic dental care
Basic dental services treat less severe oral health issues that are simpler to treat. These include mild gum disease treatment, fillings, simple extractions and periodontics (treatment of gum disease).
Major restorative dental care
Major restorative dental services address more severe oral health issues with complex or extensive procedures. This kind of work is often more expensive, and includes treatment and procedures like crowns, implants, surgery or dentures.
What Medicare does and doesn’t cover
More than 66 million Americans, most of them seniors, get health coverage through Medicare. But Medicare doesn’t cover most dental services.
You often must pay out of pocket for services like routine cleanings, screenings, fillings and tooth extractions, or items like dentures and implants. Original Medicare will, however, sometimes contribute to the costs of dental services directly tied to the success of your medical treatment – for example, treating an oral infection before cancer treatment.
The role of Medigap and Medicare Advantage
Because Original Medicare doesn’t cover most dental services, many seniors get additional dental coverage options through private health insurance plans or standalone coverage.
Medicare Advantage plans, also known as Part C coverage, are private plans that can work as an alternative to Original Medicare. All Part C plans offer the same coverage as Original Medicare, but many include additional benefits like hearing, vision and dental coverage. If you’re interested in more extensive dental coverage, choose a Part C plan that offers those benefits.
Medicare Supplement plans, also known as Medigap, work in addition to Original Medicare, covering the out-of-pocket costs associated with Medicare Parts A and B. They typically offer the same level of dental coverage as Original Medicare, so you may have to look for a standalone dental plan if you want additional coverage.
Dental insurance vs. dental savings plans: Ways to get coverage
For seniors on Medicare looking into additional dental coverage, there are often two options to choose from: a standalone senior dental insurance plan or a dental savings plan. These two choices are very different, and it’s important to know how each works and what to expect.
What seniors can expect from a dental savings plan
Dental savings plans, also called dental discount plans, are an alternative to dental insurance. They are membership-based programs that can make dental and oral care more affordable by offering discounts on certain services.
When you’re a part of a dental savings plan, you pay an annual fee and get a discount on dental services. Since it is not insurance, you do not receive any coverage towards your care. You simply receive a discount on the care that is delivered by your participating dentist. Most discount plans do not have a limit on how many services you can receive at a discount. Often with dental savings plans, the amount you save on care depends on where you go for care, what service you receive and where you live.
How dental insurance works for seniors
Dental insurance combines both discounts on care plus coverage towards your care. It works in a way similar to standard medical insurance. Your dental insurance company will pay for a portion of your dental service costs depending on what kind of treatment you’ve received and the coverage your plan offers.
Like most medical insurance plans, dental insurance plans typically include a monthly premium payment, a small deductible that you pay out of pocket before your plan starts covering dental care, and coinsurance to pay when you receive dental services.
Also like medical plans, dental insurance plans have negotiated reduced rates with dentists in their network, so you’ll pay less for dental care compared to not having dental insurance.
Dental plans also have a yearly annual maximum, which is the total amount the dental insurance pays towards your dental care in a year.
What are the pros and cons of dental insurance for seniors?
We all know that it’s not always easy to predict what kind of health services you’ll need. And your dental health is no different.
Seniors with dental insurance have peace of mind that if oral health issues occur, you’ll have coverage when you need it at a more affordable cost. Also, many dental plans include 100% coverage for preventive care, so you can avoid bigger issues down the road.
Drawbacks depend on what plan you choose. Most individual dental insurance plans have waiting periods for services such as major oral surgery, crowns and implants. Waiting periods refer to the time you have to wait, frequently six months, before you can get care for those services.
Also, dental insurance is often bound to networks, so you must receive care within your provider network for the most affordable care. You can always go out of network, but you may pay a little more for services.
What types of dental procedures are most common for seniors?
As you age, your risk of dental issues like crown and root decay, dry mouth and gum disease increases. Common treatments include fillings, crowns, dentures, implants and root canals – a mix of basic and major restorative care. Without insurance, those costs can add up quickly, and the price of care isn’t always easy to predict.
Costs for common dental services without insurance may look like:
- Fillings: $130 to $900 per tooth
- Crowns: $800 to $2,500 per tooth
- Dentures: $450 to $6,500
- Implants: $3,000 to $7,000 per tooth
- Root canals: $500 to $1,800 per tooth
When is dental insurance worth it for seniors?
For many seniors, the choice to enroll in a dental plan depends on your health needs and your budget. Dental insurance is often a good choice for seniors with chronic conditions linked to oral health or for those who want peace of mind that if something unexpected pops up, they’re covered. A dental plan will also give you access to preventive care, typically at no out-of-pocket cost to you, so you can maintain your oral health before bigger, more expensive problems arise.
Seniors, it’s time to find the dental plan that’s best for you
Ready to find a flexible, affordable dental plan with a robust network and benefits tailored to your needs? Explore your options with HealthPartners.
