Medicare provides excellent coverage for seniors, but there are definitely some gaps: namely vision, hearing, and possibly most importantly, dental! Fortunately, there are a couple of great options dental insurance options for seniors.

 

MEDICARE ADVANTAGE

Original Medicare (Medicare Parts A & B) cover your basic inpatient and outpatient healthcare.  However, it does not cover dental.  Medicare supplement plans also do not cover dental.  However, many Medicare Advantage plans do.  Medicare Advantage (also known as Medicare Part C) replaces Original Medicare and often encapsulates additional benefits such as vision, hearing, dental and more. However, if it sounds too good to be true, it might very well be.  Let’s go over the pros and cons.

 

Positives:

  • Convenience– having one plan that encapsulates so many benefits is certainly convenient.  Less payments and cards to keep track of.
  • Cost– Medicare Advantage plans can offer major cost saving benefits.  They are usually cheaper than Medicare plus a Medicare Supplement plus a dental plan.

 

Negatives:

  • Limited options-it can be much harder to find a good PPO plan or a dentist on your plan that you like.  
  • Prohibitive– in some places you may have to travel to find a doctor or hospital that accepts your plan.  So even if your dental coverage is good with your plan, you don’t want to sacrifice your health insurance.

 

If you’re interested in a Medicare Advantage plan for dental coverage, first make sure that it meets your health needs.  After that, thoroughly research the dental benefits to ensure that it is the right plan for you.  You can only join, drop or switch a plan during the AEP which is every year from Oct. 15-Dec. 7 so make sure it’s the right plan for you!  You can check out all of the plans available on Medicare.gov by using the plan finder. 

 

PRIVATE DENTAL INSURANCE

Another option is private dental insurance.  Most dental insurance plans will run you between $15-$50 per month.  You’ll also be responsible for your portion of covered services.  There are several different types of plans to choose from. You’ve probably heard of PPO’s and DHMO’s (dental health maintenance organizations), but you may not have heard of Indemnity plans. 

 

DHMO’s

PPO’s and DHMO’s work very similarly to the way their health insurance counterparts do. HMO’s have relatively low monthly premiums, but you must use an in network dentist.   With DHMOs you will only be covered with in network dentists, but your copays are set.  This makes determining your costs much easier.  Additionally, DHMO’s require a “preferred” dentist who must coordinate all visits with specialists. Also, some people report dissatisfaction with dentists in their DHMO networks.  Because DHMO dentists must see a certain amount of patients, many patients feel rushed through their appointments and prefer the services of dentists that operate on a PPO.  Of course, this is not true of all dentists.  Some people absolutely love their in network DHMO dentist.  Finally, with a DHMO, you may have a deductible you need to meet before your insurance kicks in.  

 

PPO’s

PPO’s have higher monthly premiums, but you have more flexibility with dentist choice.  If you use an out of network dentist, you will still have coverage, just less so than with an in-network dentist. With PPOs, most plans cover 100% of preventative services, 80% of basic services and 50% of major services.  You still need to check with your dentist to determine your costs.  Fees for the same services can swing widely even from county to county.  For example, a root canal for a molar can range from $500 to $2000.  That’s a pretty wide range!  So, if you’re flexible with your choice of dentist, you can certainly ask for prices and get a second opinion to make sure you’re not paying more than need be.  Additionally, most plans will only pay up to $1000-$2000.  After you have reached that cap, you will be on your own for any additional expenses!  Luckily, most plans don’t count preventative services towards these maximums.  There are also plans with much higher maximums.  Additionally, like DHMOs, PPOs may have a deductible you need to meet before your insurance kicks in.  

 

Indemnity Plans

Then there are Indemnity Plans (also known as fee for services plans).  These plans offer ultimate flexibility in the dentists and specialists you see and the coverage offered.  Additionally, indemnity plans have much higher annual caps, so if you need extensive work, this may be a plan to pursue.  However, these types of plans have higher monthly premiums and higher deductibles.  You also have to pay upfront and then complete a large amount of paperwork before being reimbursed.  

 

OTHER OPTIONS FOR DENTAL INSURANCE

If your major concerns are cost savings you may want to look into a discount dental plan (also known as a dental savings plan).  This is not actual insurance, but still a way to save money on dental procedures.  Dentists that accept this type of “plan” offer their services at a drastically reduced rate, but the networks can be rather limited.

If you are enrolled in Medicare, but your spouse is not, you may also be able to join their plan.  Whatever option you choose, please do your research.  As you get older your dental needs may change.  You may need access to more major services or dentures so it’s important to check the coverage level for those types of services.  If you have any questions, you can reach us here at iHealthBrokers at 888-918-0518 or schedule a call today!