Seniors that need dental care sometimes receive a shock at the cost. Seniors that assume that because they have Medicare they have dental insurance likely receive quite a shock when discovering that is not the case.
This comprehensive dental insurance guide from The Senior List provides information about dental insurance for seniors, options for seniors in need of dental insurance that do not have coverage and information about seniors and oral health.
Dental Insurance Through Medicare and Medicaid
The fact that Medicare does not provide dental insurance coverage likely stuns seniors that assume Medicare pays for all their health care needs, including dental care. The Medicare website specifically states that Medicare does not provide coverage for routine dental care, procedures or dental appliances such as partial plates or dentures. That means that Medicare does not pay for cleanings, dental exams, fillings or extractions. Seniors are virtually on their own, responsible for 100 percent of all their dental care needs unless they have dental insurance.
Seniors that receive Medicare Extra Help potentially assume that because they have benefits through Medicaid that Medicaid provides dental insurance for their oral health care. Seniors that receive Medicare Extra Help do have some Medicaid benefits, but those benefits do not include dental insurance coverage.
Younger individuals or children in families that receive traditional Medicaid benefits likely have some included dental coverage. Seniors receiving Medicaid because of receiving Medicare Extra Help are in another Medicaid classification. The Medicaid for seniors is typically referred to as Qualified Medicare Beneficiary (QMB).
The benefits paid by Medicaid under the QMB program help cover costs not covered by Original Medicare for eligible low-income seniors, such as Medicare deductibles, co-pays and co-insurance. The QMB program does not provide dental insurance coverage.
The various states administer their own Medicaid program, making it important that seniors receiving Medicaid fully understand their benefits. You do not want to have dental work done and discover that you have 100 percent responsibility for the costs of service.
The fact that Medicare and Medicaid do not provide dental insurance possibly affects the oral health of seniors that cannot afford dental care because of having no dental insurance.
Seniors and Oral Health
Good oral health is a major issue for many seniors. The Centers for Disease Control and Prevention (CDC) indicates that one of the factors contributing to older Americans with the poorest oral health is having no dental insurance. One of every five adults over the age of 65 has untreated tooth decay, and an estimated 68 percent of seniors have gum disease.
Another factor affecting oral health of seniors is dry mouth caused by medications. Dry mouth contributes to tooth decay because of the lack of saliva in the mouth.
Seniors without dental insurance possibly feel that they lack information about resources for dental care and dental insurance. There are several dental insurance options for seniors.
Dental Insurance for Seniors
Seniors that continue to work often have some dental benefits through their employer. If you have the option of enrolling in a dental insurance plan at your job, you provide yourself with insurance that covers a portion of your dental care costs. Most employees pay for dental insurance through a small payroll deduction and then pay a certain percentage of the costs for their dental care.
Some Medicare Advantage plans offer dental insurance coverage. If you already have a Medicare Advantage plan, check to see if you have dental coverage. When you consider Medicare Advantage options, determining whether a specific provider offers dental insurance is a possible contributing factor to the plan that seniors choose for their Medicare Advantage options.
Seniors that have Medigap possibly have dental insurance options. Check for dental insurance add-on coverage information. Call the company providing your Medigap plan to learn whether dental insurance is an option for you.
Individual dental insurance plans are a possible option for seniors. Some insurance companies that sell health insurance plans, life insurance or burial insurance plans to seniors offer dental insurance. Visit the website or ask your insurance agent or company representative if they provide dental insurance. You can also take a look at our list of the best dental insurance for seniors here.
If you do not already have other types of policies, you still have options that allow you to purchase an individual dental insurance plan. Read the plan information carefully, making sure that you note any limitations on coverage, such as waiting periods, maximum benefit amounts payable throughout the year, types of services covered and how to file a claim.
Most seniors pay out-of-pocket for more advanced procedures, such as crowns, root canals, and dentures, particularly if they do not understand limitations on their dental insurance plan. Kiplinger Associate Editor Mary Kane points out that the limitations on many individual dental insurance plans means that they typically are not set up to cover more extensive dental care needs, partly due to caps on coverage. If your annual maximum dental coverage is $1,000 and your dental care costs $2,000, that means that you pay $1,000 even though you have dental insurance.
Seniors that consider a dental discount plan have the responsibility of making sure that they understand their costs associated with joining the dental discount plan. Make sure your dentist accepts a specific discount plan before joining and paying any fees. If your dentist does not accept the plan and there is not a qualified dentist in your area that does accept a particular dental discount plan, then you paid the costs of joining a plan that you cannot use for lowering your dental health care costs.
Do You Need Immediate Dental Care?
If you do not have dental insurance, and have immediate oral health needs, consider your county community health care agency. Some county health departments have dental clinics for low-income residents. Check for specific days and times of operation.
Make sure you know the services provided before going on a given date and waiting your turn. Most community agencies provide services such as cleanings, fillings or extractions at reduced cost. They do not perform complicated procedures and do not provide crowns or dentures.
Local colleges sometimes have dental clinics, with work performed by dental students. Care is likely limited to services similar to that of community agencies, and like with the community agencies, arrive early for the first-come, first-serve dental care.
Some communities offer dental care events for residents, including seniors. The Dental Lifeline Network provides dental services for seniors that are over the age of 65, have a permanent disability, or are medically fragile. They provide the services through a network of dental professionals, and other volunteers.
When you visit the website, click the link to apply for help. Many communities have a long waiting list and are not currently accepting additional applications. This is the same situation with America’s Dentists Care Foundation, an organization that offers free community events in several states. Click the link on the website to find a community event in your area. The list changes often so check back if there is not a current event in your area.
Community dental events typically limit care to one service. Patients receive a cleaning, one tooth filled, or one tooth extracted. These limitations allow volunteer dentists and staff to help more patients.
Community events and agencies are not ongoing sources of dental care. Seniors living on a limited budget likely feel they cannot afford dental insurance. This dental insurance guide from The Senior List provides seniors with detailed information about dental insurance, which likely costs far less than paying 100 percent of all dental care needs.