It goes without saying that as we age, our bodies require more attention than they used to. But one facet of our health that we can overlook is how we care for our teeth, even though regular dental care can save us from many resulting ailments and discomfort. Since most Medicare coverage doesn’t include dental insurance, it’s no surprise that nearly 50 percent of older adults aged 65-80 don’t have dental insurance at all.
While some older adults receive the care they do get through retirement plans, Medicare Advantage options, or employer-based plans, nearly 20 percent get their dental insurance through an individually purchased plan. In this article, we’ll take a look at some of the broad strokes of dental coverage for older adults, and then highlight three providers offering plan options that can work for different seniors based on different needs.
What is Dental Insurance for Seniors?
Oftentimes when we think of our teeth, we think of them in terms of aesthetic (how they look), function (how they help us eat), and feel (if they’re causing us pain), but we may be failing to realize how they’re affecting our overall health. Our mouths are significant sources of bacteria—which generally work on our behalf—and they’re also the entry point for our digestive and respiratory systems. Infections from untreated dental and oral maladies can have wide-reaching implications for our bodies.
Think of dental insurance as you would standard health insurance: your chosen plan has a list of benefits, a provider network, copays, other out-of-pocket costs, and monthly premiums. Every dental insurance plan will have some sort of listed services that they cover; with routine checkups and cleanings generally being fully covered, and higher-level procedures like root canals, fillings, extractions, and other care like dentures (prosthodontics) being covered at some kind of split between out-of-pocket and insurance-covered expenses. The split can be 50/50, 80/20, and so on, depending on the type of plan you select. Some dental plans even bundle vision insurance together to provide all the supplemental coverage you may need beyond your health insurance.
What Are Dental Discount Cards?
Another facet of the dental insurance market is what’s known as dental discount cards or savings plans. These cards are supplemental to dental insurance and not a replacement; instead, a cardholder will pay an annual fee instead of a monthly premium. A discount plan holder will receive special discounts and reduced prices on select procedures outlined in the plan.
While dental discount plans aren’t insurance, they could be a cheaper option for those who can’t afford insurance and are instead paying for all dental work out of pocket. Discount plans, like insurance, give customers a limited list of providers to choose from; and practitioners that participate in the dental discount plan have agreed to the reduced pricing structure associated with the card. These discount plans are not insurance, and payment for dental procedures is given directly to dentists.
What to Consider When Choosing a Dental Insurance Plan?
Navigating the dental insurance market can be a bit nerve-racking, not unlike going to the dentist. However, when evaluating plans, there are some things to keep in mind that can make the process a little easier. Let’s explore some of these considerations.
Which Dentist You Can Choose
Many dental plans for older adults are managed care plans, meaning the providers have agreed to offer their services at a reduced rate. Because not all providers will participate, that typically means networks are limited, and you’ll be choosing a plan based on a list of their participating providers.
When evaluating plans, it’s important to research which providers are included and select a plan that features either a dentist you know, and trust (or has been referred to you) or is close by and easy to access. If you have a current dentist you like, check with them and see which insurance they accept, it could help influence your decision as you’re weighing options.
What the Plan Covers and What You’re Paying For
This consideration is the crux of choosing dental insurance. Unlike medical insurance, which has a much more comprehensive range of potential procedures from hip replacements to cancer treatment, the dental care procedures menu is much more limited and easier to itemize. Before selecting a plan, it’s not only essential to get a full range of what procedures are covered, but what these procedures will cost you when all is said and done.
When evaluating potential plan options, take a long look at which procedures are covered based on any potential outcomes you can see for yourself. Obviously, no one can predict the future, but if you’re signing onto a dental insurance plan that requires you to pay 90 percent of prosthodontic care when you’re at an age when dentures may be in your immediate future, it may not be the best plan for your needs.
Beyond treatment care, there are some additional costs associated with dental care that you should consider in a dental plan. One of these costs is the potential out-of-pocket cost for office visits. Another figure to consider is the deductible, meaning how much you will have to pay out of pocket before insurance kicks in. Some plans also have insurance caps, which are a maximum cost that the plan will cover in a given year.
The best insurance will offer minimal out-of-pocket costs; generous price splits for standard procedures, high annual caps, and low deductibles. Still, as with everything, these figures tend to exist in some balance, with certain elements being higher than others.
Pro Tip: PPO vs. HMO Plans: One other differentiation point between dental plans is PPO (Preferred Provider Organizations) and HMO (Health Maintenance Organizations). As a general rule, we recommend selecting a PPO plan if possible for your price range. HMOs tend to offer lower deductibles, which can mean more out-of-pocket expenses, fewer treatment options, and limited provider networks.
#1 Cigna - Best Overall Plans
What We Like Most:
- Three plan options to choose from
- Deductibles and copays waived for preventive care
- 24/7 customer service and simple claims management
- Low-premium plans available
Cigna offers three plan options, Dental Preventative, Dental 1000, and Dental 1500, with the lowest estimated premium prices starting at just $19 per month. Cigna may be an excellent option for those looking for basic and preventative care; let’s break down some of the finer points of their plans.
- Finding a Dentist: Cigna has a pool of more than 90,000 practitioners to choose from, which can be easily searched on their website. What’s more, Cigna offers a “Brighter Score” tool, which rates practitioners on their affordability and patient experience rating.
- Making a Claim: With Cigna, your dentist files your claims for you in-network, and online claims management and dedicated apps make it easy to track claims statuses.
- Deductibles: Deductibles vary among the three plans, with Cigna 1000 and 1500 each having $50 and $150 deductibles for individuals and families, respectively. The Preventive plan has no deductible. One thing we loved about Cigna because none of the plans charge deductibles for preventive and routine care.
- Copays: With Cigna, copays can vary based on the dentist you see, but like deductibles, for all plans, copays are waived for preventive care.
- Out of Network Coverage: Like most dental insurance plans, out-of-network coverage is available with Cigna, but prices will be higher for that care.
- Restrictions: Certain restrictions exist in all of the plans; for example, the Preventive plan covers routine preventive care but nothing else. It’s best to consult the individual plans for a more detailed explanation of restrictions.
- Extension of Benefits: If you had consistent dental coverage for 12 months preceding Cigna care, some waiting periods can be exempted with the 1000 and 1500-level plans.
- Cost: Costs are always variable, but the low-end estimates for each plan’s premiums are: $19 per month for Preventive, $30 per month for 1000, and $35 per month for 1500.
- Lower cost plans starting at less than $20 per month
- Copays and deductibles waived on preventive care
- Simple claims process and 24/7 customer support
- Brighter Score ratings help choose practitioners
- $1000 and $1,500 maximums set for the 1000 and 1500 plans
- Added restrictions and differing coverage in Maryland and New York
#2 Aetna - Best Coverage
What We Like Most:
- Extensive network with more than 372,000 providers to choose from
- Easy-to-use quote tool and provider look-up portal
- No-cost preventive care
- PPO plans
Aetna has two plans to choose from, with one plan, Direct Core PPO, offering lower premiums and the other, Direct Preferred PPO, providing more favorable splits in payment for basic procedures like fillings and extractions.
- Finding a Dentist: The Aetna portal is intuitive, allowing members to search from nearly 372,000 practitioners by specialty, area, and the number of miles they’re willing to travel.
- Making a Claim: As an industry leader in health insurance, Aetna’s claims and customer service process is one of the best in the business, with a suite of tech tools and apps to help track your claims.
- Deductibles: Deductibles are relatively low, with both plans requiring $50 for individuals or $150 for families.
- Copays: Aetna’s plans have variable copays that can change based on the type of procedure or whether you’re visiting a specialist; it’s always best to confirm copay costs ahead of time.
- Out of Network Coverage: Aetna supports out of network coverage, but choosing an out-of-network provider will likely be more costly as they don’t qualify under Aetna’s negotiated prices.
- Restrictions: There are several procedures not covered by Aetna, so it’s best to consult their full list of restrictions. Also, it’s important to note that Aetna insurance is unavailable in Massachusetts.
- Extension of Benefits: In certain circumstances, Aetna will cover some treatments beyond existing benefits; if you had denture impressions done before your plan kicked in, for example. But most of these circumstances are case by case and should be discussed with Aetna before you decide on a plan.
- Cost: Plan premium costs depend on a number of factors, including location and patient type. Generally speaking, however, the lowest premium cost for their Preferred PPO plan is around $75 per month, and the Core PPO plan runs roughly $65 per month.
- Broad network coverage
- Easy to navigate benefits and provider network
- Routine care is fully covered
- High out-of-network costs
- Limited number of available plans
- Unavailable in Massachusetts
#3 Delta Dental - Best for Retirees
What We Like Most:
- A wide range of plans including both PPO and HMO options
- Deductible-free plan available
- AARP discounts available
- Coverage offered in all 50 states
Delta Dental is the largest dental insurance provider in the U.S.—mainly because of its partnership with AARP—with a customer base exceeding 80 million Americans. Because of their relationship with AARP, Delta Dental offers specific services geared towards seniors, unlike most dental insurance providers. Let’s break down some of Delta’s offerings.
- Finding a Dentist: Delta Dental has an easy-to-use online portal to search for dentists in your area based on the dental insurance plan you have; you can even filter results based on specialty.
- Making a Claim: The claims process for in-network care is handled by the practitioner, while out-of-network claims may need to be filed separately.
- Deductibles: Delta Dental offers two PPO plans, plan A and B, which have a $40 and $90 deductible, respectively. They also offer an HMO plan, DeltaCare® USA, which has no deductible.
- Copays: Copays range among the three plans, with the PPO Plan A requiring no copays for visits (but higher premiums), Plan B requiring a 20 percent copay cost, and DeltaCare® USA working off a flat $5 copay for office visits when you go to a preselected primary care dentist.
- Out of Network Coverage: Plans A and B are less hard on customers who receive out-of-network care, but prices are still higher for that care. DeltaCare® USA is an HMO-style plan predicated on a customer receiving care from a dedicated primary care dentist, with little flexibility for out-of-network care.
- Restrictions: Restrictions for Plans A and B are mostly limited to waiting periods, after which specific procedures are available. DeltaCare® USA works primarily off itemized copays for specific procedures, which offer fixed costs on everything from cleanings to orthodontics.
- Extension of Benefits: Continuing coverage is a bit of a gray area with Delta Dental, so if you’re concerned about an extension of benefits it’s best to speak to their customer service team for specifics.
- Cost: PPO Plans A and B come with higher premiums (starting at $72 and $50, respectively), but offer more equitable splits in how much you have to pay for procedures. DeltaCare® USA is only $27 per month but requires higher out-of-pocket payments for procedures.
- Both PPO and HMO options available in all 50 states
- Plans geared specifically towards seniors, which take into account procedures more common for older adults
- Immediate coverage for common procedures like denture repair and root canals
- Widely accepted, nationally popular plan
- Relatively high premiums on PPO plans
- Deductibles and annual maximums on PPO plans
- Waiting periods for certain procedures on PPO plans
Wrapping Up the Best Dental Insurance for Seniors
Regardless of the dental insurance you decide is best for you—and remember, the three we highlighted here are just a sampling of what’s available—the important thing to remember is that good dental health can save you from a host of more serious health risks. The dental insurance market can be difficult to navigate, but hopefully, with a little research, you’ll be showing your loved ones your pearly whites long into your golden years.
- Does AARP have a dental insurance program?
While AARP doesn’t issue or administer dental insurance themselves, they have a partnership with Delta Dental which offers multiple plans for seniors at a discounted rate for AARP members.
- Is dental insurance for seniors worth it?
While some plans can be extremely expensive, there are affordable dental insurance options available to seniors that can catch potential health risks before they become serious. Dental health is an important aspect of overall physical health, and seniors who neglect it later in life could suffer from a number of related health risks.
- Is it cheaper to pay out of pocket for dental?
Like most insurance, dental insurance is worth it if you use it. For younger people with healthy teeth, it may be more cost-effective to pay for dental care out-of-pocket because treatments are typically inexpensive and infrequent, while seniors and those requiring more expansive dental care may require procedures that can become quite expensive when not defrayed by insurance.