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Know the Facts About Dental Coverage Before Enrolling in Medicare Advantage in Bradenton
While age and various health concerns often place adults over the age of 65 in greater need of dental services than the rest of the population, they have surprisingly few options when it comes to affordable dental services and insurance coverage. One reason for this is that most Americans receive dental coverage through their employer, so they are no longer covered once they retire. Sadly, about 65% of seniors end up without coverage for essential dental services, and the number is only going to grow with the aging of the baby boomers. Despite the lack of insurance options, seniors spent nearly $30 million on dental services in 2016 and had the highest growth rate in dental spending of any demographic group.
Why Do I Need Dental Benefits in Bradenton?
Adults over the age of 65 are automatically enrolled in Medicare and receive the familiar red, white, and blue ID card. Traditional Medicare only covers basic dental services under extremely limited circumstances. For example, you may be covered for a basic dental exam if it is needed as part of the pre-surgical clearance process for a procedure covered under your Medicare Part A hospital benefits. This means that you must look elsewhere if you want coverage for basic preventive care or advanced dental services.
How Much Can I Expect to Pay Without Dental Benefits in Bradenton?
A recent study by the Kaiser Family Foundation found that approximately 50% of Medicare recipients had not received dental care in the past year and that 19% of those who did seek care ended up incurring more than $1,000 in out-of-pocket dental expenses. Of course, out-of-pocket costs can vary based on the type of service received and your location, but the following provides a rough estimate of what you might expect to pay for common dental procedures:
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 Types of Plans Cover Dental Care?
Medicare recipients looking for dental benefits in Bradenton typically must choose from among the following options: Medicare Advantage supplement, a standalone dental plan from a private insurer, a dental service discount plan, or payment and financing options.
Do Medicare Advantage Plans Include Dental Coverage?
Approximately 25% of Medicare beneficiaries purchase an optional Medicare Advantage supplement. These plans offer benefits in addition to those offered by traditional Medicare, including basic dental benefits as well as coverage for vision and prescription drugs. Supplement plans are offered and reimbursed by private insurance companies, such as Aetna, Humana, and UHC, and not the federal government. Since they are separate from your primary Medicare plan, you will likely have a separate ID card. With average premiums of just hundreds of dollars per year, Medicare Advantage plans are relatively affordable and provide you with price protection benefits, such as caps on out-of-pocket expenses and low deductibles. The one drawback is that most plans limit dental coverage to basic services, such as cleanings, exams, and X-rays, which could still leave you with significant out-of-pocket expenses if you need extensive dental work.
Is Standalone Dental Insurance an Affordable Option?
A standalone dental policy normally offers the most comprehensive benefits. Most companies allow you to choose from different levels of coverage based on your needs and budget. The average cost of a private dental plan is usually between $300 and $400 per year, which is generally lower than most Medicare supplements. While you may get more coverage for dental services under a standalone dental policy, you normally do not get the additional hearing, vision, and prescription drug benefits associated with Medicare supplement plans.
What Types of Services Are Covered by Standalone Dental Insurance?
Most dental plan providers offer “100-80-50” tiered coverage. This means that services and procedures are covered at either 100%, 80%, or 50% based on the nature and complexity of the service or procedure. Most providers also offer at least three levels of plans that cover different types of services.
These are the most affordable plans and normally only cover basic preventative and maintenance services and procedures, such as cleanings, exams, and X-rays.
These plans provide a nice balance of services. In addition to the basic services offered under the lower plan, you also get coverage for more advanced services, such as dentures, specialized X-rays, orthodontics, emergency services, fillings, and inhalation anesthesia.
Premium plans are obviously the most expensive, but they also offer the most comprehensive services, including:
- Dental restoration services, such as crowns, inlays, and onlays.
- Tooth replacement services, such as complete or partial dentures.
- Advanced treatment for gum disease and other conditions, such as oral surgery and endodontic and periodontic procedures.
What Are the Benefits of Dental Discount Plans?
Dental service discount plans are offered by private companies that negotiate discounted rates for dental services with providers. Unlike dental insurance where you pay a monthly or annual premium, discount plan members pay an enrollment fee along with a low monthly membership fee. Instead of the discount provider reimbursing the dentist for the procedure or service, you pay the dentist directly at the discounted rate.
These plans do not cover as much as traditional insurance; however, they are an affordable way to lower the cost of common services, such as: routine dental exams, X-rays, fillings, root canals, dentures, crowns, cleanings, and extractions.
Many popular discount plans, such as DentRite, also offer discounts for other health and wellness services, such as glasses, hearing aids, and prescriptions.
The fact that everything is pre-negotiated does have several advantages:
- You never have to worry about copays, deductibles, or coinsurance obligations.
- There are no mandatory waiting periods, so you can use your benefits right away.
- There are no limits on the number of times that you can use your benefits during the year.
- You are free to change your dentist at any time.
- Most discount plans do not exclude on the basis of age or pre-existing conditions.
- There are no claim forms or other paperwork to fill out.
While discount plans are a viable option for many patients, you may be better off purchasing a comprehensive dental plan if you suspect that you will need extensive dental work.
What Are My Options If I Don’t Have Dental Insurance?
Even if you choose to pay for your dental services out of pocket, there are ways to make the cost more affordable. Many dentists now offer payment and financing options for qualified patients. For example, CareCredit provides financing for dental and medical services and is accepted nationwide by more than 200,000 health and wellness providers and facilities. Medical credit providers typically provide short-term financing of up to 24 months for small balances. Some companies even offer financing periods as long as 60 months for larger balances. Of course, the financing company will review your credit to make sure that you qualify. Interest rates can also be rather steep at 15% to 20%.
Senior organizations, such as AARP, can also provide you with information on everything from discounts on professional services to special rates for various types of insurance. If you’re looking for options for senior dental care, give us a call today.
Call us at (941) 584-4356 today to schedule your appointment or book an appointment online.