What to know about dental insurance for seniors on Medicare

Finding good dental care for seniors is important to overall health! As the American Dental Association (ADA) says, the relationship between oral and general health is especially pronounced for older adults. Original Medicare is a great option to get care as we get older but it does not offer coverage for most dental care, so you’ll need to get coverage from a Medicare Advantage plan, standalone insurance or dental discount programs. Let’s discuss a few options to get the dental care you need!

Does Medicare have dental plans for seniors? 

Original Medicare does not cover most dental care including cleanings, fillings, tooth extractions and dentures. (We talked more about the gaps left by Original Medicare including dental coverage in a previous blog post.) Medicare Part A may pay for certain dental services received in a hospital (e.g., emergency dental procedures). Part A can pay for hospital stays if you need to have emergency or complicated dental procedures, even though it doesn’t cover routine dental care.

Medicare Supplement (Medigap) plans can help you fill in some of the gaps left by Original Medicare, including copayments and deductibles, but these plans do not include dental care. Many Medicare Advantage plans include dental care coverage, including preventive services like cleanings and comprehensive services like crowns and dentures. Coverage and offerings vary by plan so be sure to research the plan you’re interested in to see what they offer.

How does dental insurance for seniors work? 

To get coverage for the routine and preventive dental care you need, you have a few options.

Option #1: Enroll in a Medicare Advantage Plan.

Medicare Advantage plans like ApexHealth cover the same emergency or complicated dental procedures as Original Medicare, and they can also cover routine dental care services. Coverage varies by plan, so be sure to research the plan you’re interested in to see what they offer.

ApexHealth’s Medicare Advantage plans include ApexExtras with first-dollar preventive and comprehensive dental coverage including crowns, dentures, extractions and more. Compare our plans online or reach out at (844) 279-0508 (TTY: 711) to learn more from an ApexAssistant. To find a dentist that’s part of our provider network, try our online search tool.

Option #2: Choose a standalone dental insurance plan.

As Healthcare.gov explains, a standalone plan is offered through the Marketplace and is not included as part of a health plan. Standalone plans can be helpful if the plan you choose doesn’t include dental or if you want different dental coverage. Keep in mind if you choose a separate dental plan, you’ll pay a separate, additional premium.

Option #3: Explore discount dental programs.

A dental discount plan works like a club with an annual fee-based membership. Healthcare insurance.org explains that these plans provide discounts from participating parties instead of covering dental expenses.

What are the pros and cons of each dental insurance option? 

Each dental insurance option has pros and cons. Let’s look more closely at the advantages and disadvantages!

Medicare Advantage plans

A pro of a Medicare Advantage plan is that most plans offer all-in-one coverage for medical care, prescription drugs and supplemental benefits. Most Medicare Advantage plans also use copays instead of coinsurance meaning you pay a fixed, lower out of pocket cost. Depending on the plan you choose, you may be able to get first-dollar preventive and comprehensive dental coverage including crowns, dentures, extractions and more. A con of a Medicare Advantage plan is that some plans require a referral to see a specialist.

Standalone dental insurance plans

A pro of purchasing a standalone dental insurance plan is that you can choose a plan that only covers your needs. This option is best suited for people who don’t need much ongoing dental care. However, there are a few cons. First, it can be challenging to choose the correct plan, and second, additional costs can add up if you need unexpected care. Remember, you will be responsible for paying an additional premium on top of your other Medicare costs.

Discount dental plans

A pro of dental discount plans is that there’s no limit to the amount of care you can get during the year. You will pay out of pocket for every discounted service, but you can use as many services as you like each year. However, the cons are that you will only be able to receive discounted services from in-network dentists. Also, if you have ongoing dental issues, you may end up spending more money.

What do dental plans for seniors cost?

Dental coverage varies by Medicare Advantage plan, so check with the plan you’re interested in directly to find out any costs associated with the plan. Also, check with the plan to find out what’s covered, whether you have to use a provider within a plan’s network or if there’s an annual limit on dental coverage. 

ApexHealth’s Medicare Advantage plans include dental coverage. Compare our plans online or reach out at (844) 279-0508 (TTY: 711) to learn more from an ApexAssistant. To find a dentist that’s part of our provider network, try our online search tool. Also, remember that once you’re a member, your ApexAssistant will be there to answer any questions you have about dental costs and coverage with your plan. 

For standalone dental plans, remember that you will pay the premium in addition to your Medicare costs. This amount varies by plan, but you can use tools like HealthInsurance.org to get an idea for an estimate in your state. At the time of publication, in South Carolina, premiums range from $36 to $70 per month and in North Carolina, $42 to $102 per month.

With a discount dental plan, you will pay annual fees up front and still be responsible for paying out of pocket for dental procedures, even at their discounted rate. Reach out to the plan to see what those fees are before purchasing coverage.

What are some tips to improve oral health and save money on dental care?

There are a few things you can do to stay healthy and reduce the amount you’ll pay overall for your dental health. Here are some tips from the ApexHealth team. 

Tip #1: Invest in preventive care. 

To keep costs down and ensure you stay healthy, make sure you’re keeping up on a regular dental care routine. Follow dental recommendations including brushing your teeth, flossing and getting regular check-ups. Paying for these less expensive services now could reduce your chances of paying for expensive procedures later.

Tip #2: Find a good dental provider. 

Working with a good dental network can provide the best comprehensive oral care to help you live life boldly! Compare our plans online or reach out at (844) 279-0508 (TTY: 711) to learn more from an ApexAssistant. To find a dentist that’s part of our provider network, try our online search tool.

Tip #3: Enroll in a Medicare Advantage plan with dental coverage. 

Since Original Medicare does not cover routine dental care, enrolling in a Medicare Advantage plan with supplemental dental coverage may be your best option. According to the Kaiser Family Foundation KFF, 94% of people enrolled in a Medicare Advantage Plan are enrolled in one which offers dental coverage. Dental benefits from a Medicare Advantage plan can help offset annual dental care costs. 

Dental insurance can save you money and contribute to better oral health and overall health. Think carefully about your dental care needs and find the best dental insurance coverage to get the care you need for the life you lead. 

If you have any questions about dental coverage through ApexHealth, or if you want help finding an in-network dentist, give us a call at (844) 279-0508 (TTY: 711) to speak with a licensed representative or an ApexAssistant. Our hours of operation are Monday through Friday 8 a.m. – 8 p.m. (local time) from Apr. 1 through Sept. 30 and seven days a week 8 a.m. – 8 p.m. (local time) from Oct. 1 through Mar. 31.

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