Not having dental coverage is a reality for a lot of people. One in four Americans do not have dental insurance and when it comes to seniors over 65, just over half have coverage – this gap being at least partly due to the lack of dental benefits in traditional Medicare (2016).
Regular dental care is important for seniors, and not having dental insurance can result in worse dental health outcomes. For example, those without dental insurance are more likely to require extractions, need dentures or receive treatment for gum disease.
Dental insurance for seniors may be especially important for a number of reasons:
- Gum infections can contribute to chronic health conditions like diabetes, rheumatism, stroke, and heart disease.
- Seniors may be more cavity-prone due to the side effect of dry mouth that is associated with many medications, including those for high blood pressure, high cholesterol, Parkinson’s and Alzheimer’s diseases.
- Gum tissue naturally recedes with age, exposing roots to decay; and a lifetime of use wears away tooth enamel.
- Ill-fitting or poorly maintained bridges and dentures can cause pain and make it hard to eat and sleep well.
- Denture issues can negatively affect nutrition because people without teeth or with dentures, often prefer soft, easily chewed foods instead of more nutrient-rich fresh fruits and vegetables.
So we’ve established that regular dental care is important especially for older adults – and that dental insurance can help you get to the dentist.
In the remainder of this post we’ll talk more about what Medicare does and does not cover when it comes to oral health, and what dental options are available to help seniors get dental care.
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Does Medicare cover dental?
Many older adults lose their dental benefits when they retire and they begin to receive Medicare because the federal Medicare program does not currently cover routine dental care.
Original Medicare does not pay for most dental services, such as:
- Tooth extractions
- Dental plates
- Other dental devices
How to get dental coverage if you have Medicare
Though dental insurance for seniors is not available through traditional Medicare, a couple of Medicare supplement policies may include some level of coverage.
Medicare dental insurance
Medicare Part A will pay for certain dental work when you’re in a hospital. For example, Medicare might pay for a tooth extraction if it is required before heart surgery. Or, a person with oral cancer might have a dental procedure covered prior to radiation. Learn more about Medicare Part A.
Depending on what your Medicare Advantage plan covers and the costs associated with it, you may want to explore other options such as a discount dental plan or private dental insurance.
Supplemental dental insurance for seniors on Medicare – get a quote. It just takes a minute!
Discount dental plans for seniors
A dental discount plan (aka “dental savings plan”) may be a good option for you. These types of plans are not the same as dental insurance.
Here are the key features of dental discount plans:
- Pay a yearly fee – instead of monthly premiums (typically it’s less than $150 for a family)
- No deductible – A discount of 10-60% off covered services is applied when you visit a dentist that is part of the plan’s network – you pay your dentist directly
- No waiting periods – You may be able to use your discount plan within a few days of signing up
Discount dental plans can help even if you have a dental insurance policy because many dental policies have an annual maximum benefits limit that typically does not exceed $2,000.
If you think you could max out your dental policy, a discount dental plan can help you avoid paying full price for dental services.
In addition, if you have some level of dental coverage under a Medicare supplement plan for preventive care, a dental discount plan may be able to help you afford more extensive basic or major care such as bridges, extractions, and dentures.
Private dental insurance
Whether you’re retired but not yet Medicare-eligible or you have Medicare coverage but still need dental benefits, private dental insurance is typically affordable even if you’re a senior on a fixed income.
Remember, dental plans work differently than medical insurance: you select a maximum benefit level and your plan pays a percentage of covered services based on how the service is classified by the policy. If you reach your policy’s annual maximum benefit amount your policy will no longer pay any of your dental costs for the remainder of the year.
Here are a few other things to keep in mind when deciding whether or not a private dental policy is a good value for you:
- Dental insurance plans typically utilize provider networks so make sure your preferred dentist is in the policy’s network or that you’re able to visit an in-network provider near you.
- Be sure to understand the services that are included for preventive, basic and major dental care, and what, if any, copay is required.
- Most dental applicants are accepted regardless of health history though rates are based on your age and where you live.
- With the exception of missing teeth, most policies cover pre-existing conditions.
Find out what a dental policy could cost you and compare multiple plan options.
Don’t forget about vision care!
Remember, Medicare does not cover eye exams or provide other vision care.
If you’re over 60 years old, you have a higher likelihood of experiencing age-related vision changes like macular degeneration, cataracts, and glaucoma.
Regular eye exams and early detection can improve your chances of maintaining good eye health as you age and the American Optometric Association recommends annual eye exams for anyone over 60.
Summary + Next Steps
While buying an individual dental insurance policy results in an extra bill each month, preventive dental care (often covered 100% by dental policies) can actually save you money in the long run by helping catch relatively minor issues early.
It’s easier and less expensive to fill a cavity than to let it go untreated and eventually need to undergo a root canal.
Oral health and dental insurance are important for those over 65:
- Having dental coverage has been shown to encourage preventive oral healthcare and increased visits to the dentist, which in turn supports good overall health.
- Traditional Medicare does not include dental coverage.
- A dental discount plan (not insurance) may be a good option, especially if you have some level of coverage through a Medicare supplement plan.
- If you’re shopping for senior dental plans, make sure you understand how the plan’s cost-sharing works and what the annual maximum benefit limit is.
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