What Every Senior Needs to Know About Dental Care and Medicare Advantage in Connecticut
Even though adults over the age of 65 typically have the least access to affordable insurance coverage for dental services, they are perhaps the demographic most likely to need both routine and advance dental procedures. Even with the lack of insurance alternatives, the growth rate of dental spending among seniors was higher than in any other group. In fact, 6 million more seniors sought dental services in 2016 than in 2006, and the trend does not seem to be slowing. In 2016 alone, seniors spent nearly $29 billion on dental services. Even with the rapid growth of dental spending among seniors, far too many older adults go without dental benefits.
Like any type of medical service, the cost of even a routine dental visit can easily cost hundreds of dollars. A survey conducted by the Kaiser Family Foundation found that nearly one-fifth of Medicare recipients who received dental services in the past year incurred more than $1,000 in out-of-pocket costs. Although cost can vary significantly based on your location and the specifics of your dental issue, the following are examples of the expenses that you might incur 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 Options Do I Have for Dental Benefits in Connecticut?
The majority of Americans get their dental coverage through their employer, which means that they lose that coverage once they leave the workforce. Traditional Medicare, which is the primary source of health benefits for individuals who are permanently disabled and adults over the age of 65, only covers dental procedures when they are required as part of another procedure covered under Medicare Part A hospital benefits, such as a basic exam conducted for presurgical clearance. Because of limited affordable options for dental benefits, approximately 65% of seniors go without essential dental coverage. With more than 10,000 baby boomers reaching retirement age every day, that percentage is likely to increase significantly in the next few years. Of seniors who do have dental coverage, approximately 25% receive their coverage through a Medicare Advantage plan. Another 10% purchase standalone coverage through private insurers.
Do Medicare Advantage Plans Provide Dental Benefits in Connecticut?
It is possible to get dental benefits in Connecticut by purchasing a Medicare Advantage plan. These are optional supplements that expand the coverage offered by traditional Medicare. In addition to getting access to a preapproved network of providers, you also get the benefit of low deductibles, out-of-pocket spending limits, and other cost-sharing measures. While the government reimburses the providers for services covered under traditional Medicare, the benefits offered under Medicare supplement plans are reimbursed by private insurers, such as UHC, Humana, and Aetna. In most cases, you will receive a red, white, and blue ID card for your traditional Medicare and a separate card for your supplement. In addition to vision and prescription drug coverage, most Medicare supplement plans also cover basic dental exams, routine cleanings, and standard dental X-rays. According to MedicareAdvantage.com, the average cost for a Medicare supplement is just over $400 per year. Since the dental benefits are relatively limited in scope, you may still face significant out-of-pocket expenses if you need a complex procedure or have multiple dental issues.
How Does Standalone Dental Insurance Work?
Private dental insurance plans typically operate on a tiered coverage structure. This means that routine and prophylactic services are normally covered at 100%, fillings and similar procedures are covered at 80%, and advanced procedures are covered at 50%. Your premium, as well as the types of services covered, will vary based on the level of plan that you choose. A Bankrate study found that the average cost of standalone dental insurance was $350 per year. While this may be lower than the cost of most Medicare Advantage plans, most private dental plans do not include additional vision, prescription, or hearing benefits.
Basic Dental Plans:
A basic dental plan typically provides coverage for minor preventative and diagnostic services, such as cleanings, routine exams, and basic X-rays.
Mid-level Dental Plans:
A mid-range dental plan offers a wider variety of coverage for services than a basic plan, including dentures, fillings, inhalation anesthesia, emergency services, advanced X-rays, and orthodontics.
Premium Dental Plans:
If you have a history of oral health issues or anticipate needing advanced dental procedures in the near future, your best option may be a premium dental plan. Although they come with the highest premium, top-tier plans normally offer partial coverage for advanced treatments and procedures, such as restorations, including crowns, inlays, and onlays; complete and partial dentures; endodontic and periodontic procedures; and oral surgery.
Are Dental Discount Plans Worth the Money?
If you are looking for an affordable option to traditional insurance, you may want to enroll in a dental discount plan. You purchase discount plans from private companies that have locked in discounted rates for dental and other types of services with participating providers. You simply pay a small fee at the time of enrollment followed by your monthly membership fee to the plan provider and then pay the dentist a flat discounted rate at the time of service. In addition to the low price, discount plans do have some advantages over insurance, including:
- You can see the dentist as many times as you want during the year.
- Your benefits go into effect right away.
- You don’t have to worry about additional fees, such as copays.
- You can switch dentists at any time.
- You can add family members to your plan.
- There are no claim forms to complete.
- You cannot be denied because of age or preexisting conditions.
- You can cancel the plan within 30 days and receive a full refund minus a small processing fee.
While the coverage may not be as extensive as private insurance, discount plans can lower the cost of many dental services, including:
- Root canals
- Routine exams.
As an added bonus, DentRite® and other discount plans typically also include discounts for hearing services, eye exams, and prescription medications. Discount plans make the most sense for individuals who are in relatively good oral health. If you anticipate needing major dental work, you may want to invest in a standalone dental plan that provides comprehensive coverage.
How Can I Manage the Cost of Dental Care Without Insurance?
Since many dental providers now offer payment plans, financing options are a popular way to make dental expenses more manageable. For example, CareCredit is accepted by hundreds of thousands of health and wellness providers across the U.S. Most medical credit companies offer short-term financing for up to two years for smaller balances. Depending on the circumstances, it may be possible to avoid interest if you pay your entire balance before the end of the promotion. Some companies also offer financing of up to five years for larger balances. The primary drawbacks of medical financing are that you do have to meet the company’s credit qualification criteria, and you can end up paying interest rates ranging from 15% to 20%.
If you would like to research your options further, AARP and other senior advocacy groups can provide you with more information regarding insurance and discount options for dental and other professional services.