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What You Need to Know About Dental Coverage Before Enrolling in Medicare Advantage in Florida
Even though they are typically more likely than the general population to require dental care, approximately 65% of seniors do not have dental insurance. There are a couple of reasons for this. First, seniors are automatically enrolled in government-sponsored Medicare when they reach the age of 65. Second, most people receive their dental coverage through their employer, which means that they lose it once they retire and leave the workforce.
The lack of affordable insurance options that cover dental expenses is likely to be a major health issue in the coming years since tens of thousands of baby boomers reach the age of 65 or retire every day. For example:
- Approximately 6 million more seniors visited a dentist during 2016 than in 2006.
- In 2016 alone, seniors spent more than $28 billion on dental services.
- The rate of spending for dental services was higher among seniors than any other segment of the population.
- Approximately half of all Medicare recipients did not seek out dental services in the past year. This is due in large part to the lack of insurance coverage.
Why Is It Important to Have Dental Benefits in Florida?
Traditional Medicare, the plan that comes with the red, white, and blue ID card, does not provide coverage for basic dental services, such as exams, cleanings, and fillings. Traditional Medicare will only cover dental services under limited circumstances when they are required as part of a service or procedure covered under Medicare Part A hospital benefits, such as when a dental exam is required as part of pre-surgery clearance. Medicare recipients must look elsewhere for help in paying for preventive, maintenance, or restorative dental services.
What Is the Average Cost for Dental Services Without Dental Insurance?
The cost of dental services varies based on location; however, even a relatively minor procedure can easily run into the hundreds or even thousands of dollars. According to the Kaiser Family Foundation, 19% of Medicare recipients who visit the dentist end up spending more than $1,000 out of pocket. The following are the average costs for some of the most 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 Are the Different Types of Dental Benefits in Florida?
Approximately 25% of seniors enroll in a Medicare Advantage supplement plan while 10% opt to purchase comprehensive coverage through a private insurer. Some patients also take advantage of discount plans or financing options that can be used in place of or in conjunction with insurance.
What Types of Expenses Are Covered Under Medicare Advantage?
Medicare Advantage plans are optional plans that are purchased by the Medicare recipient to expand on the benefits provided under traditional Medicare. Unlike standard Medicare where health care providers are reimbursed by the government, supplemental plans are offered and reimbursed by private insurers, such as UHC, Aetna, and Humana. This also means that you will get a separate ID card from the insurer. Medicare Advantage plans do have a number of benefits, including:
- access to a qualified network of health care providers,
- out of pocket spending limits, and
- low deductibles.
With a low average cost per year, Medicare supplement plans are relatively affordable. In addition to covering X-rays, exams, cleanings, and other basic dental services, these plans also normally include prescription, vision, hearing, and other wellness benefits.
How Does Standalone Dental Insurance Work?
If you have significant oral health issues or want the peace of mind of knowing that you have comprehensive dental coverage, you may want to consider a standalone dental policy. Most standalone dental plans offer tiered coverage, which means that basic services are covered at 100%, basic procedures at 80%, and complex procedures at 50%. With standalone coverage, you typically have the flexibility of choosing from several different levels of coverage with various benefits and price points.
Which Type of Standalone Dental Insurance Should I Choose?
Most private dental insurers offer three levels of coverage:
This plan is suitable for individuals who tend to only see the dentist for basic maintenance and preventative care. Basic plans normally cover X-rays, exams, cleanings, and preventative services.
Unless you are likely to need advanced dental care, mid-level plans offer a nice mix of expanded services to cover most common dental issues. For example, this type of plan typically offers benefits for specialized X-rays, fillings, dentures, inhalation anesthesia, emergency treatment, and even orthodontics.
Premium dental plans typically offer at least partial coverage for even more advanced treatments and procedures, including endodontic and periodontic procedures, oral surgery, crowns, inlays and onlays, and complete or partial dentures.
How Do Dental Discount Plans Work?
Although they are not insurance, dental service discount plans are an affordable alternative to Medicare supplements or private insurance for some individuals. Instead of a premium, discount plans charge a low enrollment and monthly membership fee. In return, members receive special discounted rates at participating providers. In addition to being affordable, discount plans have a number of other advantages:
- You pay the provider directly, so there are no claim forms to fill out.
- Discount plans normally accept anyone regardless of age or pre-existing conditions.
- There are no exclusion periods, so you can use your benefits right away.
- You don’t have to worry about copays, deductibles, or coinsurance obligations.
- There are no restrictions on the number of times that you can use your benefits during the year.
- You are free to change providers at any time instead of having to wait for the next enrollment period.
- Most discount plans also provide discounts for prescriptions, hearing and vision services, and other wellness services.
While discount plans, such as DentRite, offer significant discounts on services ranging from checkups to root canals, they are most appropriate for individuals who are in good oral health and unlikely to need advanced dental work. A comprehensive insurance plan may save you more money if you are likely to need extensive dental work.
What Are My Options If I Have Out-of-Pocket Costs in Florida?
Even without a Medicare supplement, private insurance, or discount plan, there are still ways to make the cost of dental services more manageable. Many dental providers now offer flexible payment plans and financing options. One such financing option, CareCredit, is accepted by hundreds of thousands of providers and wellness facilities across the country. Medical financing companies offer qualified patients short-term financing of up to 24 months as well as long-term financing of up to 60 months for large balances. Depending on your circumstances, it may be possible to get promotional financing with no interest as long as the balance is paid in full by the specified date. There are a couple of factors you should consider when financing dental services. First, you do have to meet certain income and credit criteria in order to be eligible. Second, you can expect to pay an average of 15% to 20% interest, which will increase the final cost of your treatment.
It is also a good idea to check with AARP and other senior organizations for further information on discounted professional services and various insurance plans. Call our office today for more information on dental benefits in Florida