About our Dental Plans for Seniors Catalog
Original Medicare doesn’t offer regular dental care. It’s not covered by Medicare Supplements, either. And, most Medicare Advantage plans that offer coverage – which are very few – don’t offer full coverage, and the coverage they do offer is almost impossible to decipher. That’s why we created this catalog of top dental plans for seniors.
We want to be clear that the dental coverage products we’ve organized are not specific to seniors. As we scoured what’s available, and looked at overall customer satisfaction, we felt these were the best and most affordable dental plans available.
What follows is a discussion of the various types of plans, how they work, and how you can use some plans together to get even more (and cheaper!) coverage. So, keep reading.
Why is the Dental Coverage Offered by Medicare Advantage Plans so Limited?
Don’t get us wrong, we think Medicare Advantage is a great program. In recent years, the Centers for Medicare and Medicaid Services (CMS) has approved more and more services for Medicare Advantage. For people with limited budgets, or have serious healthcare needs, Medicare Advantage is wonderful. But is it the best way to get your dental coverage?
As you might have noticed, nearly all dental plans ramp up your coverage benefits over a period of three years. The reason they do this is to prevent people from getting a bunch of expensive dental care, and then canceling their policy. Makes sense, right?
Medicare Advantage plans are not allowed to do this. CMS regulations require that all benefits provided by a plan be available on day one. So, to limit their risk, Advantage plans limit coverage.
Aetna has the largest number of plans that offer "routine dental coverage".
For the purposes of Aetna’s coverage, the following services may be considered routine:
- Oral examinations in a dentist’s office
- X-rays, including panoramic and bite wing views
- Pulp vitality tests
- Cleaning, scaling, and polishing the teeth
- Oral hygiene consultations
- Bite adjustments
- Fillings and restorations (including amalgam and composite)
- Denture adjustments
- Extractions performed in the office (non-surgical)
- Minor periodontic scalings and root plan
In the Aetna fine print, you will discover that, “Your plan may help cover and pay for certain dental services within a network. Or you may be eligible for an annual allowance. This means you pay any licensed provider for services and send us the receipt. We then reimburse you up to the allowance amount.” With a lot of digging, you will learn that the “annual allowance” is $350 for exams, cleanings and x-rays and $350 for restoration, extractions and other serious work. Cigna and Humana plans are similar.
Let’s face it, $700 of annual coverage is not enough for most of us. By age 65, most of us have greater needs. So, what’s the solution?
Let’s discuss options.
Discount Dental vs. Dental Insurance
Our catalog includes discount dental plans and dental insurance. The difference between the two is significant, so it pays to understand what they each offer.
Dental Savings Plans
Discount dental plans, also called dental savings plans (DSP), are exactly what they sound like. They are an annual subscription to a large network of dentists who offer significant discounts on both regular oral health (e.g., exams, cleanings and x-rays) and restoration work. Savings vary, but you can generally expect 20 to 60% off regular rates.
Here at Medicare Navigators, we love DSPs. Many of us use them in conjunction with Advantage plan dental coverage to make our insurance dollars stretch further. This is easy to do my asking the front office staff at your dentist to split the bill. For example, when you go in for an exam and cleaning, ask to have the x-rays and exam billed to insurance and pay for the cleaning using your DSP discount. You can also do this with a stand-along dental plan that offers only basic coverage in year 1 and year 2.
Unlike a DSP, dental insurance pays a portion of covered procedures. Most plans are indemnity insurance, but some are dental PPOs (preferred provider organizations) or HMOs. The basic difference is in how service is delivered.
Dental PPO Plans
Dental PPO plans (DPPO) offer flexibility, as compared to HMO plans. Most dental PPO and HMO plans cost less than traditional indemnity plans.
DPPOs are managed care plans with networks of dentists under contract with an insurance carrier. They offer the most savings to members who use a dentist in the network, but members can choose to see a dentist or oral specialist outside of the network.
Dental HMO Plans
Dental HMO plans (DHMO) are typically lower cost than DPPOs and indemnity plans. Like DPPO plans, DHMOs have a network of providers under contract to offer select services at predetermined rates.
The primary benefit of a DHMO plan is the cost. Unfortunately, they impose strict requirements and restrictions on their members. For example, DHMOs will not cover care that’s not provided by an in-network dentist or specialist.
Dental Indemnity Insurance
Dental indemnity insurance is dental coverage that lets the policyholder use any dentist they want. There are no networks or restrictions. The member pays the dentist out-of-pocket and submits a claim for reimbursement.
Most of these plans pay between 50 and 80 percent of the cost. The balance is paid by the member. Depending on the insurer, you could end up waiting 30 to 90 days for your claim to be processed, however, most carriers process claims within two to four weeks.
Shop Top Dental Plans for Seniors by State
Free Dental for Senior Citizens
If you can't afford a dental plan, don't go without care. Here are some free and low-cost options:
- PACE (Program of All-inclusive Care for the Elderly) is a Medicare and Medicaid program that “helps people meet their health care needs in the community…” This healthcare can include dentistry.
- The Health Resources and Services Administration (HRSA) supports federally-funded health centers for those with no insurance or limited income. Many offer sliding scale payments based on what you are able to afford. Visit the site or call 1–888–275–4772.
- The Dental Life Network provides “access to comprehensive dental services for people with disabilities or who are elderly or medically at-risk.” They have a nationwide network of 17,000 volunteer dentists and 3,700 dental laboratories; all providing free dental treatments. Visit their website or call 303-534-5360.
- The non-profit Dentistry From The Heart (DFTH) offers “free dental care to those in need.” Volunteer dentists and hygienists donate their time at events around the country. Treatment offered includes cleaning, filling and extraction.
- Eldercare Locator, a service of the Administration on Aging, allows you to search for dental care by state. To speak with an information specialist call 1-800-677-1116.
- 2-1-1 Information and Referral Search is sponsored by the United Way and will connect you with dental services in your area. Simply dial 211. The number will connect you to a trained professional who will direct you the appropriate organization that can help you.
This page was last reviewed and updated on .