Seniors must look into other options, as Medicare does not provide dental coverage.
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Even though seniors are more likely to have dental problems, getting dental insurance for retirement can be difficult. According to the Centers for Disease Control and Prevention, 20% of seniors 65 and over have untreated tooth decay. 68% have gingivitis, and nearly 1 in 5 have lost all of their teeth. Original Medicare does not cover dental care so seniors who need it must either purchase individual coverage or a Medicare Advantage plan. The plans might have restrictions that make seniors uninsured.
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- Individual Plans
It is costly to have dental work done. According to Stephen Shuman, a professor at the University of Minnesota School of Dentistry, crowns and root canals can be more expensive than $1,000. He is also chair of the Gerontological Society of America’s oral health workgroup. One tooth can cost anywhere from $1,000 to $4,500.
Monthly premiums for individual plans generally range between $20 and $80. A typical plan covers two to three checkups and cleanings per year. Jeff Smedsrud is president of Insurance at HealthCare Insurance Services. “There’s a misconception that you can’t get dental insurance, and it’s very expensive,” he says. Experts say that the plan will have a waiting period, which could be anywhere from a few months up to two years, before coverage begins for more complex procedures. This is to make sure people don’t sign up for insurance only when they have to get expensive work done. Smedsrud states that routine preventive care coverage is often available right away.
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Patients may be restricted by individual plans to only dentists within a network that has no maximum out-of-pocket. Plans usually pay a percentage of different services, typically between $1,000 and $2,000 per year. Any amount beyond that is your responsibility. Shuman says that the biggest problem is when people think they have insurance that covers all their dental needs. Then, you realize it is not.
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- Dental Discount Plans
Smedsrud says that while a discount plan for dental services (which is also sold by insurers) is often cheaper than insurance. It’s a membership program that offers discounts and savings on services for your teeth, with no waiting periods. The discounted rate you have chosen for your program means that you pay only for the services. A discount plan can be a good option if you require extensive dental care.
Medicare Doesn’t Cover
- Medicare Advantage
According to the Kaiser Family Foundation, 25% of Medicare beneficiaries had dental coverage in 2019 through an Advantage plan. Mary Johnson, Senior Citizens League policy analyst on Social Security and Medicare, said that coverage can be limited. “Don’t rush to join an Advantage plan just because you get these additional benefits like dental care.
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Shuman states that Medicare Advantage, like individual plans, often has similar waiting periods (6 months to 2 years) before the insurer will cover expensive work such as crowns and dentures. Preventive care such as cleanings, Xrays and checkups are covered immediately. Johnson states that the insurer might cover certain services up to a maximum of $2,000 per year.
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Medicare Advantage Plans Right for You?
- Self-Insure
You can choose to forego dental insurance, and instead pay out-of-pocket for your care. These expenses can be paid for by contributing to a health savings fund before you sign up at 65 for Medicare, according to James Miller, president Woodward Financial Advisors. These tax-advantaged savings account are funded with pretax dollars and can be withdrawn for qualified medical expenses. Withdrawals are exempt from tax. You can’t contribute to an HSA if you are on Medicare. There is a six-month lookback period from your 65th birthday. Miller states that self-insuring is a good option if you have the financial means to pay for it. However, it may not work if you have more complicated dental needs or are likely to need frequent visits to the dentist. Shuman states that insurance is like any other, you get what your pay for. Premiums are required if you desire a comprehensive dental plan.