Why seniors need to have a dental insurance plan

Is it worth it to have dental insurance as you get older? Guardian studies – and a growing body of third-party research – show the benefits of good oral health in helping adults avoid or better manage serious health-related issues:

  • Diabetes - Periodontal infections contribute to problems with glycemic control, which compromises the health of diabetic patients.
  • Heart disease - The inflammation associated with periodontal disease has a high potential to contribute to coronary artery disease. Good oral health can lower that risk.
  • Self-esteem - Research shows that teeth, gums, and dental health in general are important to a person’s self-esteem and how they feel about themselves.

Dental health shouldn’t be considered optional or secondary, since all of these issues can impact your life expectancy and quality of life. The CDC reports that gum disease and dry mouth are especially common for older Americans. Despite this, 1 in 4 seniors haven’t seen a dentist in the last five years. The reality is, too many people put off needed dental care because they are concerned about the cost. 

It’s hard to have a happy, active retirement when your mouth hurts and you’re worried about what’s happening with your teeth. Dental insurance can help take care of all these issues, and affordable plans can be easy to find – no matter your age.

How dental insurance plans work

The first thing to know about choosing a dental plan is how it works. Like health insurance, dental insurance plans charge you a monthly premium, and in return the insurance company helps you pay for needed care. There are other similarities, too: 

  • Most dental plans have a network of providers 
  • There’s a deductible – an amount you pay out of pocket before the plan pays for treatment
  • You pay for a portion of many procedures via co-pays (flat fees) or co-insurance (a percentage of the dentist’s charge)

There’s also a big difference: Compared to medical plans, dental coverage is focused on prevention. The most common dental treatments – preventive checkups and cleanings – are usually covered without any out-of-pocket charge. The upshot is that if you don’t have any major issues, you could go for years without having any out-of-pocket dental expenses.

Three types of plans

Most insurance plans are Dental HMOs or Dental PPOs, but some indemnity plans are also available. A Dental PPO has a network of dentists, but typically lets you go out of network to see another provider. A top dental plan will have a large nationwide network (as an example, Guardian has over 120,000 providers) – so your current dentist may well be “in-network.” Check before you get a Dental PPO plan because even though you can go out of network, it’s almost always worth your while to see an in-network provider. The insurance company negotiates discounted fees on your behalf, so if your dentist typically charges $100 for a filling, when he or she is in-network you may only be charged $60-$70 – even you haven’t met your deductible yet.* 

In a DHMO you have to see an in-network dentist, and because their networks are limited, you probably won’t get to see your current dentist; the trade-off is generally lower costs and a simpler fee structure. 

The third type of dental plan – indemnity insurance – is somewhat harder to find. This type of coverage lets you see any dentist and the insurance company reimburses a portion of your expenditures – but you have to pay the entire bill then submit a claim. 

Three levels of coverage for three types of procedures

Dental PPO plans typically have a coverage formula that indicates what you’ll pay for different kinds of care. A 100/70/50 formula means that the insurance company covers preventive care – checkups and cleanings – at 100% (you typically don’t even pay a deductible); basic procedures – like fillings and extractions – are 70% covered; and major procedures like crowns, bridges, and root canals are covered at 50%. There are variations on this formula, and some procedures may be considered “basic” in one plan and “major” in another. 

Deductibles, maximums, and waiting periods

Like medical plans, dental plans typically have a deductible – an amount you have to pay out of pocket each year before the insurance company starts to cover costs. However, the deductibles are lower – usually around $50 for an individual. But while a health plan will cap the maximum you can pay out of pocket, dental plans typically cap the total amount they will pay for care – at $1,000-$2,000 per plan member per year. Any dental expenses over your plan’s cap or maximum are your responsibility. Finally, most plans also have a waiting period before they will cover major procedures such as crowns.

How to get a dental plan for seniors

If you or your spouse are still employed, try getting coverage through work

If you’re losing coverage because you left a full-time job, look into getting dental benefits through your spouse. If you’re not married or your spouse isn’t working – but you’re still doing some part-time work – ask if you can get dental coverage there: workplace dental plans are almost always your best option because employers buy benefits for many employees at once, so they qualify for lower group rates. Also, group plans often feature higher coverage levels, and the company may pay a portion of the costs, making it an even better value. You may also be able to get group coverage through a professional association or other membership group. 

Buy coverage directly from a dental insurance company

If you need to get your own individual or family coverage, there are a lot of plans available. Many carriers, such as Guardian, let you  compare and buy coverage conveniently online. The good news is, private dental plans can still be very affordable: a senior in New York can get a plan for as little as $14/month.

If you go this route, you should spend a little time thinking about what type of plan will best meet your needs:

  • Dentist choice – This is important because when people find a dentist they like, they tend to stay loyal: 32% of people have been with the same dentist for 10 years.3 That’s a reason to choose a Dental PPO plan that lets you see any provider. Major insurance companies such as Guardian usually have an online provider search tool that can make it easy to see if your dentist is in network, so you can also get discounted fees. 
  • Budget - Many large carriers have different tiers of Dental PPO plans, e.g., bronze, silver, and gold, in addition to a DHMO plan. If you need to keep monthly costs down, consider a DHMO, or a bronze Dental PPO plan that lets you use any provider and get coverage for cleanings and basic procedures. 
  • Care needs - If you rarely have oral health problems, a basic, lower-tier plan may be a good choice. But if you or your spouse have had issues then you should look into getting a higher-tier plan that covers more types of procedures. The higher monthly premium may be more than offset by savings on major procedures. Those types of details should be displayed in a simple and clear manner to help you make a well-informed choice. For example, here’s how your options are laid out when you compare dental insurance plans online with Guardian.

Dental coverage through a Medicare Advantage plan

Some – but not all – Medicare Advantage plans provide dental coverage benefits. Read the plan’s “Dental Services” section carefully to avoid unpleasant surprises. The section should have a list of specific procedures covered (e.g., Oral exams, Dental X-rays, Cleanings, Fillings); if it just says "Medicare-covered benefits," that means there probably isn’t any extra coverage compared to original Medicare, and dental care costs are your responsibility. 

You should also know that a Medicare Advantage plan will likely have DHMO-type network with a limited choice of providers, so your current dentist may not be covered. Finally, if you are thinking about switching to an Advantage plan only to get dental benefits, there’s a chance you may not be as happy with the rest of your medical care: Medicare Advantage plans tend to have lower satisfaction ratings compared to original Medicare.

Frequently asked questions about dental plans for seniors

What is the best dental insurance for seniors?

Too many people put off needed dental care because they are concerned about cost, so the most important thing is to have some kind of dental insurance plan to help ensure you get seen regularly. The “best” plan for you should also let you see a provider you’re comfortable with, cover the types of care you think you’ll need, and fit within your budget.

How much does dental insurance cost for seniors?

Costs vary by region, but a senior in New York can get coverage through Guardian for as little as $14/month.*

Is dental insurance worth it for seniors?

Insurance plans for dental care can help reduce your financial burden if you’re hit with the cost of a major treatment like a bridge or root canal. Another benefit to having dental insurance is that it makes basic and preventive treatments like cleanings and fillings much more affordable – and often free. That encourages people to treat problems earlier on – and can help them save money afterward. For example, an untreated filling that has an average cost of $1701 can skyrocket up to $900 if you need a root canal.2

What are the top-rated dental insurance plans for seniors?

There is no official rating of top dental plans that we are aware of. It’s a good idea to review the features offered by Guardian and other top dental carriers to see which plan provides the best fit for your needs. 

Does Medicare cover dental care?

No. Original Medicare (Part A and Part B) does not cover regular dental care and procedures like cleanings, fillings, dentures, etc. – it only pays for certain medically necessary dental and oral procedures services that you might need in a hospital. Some Medicare Advantage plans include dental care, but each plan is different. You need to review the “Dental Services” section carefully: if it says "Medicare-covered benefits," that means there probably isn’t any extra dental coverage.

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Disclaimer

1 https://www.nerdwallet.com/blog/health/medical-costs/how-much-does-a-filling-cost/ (Last accessed January 2020)

2 https://www.nerdwallet.com/blog/health/how-much-does-a-root-canal-cost/ (Last accessed January 2020)

3 Guardian, “Stay in Good Company,” 2018

DentalGuard Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York,   NY.  Products are not available in all states.  Policy limitations and exclusions apply.  Optional riders and/or features may incur additional costs.  Plan documents are the final arbiter of coverage.  This policy provides DENTAL insurance only.  Managed DentalGuard products underwritten by: (IL) - First Commonwealth Insurance Company, (MO) - First Commonwealth of Missouri, (IN) - First Commonwealth Limited Health Services Corporation, (MI) - First Commonwealth Inc., (CA) - Managed Dental Care, (TX) - Managed DentalGuard, Inc. (DHMO), (NJ) - Managed DentalGuard, Inc., (FL, NY) - The Guardian Life Insurance Company of America.  All First Commonwealth, Managed DentalGuard, Inc. and Managed Dental Care entities referenced are wholly-owned subsidiaries of The Guardian Life Insurance Company of America.  Products are not available in all states.  Limitations and exclusions apply.  Plan documents are the final arbiter of coverage. and are a summary only.

* Material discussed is meant for general informational purposes only. Although the information has been gathered from sources believed to be reliable, please note that individual situations can vary. Therefore, the information should be relied upon only when coordinated with individual professional advice. Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.

GUARDIAN® is a registered service mark of The Guardian Life Insurance Company of America. ©Copyright 2020 The Guardian Life Insurance Company of America.

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