Dental insurance plans for seniors
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Taking good care of your teeth is a lifelong commitment. But if you are in the process of winding down your career, you might be faced with giving up your employer-sponsored dental plan. Fortunately, dental insurance plans for seniors are available to help you stay on top of your dental care. This guide will tell you about:
What Standard Medicare does and does not cover
How dental insurance coverage works
Ways to get a dental plan for seniors
Why dental insurance is especially important for older adults
Oral hygiene has a big impact on your comfort, well-being, and your overall quality of life. And importantly, oral health and overall health are closely linked — meaning healthy teeth help support a healthy body overall. Plus, common dental health concerns like gum disease and dry mouth are very often seen in Americans ages 65 and older — and the risk of oral cancer also increases as you age.1
Dental insurance can help lessen out-of-pocket dental care costs when a dental problem requires treatment. It can also help prevent small problems from becoming big issues by encouraging regular dental wellness visits and checkups, because plans typically lower — or even eliminate — the cost of these preventive visits. Good dental coverage may also provide more predictability in costs for those living on a fixed income.
Medicare and dental coverage
Standard Medicare (Part A and Part B) does not cover dental care in most situations.2,3 That means you’ll typically pay out-of-pocket for dental services like routine cleanings, fillings, tooth extractions, or items like dentures, without any reimbursement from Medicare.
Often the only times that dental procedures may be covered by Medicare are when treatment is deemed necessary to continue with a standard medical need. For instance, if you're being treated for oral cancer (which would fall under standard medical care), a tooth extraction to facilitate treatment could be covered by Medicare.
Some, but not all, Medicare Advantage (Part C) plans provide dental coverage. However, actual coverage details vary widely from plan to plan. Many Medicare Advantage plans have very limited dental benefits — and in any case, it’s estimated that around 65% of Medicare beneficiaries had no dental coverage.4
Types of dental insurance options available to seniors
Broadly speaking, there are two main types of dental coverage available for seniors who are no longer eligible for dental benefits through work:
Medicare Advantage plans (Medicare Part C)
If you are 65 or older, you may be eligible to enroll in a Medicare Advantage plan that offers some dental care benefits. Unlike standard Medicare (Parts A and B), these plans are not directly administered by the federal government — services are provided through private health insurance companies, and benefits vary.
Learn more about the different types of Medicare Advantage plans here.
Individual dental plans
Individual dental plans for seniors are available from a variety of private dental insurance companies. Dental plans tend to focus on making preventive care more affordable: Most plans cover 100% of preventative care costs, according to the National Association of Dental Plans.5
There are two main types of dental insurance plans to know about:
Dental PPOs (also called Dental Preferred Provider Organizations or DPPOs) are more common. PPOs tend to have a large number of dentists "in network," — but plans vary, so check to see if a nearby provider you like is in the network before signing up. These network providers have pre-negotiated rate discounts, with the insurance company that can help you save on all your dental care.6 Data from the Consumer Health Alliance reported that on average, discount plans resulted in about 40% savings on the cost of dental services. So even if a complex procedure (like a root canal) isn't covered under your plan, you'll get a discounted rate for the care you need — and their office will handle your claim with the insurance company.7 Dental PPO plans also let you go out –of network to see a dentist, but your costs will typically be higher, and you will likely have to pay the full bill and submit a separate insurance claim for reimbursement.
Dental HMOs (also called Dental Health Maintenance Organizations or DHMOs) may be somewhat harder to find, but can be a good alternative. These dental plans tend to offer lower premiums and deductibles, but there's also less flexibility with a limited network of providers.8 Like HMO health care plans, members choose a Primary Dentist and have to go through that provider for all their care, including specialist referrals. Many DHMO dental plans have no deductibles or caps – and while there may be a flat-rate copayment for non-preventive treatments, your overall costs will likely be lower.
What dental insurance covers
Each dental insurance plan varies in coverage, costs, and plan details. It’s important to understand the details of any plans you are considering.
In most cases, an individual dental insurance plan will cover routine dental care – checkups, cleanings, and often x-rays — at little or no cost to the plan holder.9
Depending on the specific plan, dental insurance can also cover more substantial dental work — like simple extractions and cavity fillings — or even major procedures like crowns and bridges. However, these basic and major treatments and procedures typically require a waiting period of 6 to 12+ months from the date of initial coverage.10 In other words, you can’t just sign up for insurance when your teeth start hurting and expect to have your treatment covered right away.
How much does senior dental insurance cost?
With dental insurance, there are three main costs to be aware of:
Monthly premiums – These can range from about as low as $7 per month to $87 per month or more, depending on your state, the type of plan (DHMO or DPPO), specific coverage details, and which dental insurance company you choose.11 Data from the NADP indicates that average monthly premiums nationwide are $13.83 per month for DHMO plans, and $35.16 per month for DPPO plans.
Plan deductible: Many plans have a deductible. This is the amount you need to pay before the dental plan starts paying. The good news is that regular preventive visits typically aren't subject to the deductible, and once you've met the deductible for any other care, you won't pay it again until it resets the following year.
Coinsurance/cost sharing: Treatments you receive may have an "out-of-pocket" cost you must pay the dentist. Sometimes, it's a percentage of the fee: some plans cover major care at 50% — meaning 50% of the costs will be your responsibility. But remember: when you see a network PPO dentist, that fee may have already been discounted by about 30%, so at the end of the day, your out-of-pocket cost may only be 35% of the full "list" price. In a Dental HMO, out-of-pocket charges are typically simple flat fees for each service: for example, $50.12
Finally, there are annual maximums to keep in mind. This is the most that the plan will pay in a given year — $2,000, for example. If your care exceeds this maximum, the remaining cost may be your responsibility.