Seniors who are Medicare beneficiaries have their health insurance covered, more or less. Now, family members may wonder whether to purchase senior dental insurance for them, as it only covers a portion of dental procedures like root canals, fillings, and extractions. Going through dental plans and their pros and cons can help families make informed decisions. Here is what one needs to know about investing in a senior dental insurance plan and its disadvantages:
Dental insurance – What it is
Many consider dental insurance to be the same as health insurance or part of it. And while it is insurance for the teeth, there are some similarities and differences between these two types of insurance. Just like in health insurance coverage, there are factors like emergencies and other treatment-related expenditures that can be covered; in dental insurance, the coverage includes emergencies like injury to the tooth or getting an oral infection. However, one significant difference between dental and health insurance is the coverage provided under the policy and how this coverage works for individuals.
Regular dental plans for seniors
While dental plans vary from person to person, generally, the following are the only things covered under the dental plan for seniors: They include:
Tooth extractions, fillings for cavities, x-rays for annual exams, root canals, crownings, and two preventative cleanings are needed each year. This can be every six months or twice a year, at any time suitable for the individual.
However, for a price, there are some plans that are more comprehensive and cover more oral health issues, like:
– Orthodontics
This is for correcting poorly aligned teeth or misaligned bite patterns.
– Prosthodontics
This includes procedures like tooth restoration and getting dentures.
– Periodontics
This refers to treatments that treat gum disease or dental implants.
Cons of dental insurance for seniors
There are some disadvantages to dental insurance for seniors, and here is what one needs to know:
- According to statistics from the Centers for Disease Control and Prevention, two out of three adults 65 and older have gum disease. Another statistic observes that one in five adults 65 and older have tooth decay, which remains untreated, and one in five adults 65 and older have lost all their teeth with age. The statistics also show that more than half the senior population—around 53%—said they had to delay dental care because it was costly. 23% of the Medicare seniors stated that they, too, have been delayed or gone without dental care for a long time due to its high costs. Since dental care does not cover too many ailments, the premium paid for the insurance can probably only cover two cleanings a year, and anything beyond that becomes an out-of-pocket expense for the senior.
- Medicare does not cover dental care; however, a couple of exemptions can be noted. Any X-rays related to the fractured jaw or facial bone can be covered, as can any removal of teeth for radiation treatment for a tumor, oral or dental exam that is part of the procedure before kidney transplant or heart valve replacement surgeries, and also wiring teeth when treating a jaw fracture in seniors.
Medicare Part A and B are infamous for not covering dental care. However, anyone with a Medicare Advantage plan or Part C could see some dental benefits covered. It is still to be noted that the premium for these insurances goes up as more illnesses are covered under them.
Coverage
Regular expenses like the monthly premium, deductibles, copays, and coinsurance are similar to those of a regular health insurance plan. However, one major difference is the coinsurance amount. Suppose the coinsurance is 20% of regular health insurance; it will double in dental plans. In some cases, this may even go above 40%.
It’s important to know that dental insurance companies have an annual cap between $1000 and $3000, and realistically, this is a low amount for the kind of expense that dental work requires. So, one may have to pay a substantial chunk of the treatment cost out of pocket. This insurance plan may work for someone who only needs some preventive care and a filling or two; however, managing more than that becomes difficult. This is especially true for seniors, as they are more at risk of developing dental issues, and the source of income becomes significantly less or zero in some cases.
