Medicare Advantage dental benefits in Philadelphia (Seniors 65+)

Despite many seniors lacking dental coverage, they continue to spend on dentistry services. In 2016, those over 65 spent $28 billion on dental services, and this demographic represents the highest rate of dental spending growth across all population segments. Additionally, the American Dental Association found that 6 million more seniors visited the dentist in 2016 than they did in 2006.

Even though more seniors are seeing a dentist each year, Medicare recipients are still going without adequate dental services. A study by the Kaiser Family Foundation revealed that jus under 50% of those on Medicare didn’t receive dental care last year. Plus, of those who did see a dentist, 19% spent $1,000 or more out of pocket. Below is a list of common dental procedures and their costs:

Checkups and Cleanings:

• Basic exam–$50 to $100
• Dental X-ray–$20 to $250
• Standard cleaning–$70 to $200

Fillings:

• Silver amalgam–$50 to $300
• Composite–$90 to $450

Extractions:

• Simple extraction–$75 to $450
• Surgical extraction–$150 to $650
• Wisdom tooth extraction–$75 to $3,000 based on the number and complexity of the extractions

Crowns:

The cost of a crown can range from $500 to $3,000 based on the type of material used.

Root Canals:

The cost of a root canal can range from $300 to $2,000 based on the location of the tooth and the complexity of the procedure.

What Dental Insurance Options are Available for Those Over 65?

Provided by the United States Government, Medicare is available to all Americans over 65 or those who are permanently disabled. Recipients of the nationally funded medical insurance plan receive a red, white, and blue ID card to present when receiving medical care. While Medicare covers many general medicine expenses, it does not offer coverage for routine dentistry like oral exams and cleanings. In fact, those with Medicare Part A may only receive coverage if the dental exam is necessary as part of a covered procedure, such as a surgery.

Medicare’s limitations leave many seniors searching for affordable dental benefits in Northeast Philadelphia. Twenty-five percent of seniors will choose Medicare Advantage plans while only 10% will choose a standalone insurance option.

How Does Medicare Advantage Work?

Offered through private companies, Medicare Advantage plans are supplements to your existing Medicare coverage and provide enhanced benefits. Advantage plan participants will be able to select a provider from a wider network, and they will also receive price protection through low premiums, cost-sharing, and limits on out-of-pocket expenses. With a Medicare Advantage plan, costs are reimbursed by the private company instead of the government. Some of the most popular providers of Advantage supplements include UHC, Aetna, and Humana.

You’ll receive an ID card similar to those given to insurance plan participants when enrolling in an Advantage plan. One benefit of an Advantage plan is that they often provide additional benefits for eye care, hearing aids, or prescription medication as well. Another advantage is that the plans are usually quite affordable. In 2018, the average cost of an Advantage supplement was around $420 each year. There is one drawback; these plans typically only cover routine services, including dental exams, X-rays, and cleanings. If you will need more comprehensive benefits, a standalone dental insurance plan may be a more cost-effective option.

Do I Need a Standalone Dental Insurance Plan?

With a standalone plan, seniors can receive more comprehensive coverage than they would with a Medicare supplement. These plans are provided by private insurance companies, and several levels of coverage are often available. Generally, your monthly premiums, coinsurance requirements, and copays are determined by what plan you choose. Here are three examples of popular standalone insurance plans:

Basic Plans: Most basic plans cover preventive care, including routine dental exams, professional cleanings, and other diagnostic procedures including X-rays.

Mid-Level Plans: A mid-level plan provides expanded coverage, including nitrous oxide, orthodontic procedures, emergency dentistry, and specialized X-rays. Restorations like dentures and fillings also may be included.

Premium Plans: The highest level of coverage, premium plans provide partial to full coverage for more extensive procedures, including more complex restorations and dental surgeries. Some of the services covered by premium-level plans include:

• Dental inlays and onlays
• Oral surgeries
• Endodontic services
• Partial and complete dentures
• Periodontal treatment
• Tooth crowns

A “100-80-50” tiered system is often used for private dental plans. This means that routine dentistry is covered at 100%, basic procedures receive 80% coverage, and more extensive dental work is covered at 50%. Private plans can be lower in cost than Advantage plans – according to Bankrate, the average cost of a standalone plan was $350 last year. However, private plans often don’t include the additional savings on vision or medication.

Should I Choose a Dental Discount Plan Instead of Insurance?

Dental discount plans are offered by private companies just like standalone insurance plans and can help you reduce your out-of-pocket dentistry costs. However, they are not insurance. Instead, the discount provider negotiates lower fees with providers and then passes the savings on to members. Members participate by paying a small monthly fee and an enrollment fee. Like Medicare and private insurance, you’ll receive a card to present at the time of service. With a discount plan, patients pay the dentist directly instead of going through a claims process.

When comparing a dental discount plan vs. traditional insurance, it’s important to consider the perks of a discount plan, including:

• No copay, deductible, or coinsurance requirements
• No waiting period before undergoing treatment
• Members can change dentists at any time
• No limits on how often you can visit a dentist
• No paperwork or lengthy claims process
• Preexisting conditions are not excluded
• No age limit to join

Standalone insurance may offer more comprehensive dental benefits in Northeast Philadelphia, but discount plans are ideal for routine dental services. Some of the discounted services include:

• Routine dental exams and teeth cleaning
• X-rays
• Extractions
• Many restorations, including crowns and fillings
• Root canal therapy

Smile Alliance Club is a popular dental discount provider that also offers savings at eye care centers, hearing aid manufacturers, and pharmacies. If you are in good dental health and will only need maintenance services, a discount plan may be an excellent money-saving option for you. However, those with extensive dental health challenges may need to consider a private insurance plan. Please give us a call if you have questions.

How Can Seniors Manage Expensive Dental Costs?

When dental services are necessary, many seniors face challenges when managing the costs. Fortunately, dental payment options – such as ones offered through CareCredit – can make large dental expenses more budget-friendly. Many payment options offer interest-free financing during a promotional period, and longer term financing for large expenses. Long-term financing can be up to 60 months, so be sure to ask your provider about your payment options when receiving care. Remember that taking out a line of credit for dental costs can have some drawbacks, including:

• The application often involves a credit check, so not everyone will qualify for financing.
• Interest rates can be up to 20%, adding to the treatment cost.

If you have questions about seniors’ dental benefits in Northeast Philadelphia, Medicare Advantage, or dental payment options, several resources than help. These include the AARP, local seniors’ organizations, or our office. Please call us if you need more information about our affordable dental services for seniors.