As much as we would like to ignore the fact, our teeth matter. Whether or not we had dental insurance through our jobs before retirement, some 70 percent of seniors have no form of dental coverage. Yet we all hear how important good oral health is to our overall health. It is about more than teeth and gums; poor oral health can actually have harmful consequences for our entire bodies.
The Government might show it cares about our bodies by providing coverage through Original Medicare. However, healthy teeth and gums are considered nonessential, even to our Medigap policies. So it is up to us. Entering the complex world of dental insurance may be as appealing as pulling teeth. But with some research, we can find a solution that works for us.
For any senior moving onto a fixed income, particularly a financially restrictive one, dental work is an expense that almost always forces itself onto our budgets at an inconvenient time. Much simple dental work can be put off for some time but, when something becomes painful or dangerous, a solution has to be found. And even if you have Medicare or Medicaid, very little qualifies for coverage unless it is deemed medically necessary.
We will be looking at dental coverage in two forms: individual dental insurance policies and dental savings plans.
Three factors start the selection process for you: how urgent the work is, how much you can afford and what a typical year's needs look like for you.
Urgency is a factor because many individual dental insurance policies use a 3-year graduated benefit model, which means there are tight (but growing) annual limits on how much is paid out in Year One, then Year Two and Year Three (for example, $1,000/$1,500/$2,000). Some also have waiting periods for everything but preventive work, like cleanings, which means your root canal will not be covered for 6-12 months.
Alternatively, dental savings plans (which are not really insurance) could be the solution: these are pre-negotiated rate plans with certain dentists. You are dealing with a one-time annual premium, no annual limits, no waiting periods and a known discount off listed prices.
Affordability is determined by your budget. With a number in mind, you then look at your options. Individual insurance policies charge a monthly premium on an annual contract. When you use your insurance, often you will pay the dentist directly and submit a claim to your insurer. You will eventually receive a refund as a percentage (pre-determined for each procedure) of what the dentist billed, up to your annual cap, less your coinsurance and your deductible.
With dental savings plans, you can obtain a schedule of benefits (a price list for procedures and the percentages paid for each procedure). When you have the work done, you pay your portion directly to the dentist. No claims, no surprises, no waiting.
Your past dentistry needs will help you calculate which form of coverage works best for you. You will need to obtain the schedule of benefits for each proposed plan, whether individual insurance or direct savings and run some "what if" calculations. It is up to you to read the fine print, including exclusions, to avoid any surprises or miscalculations.
Like any other insurance, selecting dental insurance is much more than comparing premiums. Dental insurance is made complicated by so many factors: in-network, no network, coinsurance, deductibles, exclusions, annual maximums and lifetime maximums, for example. However, considering the importance of having coverage, it is well worth the effort.
For seniors, like for anyone else, finding a dentist you like and following good oral health care practices are important steps to prevent other health concerns. Yet almost 40 percent of adults over 65 never even visited a dentist in 2016, and nearly half of those adults said cost was the reason for not doing so. Finding a workable dental insurance plan can change that.
Poor oral health affects far more than just the mouth. It can also increase the risk for systemic diseases. In fact, one source lists common problems associated with or caused by poor oral health: cardiovascular disease, dementia, respiratory infections, diabetes, erectile dysfunction, cancer, kidney disease and rheumatoid arthritis.
Seniors can take the preventive step of looking at the side effects listed for the ever-growing number of prescription and over-the-counter medications taken with age. Over 400 commonly used medications are known to have the side effect of causing dry mouth, which means less saliva in our mouths.
Saliva contains helpful antimicrobial elements and minerals that help rebuild tooth enamel attacked by decay-causing bacteria. Without saliva, we have more oral disease which, in turn, can contribute to the other diseases listed above.
Many seniors do not go to the dentist until something hurts and, by then, it is already a costly problem in more ways than one: financially it would have cost less had you treated it preventively, and it could cost you dearly in terms of your overall health.
While dental insurance varies from other types of insurance in many ways, the initial concerns are pretty typical: the price of premiums, how easy it is to enroll, what the service covers, how fast you can use the service and how easy it is to get customer support.
\Also, you want to know what deductibles and coinsurance you might have to pay, and any annual limits to coverage. Then ask, can you keep your dentist? Lastly, on the administrative side, how can you pay?
Each insurance or discount plan provider will partner with various dentists in certain regions and states. Those dentists charge for services according to a pre-negotiated rate schedule. In some cases, even if your policy specifies a network, you may be able to go outside the network if you are willing to pay a higher price. In other cases, that is not even an option.
If you have a favorite dentist and it is very important to you to continue with that dentist, the first step is to find out what your dentist accepts as dental coverage. That will lead you to specific carriers, plan providers and/or policies.
If that is not a major qualifier, then your first major decision is whether to go with an individual dental insurance policy or a dental savings plan.
Individual dental insurance works like any other form of insurance, with premiums, contracts, coinsurance and deductibles. However, it may also include annual limits, lifetime limits and time limits. In the case of dental insurance specifically, it also comes with services being divided into different classes, which then become available to you over time. Those classes are:
- Class 1: Preventive dental care, which means basic exams, cleanings and X-rays. Most good plans cover 100% of these costs immediately.
- Class 2: Restorative dentistry, which means fillings, root canals and periodontal work. With time, 80 percent of your expenses should be covered for this class.
- Class 3: Major restorative dental care, which means bridges, crowns and dentures. With time, up to 50 percent of your expenses may be covered, if at all, and this is the work most seniors will need.
- Class 4: Orthodontic dentistry, which means braces, implants and tooth pulling. With time, your expenses may be covered up to a yearly limit (usually around $1,000), if at all.
Understanding these classes will help you ferret out what a policy is truly offering. Then look for any annual limits on how much is paid out in the early years. The combination of the two will tell you if you will be paying a premium each month for something that will not significantly cover the dental work you know is ahead of you.
However, if your mouth is healthy, but you think you will want more robust coverage a few years down the road when you are more likely to have problems, it might make sense to settle into monthly premiums and allow the annual limits of coverage to build. Meanwhile, you can benefit from the annual cleanings, annual exams and basic restorative work covered by the policy premiums.
Alternatively, a dental savings plan is simple. You pay an annual fee for the plan (but no monthly premiums), you know the discounted price of each service, you know what percentage you will pay (often 40-80 percent) and you pay that to the dentist. That's it.
Two areas differentiate what seniors prioritize when examining a service: age friendliness and health-related value.
Typically, as we age we find that our teeth and gums become more susceptible to decay, inflammation and disease, so the importance of having a good solution increases with age. As we age, we also are less comfortable with change, so having a plan that includes our favorite dentist has a special value.
As we age, we also like to keep things simple. Payment with a discount savings plan holds no mystery: we know what things cost and what we will pay. With an individual dental insurance policy, on the other hand, we will pay the entire bill, then have to submit a claim for reimbursement and possibly go back-and-forth with the insurance company.
Regarding health-related value, as our health declines, we become more and more vulnerable to the side effects of poor oral health. In fact, some research has found linkage between gum disease and heart disease, and some believe that pneumonia, for example, can be triggered by poor dental hygiene.
Also, declining health can increase the number of medications we take, and many of them can cause dry mouth which, in turn, affects oral health.
If keeping our mouth healthy depends on dental care being affordable, then the right insurance policy or savings plan could make a critical difference.
When examining options to cover dental care needs, budget considerations have to include the monthly or annual cost of a plan, as well as your potential out-of-pocket responsibility.
With individual dental insurance policies, the amounts paid as premiums and as out-of-pocket coinsurance payments will depend on whether you select an HMO, PPO or indemnity plan. As with other traditional insurance, whether you use in-network or out-of-network dentists will affect how much you will be reimbursed.
Basic dental insurance policies may run $30-50 per month in premiums. Also, you could pay a copayment at each visit, plus 20-70 percent in coinsurance. Upgraded policies may run $60-75 per month, plus coinsurance. You pay the premium whether you see a dentist or not.
Dental savings plans cost around $120-150 per year for an individual, and $175-200 for a family, plus the discounted cost of the service. Savings on services typically run 20-60 percent, which means you pay between 80 percent and 40 percent of the pre-determined rate. Beyond the annual fee, you only pay for what you use.
A senior deciding on dental insurance will typically want to know the price of monthly premiums, the ease of enrollment, what is covered, how quickly you can access the service and how convenient the customer service will be
Price: In the case of individual dental insurance, you will pay a monthly premium, a coinsurance percentage that depends on the policy you select, plus possibly a copayment with each visit to the dentist. Under a dental savings plan, you will pay a one-time annual fee for the plan, plus a percentage of a pre-determined discounted rate sheet of benefits for any services used.
Ease of enrollment: Besides having a website that explains the services offered, a company should make it easy for customers to enroll by giving them ample access to customer service representatives to get any questions answered before committing to a policy.
Coverage: In selecting a dental insurance plan, you will want to know the exact coverage you will have. Deciphering the fine print of the contract will be far easier if you understand how the insurer or plan provider classifies its different services (basic preventive, basic restorative, major restorative and orthodontic, for example).
Waiting period: Almost all individual dental insurance policies have waiting periods for the different classes of services. Anything beyond simple preventive cleanings and exams could have waiting periods of 6-12 months. Dental savings plans would not.
Customer support: Your overall experience with a service provider often rests on how easy it is to contact the company’s customer service if you need assistance. Some plans only provide live customer support during regular business hours, Monday through Friday. Be sure to check the company’s availability if having live access more often is important to you.
The cost of a dental insurance solution is not just the monthly premium or annual fee. You will want to know how much of a deductible you will have to pay before your insurance kicks in. That, plus any per-visit copayment and service coinsurance, will make up the amount of your exposure to out-of-pocket payments.
In the case of individual dental insurance policies, you may face annual limits on what the insurance company will pay. The more basic policies will likely have a 3-year graduated benefit, with the annual limit increasing over Year One, Two and Three as $1,000/$1,500/$2,000, for example.
Be wary of lifetime limits, as they can lower the long-term value of a contract.
Dental savings plans have neither annual limits nor waiting periods. As long as you are willing to pay your part of the pre-negotiated price of a service, you can use it as often as you like.
Whether or not you can keep your dentist may be important to you. If it is, check whether you are limited to certain networks of dentists and whether you can access dentists outside the network at a higher cost.
You also want to know how easy it will be to make monthly premium payments in the case of individual dental insurance policies. In the case of dental savings plans, you only have to concern yourself with the one-time payment for the plan.
In summary, as with any other insurance, it is important to read the fine print on any policy you are considering. What looks like a great deal may turn out to have so many exclusions that it is virtually unusable.
One last consideration: Say you want to get on an individual dental insurance policy, but you have some urgent major dentistry needs. If you can afford to do so, sign up for both the individual insurance policy and a dental savings plan. The savings plan will provide valuable discounts while you wait out the 6-12 months until your individual insurance policy covers those more costly services