Medicare Advantage Dental Benefits in Western Massachusetts

The population of seniors, those who are 65 years or older, is growing at the rate of 10,000 each day and they account for almost one-fifth of the U.S. population. Although they may all be enrolled in traditional Medicare for medical coverage, they are the most under-insured demographic in the nation. During their working years, most had dental and medical insurance through their employers. Upon retiring from the workforce, however, many found that they couldn’t afford the high cost of dental insurance and are subsequently without any insurance coverage for their dental needs. Almost two-thirds of seniors simply go without insurance, and therefore without the dental treatments they may need. This can cause a decline in their overall health, since physical health and oral health are closely linked.

In spite of a lack of insurance, in 2016, seniors spent more than $28 billion on their dental needs, and dentists saw 6 million more seniors than in 2006 seeking professional dental treatment, according to the American Dental Association. The rate is expected to increase since the number of seniors is increasing daily. Despite these numbers, the results of a study by the Kaiser Family Foundation revealed that about half of all Medicare recipients hadn’t sought dental care in the preceding year. Of those who visited a dentist, 19% spent more than $1,000 on out-of-pocket costs. Part of the reason for the lack of dental care among seniors may be the costs of the treatments. The following examples are typical of costs for common procedures.

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.

Are There Any Dental Insurance Options for Seniors?

When a person reaches the age of 65, they are automatically enrolled in traditional Medicare Part A at no cost. Those who are permanently disabled are also eligible for Medicare, regardless of their age. Normally, traditional Medicare doesn’t cover dental procedures unless a specific procedure is required as a prerequisite for surgery. This means that Medicare beneficiaries must seek elsewhere for dental benefits. About 25% enroll in one of the Advantage plans available from one of the large insurance providers. Another 10% obtain benefits from private insurers. This still leaves almost two-thirds of seniors without insurance.

How Do Medicare Advantage Plans Help Seniors?

Medicare Advantage plans are supplemental insurance plans that provide coverage for procedures that Medicare doesn’t provide. They’re purchased separately by the Medicare beneficiary who will receive an ID card for their Medicare Advantage plan that’s separate from their Medicare ID card. A Medicare Advantage plan has low deductibles, reduced out-of-pocket expenses, and cost-sharing provisions, so it’s affordable for more seniors. 

MedicareAdvantage.com reports that the average 2018 Advantage premium was about $420 annually, which is about $35 monthly. Advantage subscribers have a network of providers from which to choose, and they often have access to hearing, vision, and prescription drug benefits. If you have questions on Advantage plans, call our Western Massachusetts office and we can help you.

Will a Standalone Dental Insurance Policy Be Prudent for Me?

If you want or need more dental benefits in Western Massachusetts than your Advantage plan provides, then a standalone dental insurance plan may be the answer. They’re available from most insurance companies and there’s an assortment of price ranges and coverage options. The more coverage options you have, the higher your premium will be. Examples of standalone plans are as follows:

Basic Plans

Usually, basic plans cover only cleanings, exams, and diagnostic x-rays and are best for those who need only very basic coverage.

Mid-Range Plans

Mid-range dental plans will usually cover emergency procedures, dentures, fillings, inhalation anesthesia, orthodontics, and specialized or standard x-rays, and non-covered services may be offered at a discount.

Premium Plans

In addition to the above, premium dental plans usually cover:

  • Crowns
  • Dentures
  • Endodontic procedures
  • Inlays and onlays
  • Oral surgery
  • Periodontal procedures

Most standalone plans have 100-80-50 tiered coverage, which means that they’ll pay 100% of the cost of routine examinations, 80% of the cost for basic procedures, and 50% of the cost for complex procedures. You’ll be responsible for payment of the balance of each procedure, so it may be prudent to have a backup plan for financing because it can be costly. Call us for more information on your standalone dental benefits in our office.

Do Dental Discount Plans Help Seniors?

Discount dental plans are discount plans sold by private companies, they’re not insurance and don’t replace insurance benefits. Discount plans are membership-based and the member pays an enrollment fee and a monthly membership fee. The dentist receives payment directly from the patient rather than from an insurance company and services are provided at a previously negotiated rate between the dentist and the private company. They’re usually very affordable and they offer some benefits that insurance plans don’t, such as:

  • Discount plans have no copays, deductibles or coinsurance payments
  • You have no waiting period, you’ll receive full benefits immediately
  • You can make as many appointments as you need, there are no annual limitations
  • There are no tedious claim forms or paperwork to complete
  • You can change dentists as often as you like without waiting
  • There are no age limits or exclusions for pre-existing conditions

Discount plans may cover fewer procedures than traditional insurance plans, but they’re usually less expensive and have lower out-of-pocket costs for:

  • Checkups
  • Cleanings
  • Crowns
  • Dentures
  • Extractions
  • Fillings
  • Root canals
  • X-rays

Some discount plans offer options for vision, hearing, and prescription drug discounts. For those who are in good health overall, a dental discount plan such as DentRite may be an excellent alternative for dental benefits in the area. However, if you need more extensive dental treatment, a standalone plan may be a more cost-effective and more prudent choice.

How Can I Lower Out-of-pocket Costs?

Even with insurance plans and discount plans, dental procedures can be costly. Many dental offices provide flexible financing options and repayment plans, but if yours doesn’t then a medical credit company may help you. CareCredit is accepted by more than 200,000 providers across the nation offers short-term financing for dental treatments and they usually have a 24-month, same-as-cash option that will incur no interest charges if the balance is paid in full within the agreed-upon term. A 60-month option is available from some companies, but not on a same-as-cash basis. The drawback to financing dental procedures is that the interest rate can add substantially to the overall cost of the procedure. Interest rates start at 15% and can go to more than 20%, and there will be an application and an approval process, so not everyone will qualify for financing. If you want more information on financing your dental procedures, then call our Western Massachusetts office and we’ll be happy to answer your questions about out-of-pocket dental expenses.

Many senior organizations such as AMAC and AARP provide numerous discounts to seniors for both goods and services that include insurance, so check with them for additional discounts that may help you manage your out-of-pocket dental expenses.

If you need senior dental services in Western Massachusetts, then call Baystate Dental at and we’ll help you. We’d love to help you restore your good oral health, so call us today and let’s get started. We look forward to speaking with you.

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