Medicare Advantage dental benefits in Pennsylvania (Seniors 65+)

Why Is Senior Dental Insurance Important?

Seniors age 65 and older who start receiving Social Security and qualified disabled persons are automatically enrolled in Medicare. Medicare is our nation's federal health insurance program. People who have disabilities are also enrolled in Medicare; however, beneficiaries are typically senior citizens. Parts A and B of Medicare, known as Original Medicare, cover hospital and medical expenses; however, there are no dental benefits. Coverage for dental procedures is limited to medically necessary care such as oral examinations before certain surgeries.

Seniors cannot rely on Medicare to pay for their dental bills, but they do have other options. Seniors can take advantage of standalone dental insurance, medicare advantage plans or discount dental plans to have dental benefits in Pennsylvania. Senior dental care is essential as seniors are more prone to dry mouth from certain medications which can cause cavities, including root cavities. Seniors are also prone to periodontitis. The most affordable way for seniors to take care of their teeth and gums is to see a dentist regularly. Preventing cavities is more affordable than treating them, as evidenced by the cost of services below. Contact us for more information about the benefits available to seniors today.

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 Is Medicare Advantage?

Medicare Advantage is the name of Medicare's private health care plans, known as Medicare Part C. Private companies approved by Medicare offer plans which deliver Medicare Parts A and B benefits. While everyone who get Medicare Parts A and B is eligible to sign up for an Advantage plan, the person must live in the plan's service area to be eligible. You pay premiums, which are usually less than Medicare charges, to the company. Some Medicare Advantage plans have a $0 premium, but people who enroll in an Medicare Advantage plan still have to pay their Medicare Part B premium.

About one in three seniors choose an Medicare Advantage plan over Original Medicare, possibly because of the supplement benefits many plans offer, such as hearing, vision and dental benefits. Growth has been steadily increasing over the last decade. The COngressional Budget Office estimated that by 2028, 42 percent of Medicare beneficiaries will be enrolled in a Medicare Advantage plan.

Benefits, deductibles and out-of-pocket costs vary, so it's important to review plans carefully to see if they match your needs. Aetna and Humana are among the largest providers of Medicare Advantage plans. Most Medicare Advantage enrollees choose an HMO plan, and PPO plans are the second most popular choice. Medicare Advantage plan benefits differ widely by a senior's geographic location.

Is Standalone Dental Insurance Helpful?

People choose stand-alone policies when dental coverage isn't part of their medical insurance or if they prefer different coverage. Insurance from private companies, brokers and agents offers a variety of plan options, each with unique premiums, deductibles, copays and ways in which they pay claims. Deductibles are what you pay until your coverage kicks in.

Most insurance operates on the 100-80-50 principle:

• Preventative care is 90 to 100 percent covered. Preventative care includes exams, bitewing x-rays, professional cleanings and fluoride treatments.
• Basic restorative care is generally 80 percent covered. This includes fillings and extractions.
• Major restorations, such as crowns or dentures, are 50 percent covered.

When considering a plan, seniors should look for coverage for gum disease treatment, extractions, dentures and other dental issues they may be experiencing. Seniors can buy insurance directly from a company online, a broker or an agent. Group plans, which many retirees lost when they left the workforce, are almost always less expensive. Seniors should ask any professional organizations they belong to if there is a group policy available.

Most seniors can choose from Dental Health Maintenance Organization plans, Preferred Provider Organization plans and fee-for-service, or indemnity, plans. HMO plans are popular because they are affordable, but they often offer fewer benefits. Participants must choose one dentist in the plan's network and they do not have coverage if they see another dentist. PPO plans let participants choose an in-network dentist and they can switch dentists anytime. They can see an out-of-network dentist as well, but receive less coverage.

Insurance companies frequently cap benefits at $1,000 to $1,500 per year. According to CreditDonkey, 50 percent of PPO plans have an annual yearly benefit of $1,500. Your yearly maximum benefit is easily eaten up if you need a root canal and crown procedure. Seniors who need extensive dental work should pay careful attention to the cap on benefits. All plans don't cap benefits, but many do.

Insurance companies may also have waiting periods before coverage is available for major procedures. Don’t plan on purchasing insurance and having coverage for pre-existing conditions. Insurance rarely pays to replace teeth that were missing prior purchasing the policy. If you're in the middle of dental work, it probably won't be covered by a new policy.

Do Dental Discount Plans Provide Worthwhile Dental Benefits in Pennsylvania?

A discount dental plan offers discounted fees for dental services provided by participating dentists. It's an affordable alternative to insurance for managing dental expenses. You pay an enrollment fee and sometimes an annual membership fee; you’ll also be given a card which you show to receive your discount. Typical services included in discount dental plans include:

• Routine exams
• X-rays
• Teeth cleanings
• Fillings
• Extractions
• Root canals
• Crowns
• Dental bridges
• Dentures

Discount dental plans have a number of advantages over insurance, including:

• Everyone is accepted. There are no age limits.
• There's no waiting period for major work. This enables a person to get the work done immediately instead of waiting and letting their condition worsen.
• Pre-existing conditions are covered. Most insurance companies have missing teeth clauses which means they won't cover treatment to replace a tooth which was missing before the policy was bought.
• No claim forms; simply show your card to receive your discount.
• No annual cap of benefits. You can use your card as many times as you need to without any restrictions.

Smile Alliance Club and other popular plans also offer discounts on hearing, vision care and generic and brand name prescription drugs.

What Can Senior Citizens Do About Out-of-pocket Dental Care Expenses?

Seniors who find their copay or discounted fee too much to handle at once can ask their dentist about a payment option to spread out the cost of treatment over several months. Many dental offices accept CreditCare, a medical credit card. You can apply over the phone or using the automated system which is available 24 hours at day. If a person qualifies, they may be able to take advantage of promotional offers with 0 percent interest. If you don’t pay the balance by the end of the offer, the APR is similar to the interest rate conventional credit cards charge, sometimes more than 20 percent. The promotional offers typically last from six to 24 months.

AARP and other senior organizations can also be a source of information about discounts on insurance, low-cost discount dental plans or other dental benefits in Pennsylvania.