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Medicare Advantage Dental Benefits in Orlando (Seniors 65+)

Maintaining great dental health is important no matter what your age. Unfortunately, many seniors over the age of 65 have little or no access to dental health services – and they’re often the age group that needs it most. This is usually due to lack of insurance, which is often provided by employers. As seniors leave the workforce, they must look for affordable ways to receive dental benefits in Orlando, including Medicare Advantage plans, dental savings plans and private insurance coverage. Despite these options, nearly 65% of seniors go without any type of coverage – and the number is expected to rise as more people reach age 65 every day.

Even though many seniors lack dental insurance, overall spending on oral health treatment is rising. Last year, seniors spent more than $28 billion on dental services, and they are the fastest-growing demographic in terms of dental spending overall. In 2016, 6 million more seniors visited a dentist than in the previous decade, according to a study from the American Dental Association Health Policy Institute. This number is expected to steadily increase over time.

While dental spending among seniors is on the rise, nearly half of Medicare recipients haven’t seen a dentist over the past 12 months. Plus, 19% of Medicare recipients spent over $1,000 out of pocket. The list below offers a general idea of typical dental procedure 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.

Are There Different Dental Insurance Options for Seniors?

If you’re a senior over 65 and searching for dental benefits in Orlando, it’s important to know that you have options. Medicare is available to all seniors over 65 and those who are considered permanently disabled. You’ll receive a red, white, and blue ID card if you receive Medicare.

Medicare does have some limitations as it does not cover routine dental care. Coverage for dental checkups, cleanings and routine procedures like tooth fillings and extractions is typically not available. In fact, dental procedures are usually only covered by Part A benefits if they’re needed to clear a patient for covered procedures, including surgeries. These limitations often cause seniors to look for other ways to manage dental costs. Some options include private insurers and Advantage plans.

How Do Medicare Advantage Plans Work?

Medicare Advantage expands your existing Medicare benefits to offer more savings and options on medical costs. With this type of plan, you’ll have access to a larger network of medical providers. The plans usually have lower deductibles, cost-sharing measures, and out-of-pocket spending limits. Unlike Medicare where all costs are reimbursed by the government, supplement plans are reimbursed by the insurance company. Most importantly, these plans often provide coverage for dental procedures, vision care, and medications. Aetna, Humana, and UHC all provide Medicare supplement plans.

These plans usually include a separate ID card that you present when receiving dental care. The plans often have lower premiums, making them an excellent choice for those on fixed incomes. However, their benefits are often limited to X-rays, dental cleanings and other preventive treatments. 

What Is Standalone Dental Insurance?

If you require more comprehensive dentistry coverage, you may want to consider a standalone dental plan. Provided by insurance companies, standalone plans are usually available in different tiers of coverage. Your premium costs, the services covered, and what percentage is covered depends on the type of plan you choose. Here are a few common examples of standalone dental insurance plans:

Basic: This type of plan usually covers routine preventive services, such as dental exams, professional cleanings, oral cancer screenings and X-rays. More complicated procedures typically aren’t covered.

Mid-level: Expanded services are covered under a mid-level plan, including braces, emergency dentistry, and panoramic X-rays. Inhalation sedation methods and restorative treatment may also be included.

Premium: The top level plan provides at least partial coverage for more invasive procedures. If you require extensive dental work, a premium plan may be right for you. These plans cover:

  • Dental crowns
  • Inlays and onlays
  • Endodontic procedures
  • Oral surgeries
  • Dentures, both complete and partial
  • Treatment for gum disease

Private insurers often use a “100-80-50” system to determine premium plan coverage. Typically, this means that routine services like dental exams are completely covered, basic procedures are covered at 80%, and more extensive treatment is covered at 50%. Standalone plan premiums may be lower in cost than Medicare Advantage premiums, but keep in mind that these plans don’t usually offer hearing, medication, and vision benefits.

Is a Dental Discount Plan a Good Option?

Dental discount plans are sold by private companies just like standalone insurance plans, but it’s important to note that they are not insurance. Instead, dental discount providers negotiate reduced rates with dental practices for routine services. They pass the savings onto members, who will pay an enrollment fee and monthly dues to participate in the discount program. Members also provide payment directly to the dentist instead of having to navigate the insurance claims process.

With low monthly fees, discount plans are often quite affordable. They provide multiple benefits over private plans, including:

  • No copays, coinsurance requirements, or copays
  • Zero waiting period before receiving care
  • No limits on how often you can see the dentist, and you can switch providers at any time
  • No lengthy paperwork to fill out or confusing claims processes
  • Preexisting conditions and age limitations are not included

Traditional insurance plans may offer more coverage for some procedures, but discount plans offer significant savings on routine care. Some of the discounted services include:

  • Regular dental checkups
  • Professional cleanings
  • Tooth extractions
  • Restorative treatment, such as crowns and fillings
  • Root canal therapy
  • Dentures

Many discount plans, including DentRite, offer reduced rates on medication, hearing aids and eye care. Those in good dental health who will only require routine services may want to consider a discount plan.

What Can I Do to Afford Out-of-Pocket Dental Costs?

When on a fixed income, many retired seniors have concerns about managing out-of-pocket dental expenses. Fortunately, flexible financing can make affording dental services possible. CareCredit is one popular financing provider that is accepted at more than 200,000 offices nationwide. Medical credit providers such as CareCredit provide short-term financing, which is often interest-free if the balance reaches zero during the promotional period. Additionally, long-term financing is available for large purchases.

Patients should be aware that taking out a credit line for a large dental expense can have drawbacks, including:

  • Having to apply and be approved – not every patient will qualify for financing.
  • Occasional high interest rates of more than 20%, which add to the overall treatment cost.

We believe that every senior should be aware of their options when looking for dental benefits in Orlando. Questions about your benefits or Medicare can be directed to your local senior organizations, or you can check AARP resources for information. You can also contact our office if you have questions about Medicare Advantage, our services, or our payment options.

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