Medicare Does Not Cover Dental... except in certain medically necessary situations...
Medicare and Medicaid do not include oral health coverage for most people. Even those programs that do include coverage only contain provisions for extractions of teeth, and exclude the common oral procedures we all need as we age.
Basically, no help is available through Medicare for obtaining primary tooth repair or for having missing teeth replaced. There's virtually no aid for just about any type of oral care seniors require except as medically necessary in the care of a serious health problem, such as cancer.
That's it. Unfortunately, there is no such thing as Medicare Supplemental Dental Insurance, or even specific dental insurance plans for seniors on Medicare. Dental insurance for senior citizens is the same as it is for all other individuals. Discount dental plans for seniors are the same, too.
What's the Best Dental Plan for Seniors?
PPO Dental Insurance Plans for Seniors: Good Coverage, High Price
PPO dental plans are a popular option for senior citizens due to the freedom they allow plan members in selecting their own dentist. Typically PPO plans are touted for their flexibility compared to HMO plans, and their low cost compared to traditional indemnity plans.
Businesses use them to provide a valuable option to employees, although the annual payments are typically more expensive than other options. PPO plans are available to individuals and families as well.
Preferred provider organizations are managed care organizations with networks of dentists under contract with an insurance carrier. They offer the greatest savings to plan members who select a dentist within the network, but members have the freedom to choose a provider outside of the network.
When seeing a dentist, you the member pay the dentist directly for the services rendered as well as the copay, and are reimbursed at a later date by the insurance carrier. Occasionally, PPO organizations will pay the dentist directly.
Though dental PPO plans have definite dental benefits for the elderly, be aware this flexibility comes at a price: PPO annual premiums are typically much more costly than other types of dental insurance for seniors. In addition to higher premiums, patients must pay their deductibles before coverage actually begins. Many seniors looking for coverage on a limited income may find the monthly payments quite cumbersome.
There are also tedious claim forms to be filled out, and patients usually have a lengthy wait to receive reimbursements. In addition, since most PPO insurance plans only cover a portion of the dental fee, patients must make a copay out of pocket. Many choose this type of plan due to the flexibility it offers in selecting a dentist.
HMO Dental Insurance Plans for Seniors: Affordable, Limited Flexibility
HMO dental plans, also known as dental health maintenance organizations (DHMO) are usually much cheaper than PPO plans and indemnity plans. Similar to PPO plans, a network of dental providers is under contract with the dental insurance company to provide select services at predetermined prices.
Low cost dental insurance for seniors such as HMO plans are most popular with businesses who use them to insure their employees at affordable rates. But if you are not insured by an employer, you can easily access an HMO policy.
The main advantage of HMO dental insurance for seniors is the low cost compared to DPPO or indemnity plans. Unfortunately, DHMOs impose strict requirements and restrictions on insured members. For example, the dental HMO will not pay for oral health care unless it is rendered by an in network provider.
Different than PPO or indemnity plans, HMOs assign a member to a panel of dentists and oral health specialists from whom they must choose. You do not have the option of selecting a provider out of network. In fact, if you need to see a specialist, the HMO carrier will only pay for services from a specialist referred by your dentist.
The most unique feature of DHMO companies is the method by which they pay their dental providers. They are paid based on the number of patients they treat and are expected to see a certain number per year. Occasionally you will hear patients complain of being rushed through the process or receiving substandard care.
DPPOs, in comparison, allow providers to spend more time with each patient. Despite obvious restrictions and cumbersome guidelines, many people choose HMO insurance plans due to their low cost in relation to other insurance options.
Dental Indemnity Insurance for Seniors: Traditional Dental Coverage
Dental indemnity insurance, also known as traditional insurance, is a type of plan in which the policyholder chooses any dentist he or she wishes. The patient pays the dentist directly for services, and is then reimbursed by the insurance carrier by means of a claims process.
Typically these plans cover 50%-80% of the cost of dental work, and the remaining amount is paid by the patient. Members of indemnity insurance plans often must wait a long time after they file their claim forms to receive reimbursement for services paid out-of-pocket.
For these reasons, this type of dental insurance, for seniors, is simply not the best option. Group members and employees have the flexibility to choose their dentist, change dentists and see a specialist without a referral.
Despite these freedoms, these plans are less popular today due to their expensive annual premiums, higher deductibles and tiring claims procedures. Indemnity insurance is typically structured to appeal to groups and businesses, so it is not the best option for individuals and families.
Dental Savings Plans: Not Insurance, Low Cost Dental Care for Seniors
Discount Dental Plans are alternatives to traditional dental insurance.. Since they are not insurance, these plans charge very low annual fees – some starting as low as $9.95 per month - require no copay or deductible and carry no annual maximum limits.
Again, to be clear, a DSP is not insurance, it's a discount plan not an insurance plan designed to save you a serious amount of money when you go to the dentist.
It's important to keep in mind you will be responsible for paying the dentist the discounted fee when you use a DSP. There's no payment reimbursement by the plan provider. Their role is to get you the best discount possible.
No Claims, No Waiting!
Dental discount plans do not require claim forms because there's nothing to process - as a plan member you pay the dentist directly, and that's it. No other payments required. No waiting for reimbursement checks to come in the mail.
Many seniors who do not have access to employer plans or who cannot afford expensive premiums are turning to discount dental plans. Even if you do have dental coverage but are caught in a long waiting period, this type of plan can easily operate in conjunction with an existing policy.
Can't Be Turned Down.
You may have a preexisting oral health condition that is not covered by your current dental policy. Because discount plans are not insurance, they have no waiting periods. You can sign up today and be at the dentist in 30 minutes. If you've reached your annual maximum, you can use a discount plan to pay for a procedure you have been reluctant to get because of the out-of-pocket expense.
Dental providers contract with dental savings plans to provide the same quality dental work at reduced prices. Dentists realize that for many seniors, insurance is not the best option and, in many cases, doesn't provide all of the coverage they really need. You benefit by gaining access to discounts of up to 60% on routine and major oral healthcare.
Works with Regular Dental Insurance.
Because of their low cost, many people choose to carry this type of plan in addition to regular dental insurance, in case of dental emergencies.
It's worth your time comparing what they offer!