Dental Insurance For Seniors: What’s Covered And What’s Not

While getting old, dental care becomes all the more crucial and costly. Many American seniors struggle to pay for treatments, particularly because traditional Medicare does not cover common dental care.

This is here where dental insurance for seniors can really come into play. These are designed specifically to provide financial relief for routine dental and more major procedures, which become more frequent in later years.

What Is Covered Under Dental Insurance For The Elderly?

Preventive, basic, and, in some cases, major services are included in most dental insurance for senior citizens. The intent is to lower out-of-pocket costs for treatments likely to help maintain oral health over the long term.

Basic Restorative Procedures

Basic Restorative care is limited to services such as fillings and simple tooth extractions. These are typical needs for senior citizens who have dealt with tooth decay or other minor damage throughout the years.

70 to 80 percent of dental plans for seniors provide coverage for these treatments. Although it can differ based on the particular kind of plan (PPO, HMO, or service benefit), most cover at least some portion of its cost.

Major Restorative Procedures

Since dental health deteriorates with age, more complicated treatments in terms of dental crowns, bridges, and dentures are also needed.

Extensive restorative work is typically more expensive and may take several appointments. These procedures are covered by many senior dental plans but at a reduced percentage, usually 50% or less.

Also, some plans have a waiting period of 6 to 12 months before you can get coverage for major procedures. Seniors need to read the fine print if they expect extensive restorative work to be necessary soon.

Specialist Care Coverage

Occasionally, seniors need help from dental specialists like periodontists (for gum disease), endodontists (for root canals), or oral surgeons. Some plans offer limited coverage for these services, especially if they are deemed medically necessary.

For example, seniors with long-term gum issues will typically have to undergo more complex periodontal treatment.

Of course, not all specialist services are paid for on a general dental plan. However, many senior dental plans do provide some coverage for them, particularly if the care is referred by a general dentist.

Diagnostic Services

Preventive care and early detection are crucial to the management of oral health. It is especially important as individuals age.

Routine exams, claims, and X-rays are typically part of most dental plans for seniors. Typically, these diagnostics are 100% covered, sometimes twice a year. Routine checkups identify problems early to prevent pricier treatment later.

Thus, it is one of the most useful aspects of dental coverage. It offers good protection for your dental health in the long run and could help to prevent more serious problems further down the line.

What Is Not Covered Under Dental Insurance For The Elderly?

As much as senior dental insurance plans might be able to help you out, they don’t always include everything. It’s just as important to know what may be excluded before you choose a plan.

Cosmetic Procedures

Cosmetic procedures such as bleaching, veneers, and bonding are not generally regarded as medically necessary. Therefore, as it stands, the majority of insurance companies do not cover these costs.

Even if a cosmetic procedure holds the potential to increase self-confidence or improve a person’s overall quality of life, if it’s not a functional or health component, it will generally not be covered.

If seniors want cosmetic dentistry, they will have to find a way to pay for it. These treatments are not covered by insurance, and discount dental plans don't usually apply.

Dental Implants

Dental implants are another option for senior citizens who have had their teeth extracted. But, for the most part, implants are not covered by traditional dental insurance because they are considered both restorative and cosmetic and because of the cost of their maturity.

Some of the best deals do not have a large premium attached, however, and most are only available with an expensive or strict insurer.

For seniors who expect to require cosmetic implants, they will need to search for plans that provide implant benefits or consider purchasing supplemental dental insurance to defray the cost.

Out-Of-Network Treatments

Another widespread limitation is out-of-network coverage. The majority of dental insurance plans have network dentists.

If a senior opts to see a dentist who is not within this network, the insurance may refuse to pay or may simply reimburse at a much lower rate. It can result in surprisingly high bills.

Seniors must be sure to verify that their choice of dentist is, in fact, capable of providing coverage under the plan of the senior’s insurance (either an individual senior plan or a group senior plan through a company). PPO plans often provide more options for out-of-network care than HMOs.

Choosing The Right Dental Insurance Plan For Aged People

With so many to choose from, choosing the right dental insurance can feel overwhelming if it meets your needs and goals. Be sure to compare plans carefully according to your present and future dental needs.

Here are a few things to consider that will help you make your decision:

• Scope Of Coverage: Consider what procedures are covered, dental emergencies in particular, as well as major restorations, cleanings, and diagnostic services.
• Waiting Periods: There are plans that will make you wait before they cover some treatments. Select a plan with shorter waiting periods or none at all if you require immediate care.
• Annual Maximums: Look for the amount the plan will pay annually at the low end; based on that, the plan will only pay that much annually. Seniors who need more dental work should consider a higher annual maximum.
• Provider Network: Confirm your dentist of choice is in-network, or select a plan with favorable out-of-network benefits.
• Monthly Premium vs. Out-Of-Pocket: Consider the monthly expense in conjunction with the chance of additional out-of-pocket costs for services not covered.

Selecting the best plan may save you money on dental expenses over the long term and will help prevent health complications.

Conclusion

Choosing the right dental insurance for seniors involves understanding what’s included and what’s excluded. From minor maintenance to major procedures, understanding the boundaries of your policy allows you to make wise choices about your dental health.