Who Has the Best Dental Insurance for Seniors?

Medicare Benefits Solutions
Aug 5, 2022

Routine dental care is important, especially as we age. Medications, illness and injuries can play a role in oral health. Tooth and gum disease can also lead to infections and other serious complications.

According to the Centers for Disease Control and Prevention (CDC), older adults frequently overlook dental care, largely attributed to lack of access due to high cost.

The key findings of the 2017 National Health Interview Survey revealed:

  • Adults aged 65 and over, only 29.2% have dental insurance
  • For adults with dental coverage, the percentage declined with age: 34.3% for ages 65 to 74, 22.3% for ages 75 to 84, and 19.9% for ages 85 and over
  • Of adults aged 65 and older, only 8.1% of seniors with limited income and resources have dental insurance

Before deciding if dental insurance is worth the cost, first take a look at what services are typically covered.

What Do Dental Plans Cover?

Dental insurance for seniors should provide coverage for preventive and comprehensive services with minimal deductibles, coinsurance, or co-pays.

Preventive dental care services include:

  • Routine exams, typically every six months
  • Cleanings
  • X-rays

Comprehensive dental services include:

  • Diagnostic: detection of tooth decay, gum disease and oral cancer
  • Restorative: repair or restoration like fillings and implants
  • Endodontics: root canal
  • Periodontics: treatment of diseases involving such structures as gums and jawbone
  • Extractions: removal of teeth
  • Prosthodontics: devices like crowns, bridges and dentures
  • Maxillofacial: reparation of defects and deformities in the face, jaw or mouth to reduce pain and restore function

Is Dental Insurance Worth the Cost?

Evaluating if dental insurance is worth the cost starts with understanding the impact of oral health on your overall well-being. Your dentist is trained to look for problems related to general health conditions, with knowledge regarding the potential link between dental issues and specific diseases.

Acknowledging that dental care is critical, consider the cost of dental care without insurance. It is the high cost of dental services and devices that has seniors searching for the most cost-effective and best dental insurance for retirees.

Typical Costs of Dental Services

High cost is often a barrier to regular dental care. The following are ballpark prices for common dental procedures and devices. Prices will vary based on the dental practice and location.

  • Cleaning (basic scaling and polishing): $75 to $200
  • X-rays (panoramic): $100 to $200
  • Fillings: $50 to $250 for one or two teeth, depending on the material – amalgam, composite, glass ionomer, or gold
  • Crowns: $500 to $2,000 each, depending on the material – metal, ceramic, or porcelain
  • Extractions: $75 to $800, and over $3,000 for a full-mouth extraction
  • Root canal: $500 to $1,500, depending on whether the procedure is for an incisor or molar
  • Dentures: $300 to $4,000 per denture, depending on the quality of the dentures and if extractions or customizations are needed

These prices illustrate why it’s important to get the best senior dental insurance you can find. The question is, what is the best dental insurance for seniors?

Does Medicare Cover Dental Work?

care. But if you are a Medicare recipient searching for the dental insurance that will be right for senior citizens, be aware that your Medicare dental coverage is limited to:

  • Emergency or complex dental services while you are admitted as a hospital inpatient if hospitalization is medically necessary either due to an underlying condition or the severity of the procedure
  • Dental services that are crucial to a procedure that Medicare covers, such as an injury that requires jaw reconstruction
  • Extractions that are performed to prepare a patient for radiation to treat jaw-related neoplastic diseases
  • Oral exams that are necessary for preparation for a heart valve replacement or kidney transplant

Medicare does not cover routine dental services like cleanings, X-rays and extractions. Medicare also excludes benefits for dental apparatus like crowns, fillings and dentures.

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What Types of Dental Plans are Available to Seniors?

If you’ve had dental care coverage through group or employer insurance but are eligible for Medicare now, you may be wondering how to get dental care benefits. While Original Medicare does not include routine dental care, you do have options.

Here are a few options to explore if you are looking for dental insurance coverage.

Medicare Advantage Dental Coverage

You can find dental coverage that fits your needs and budget by comparing Medicare Advantage plans that include dental care and dental insurance plans for seniors.

Many Medicare Advantage (MA) plans encompass Part A, Part B, and sometimes Part D (prescription drugs) as well as dental, vision, and wellness services. If you are an MA member, check your Evidence of Coverage (EOC) for details, including the annual maximum benefit and whether you have to use network providers.

If your MA plan does not include dental services, you can change to another MA plan during the annual Open Enrollment Period, October 15 to December 7, or during Medicare Advantage Open Enrollment, January 1 to March 31. If you need help, a licensed sales agent can provide guidance.

Medicaid Dental Coverage

If you are eligible for Medicaid, contact your state Medicaid agency to find out if dental benefits are covered for adults. Medicaid must cover dental benefits for children, but adult coverage varies by state. For Medicaid recipients 21 years old and over, the majority of states cover emergency dental, but under half offer comprehensive benefits.

Marketplace Dental Insurance

If you are under the age of 65 and do not qualify for Medicare, the state-based health insurance marketplace shows two categories of stand-alone dental plans that offer a trade-off of premiums and out-of-pocket costs. The high-coverage plan requires higher premiums but your copays and deductibles are lower.

The low-coverage level is the best senior dental insurance if you want lower premiums, but you will have to pay higher copays and deductibles. When comparing dental insurance plans for seniors in the marketplace, be sure to check the details about cost and services so you can decide what is best for you.

Community Dental Services

If there are dental schools in your area, contact them to find out if they have clinics open to the public. You can check community health centers too. These are good options for seniors hoping to lower dental costs and get quality care.

Lowering Your Dental Costs

Dental insurance options for senior citizens may include dental savings or discount plans. Some dental insurance companies sell discount plans as well as insurance plans. When you join a discount savings plan and use a network dentist, you get a discounted rate without having to negotiate it yourself. However, unlike insurance where the dentist submits a claim and bills you for the uncovered amount, you have to pay the bill, at the discounted rate, directly to the dentist.

Another way to potentially lower the cost of dental services is to use your current dentist as a resource. Ask which insurance plans the dental practice will accept and if the practice will negotiate rates with you. Some dental offices offer a senior discount or reduced rates when you need a lot of work such as multiple root canals and crowns.

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