Seniors Dental Benefits Program
The provincial Dental and Optical Assistance for Seniors programs provides basic dental coverage up to a maximum of $5,000 every five years.
Basic dental services covered include the following:
- Checkups and diagnostic services, such as examinations and X-rays.
- Cleanings and preventative services, such as polishing and scaling.
- Restorative services, such as fillings and trauma or pain control.
- Extractionsboth simple and complicated.
- Procedures related to gum disease, such as periodontics and root planing.
- Prosthodontics and full or partial basic dentures.
There is a maximum amount of coverage for each dental procedure and a specific number of times you can receive assistance within certain time periods. If youre eligible for the maximum amount , youre eligible for up to the maximum coverage allowed under the schedule of dental procedures for this program. A minimum coverage of 10 to 99 per cent is allowed under the schedule and increases as annual income decreases.
The Dental Assistance for Seniors Program pays dental expenses according to the plans fee schedule. To maximize your dental benefits, you may wish to compare the fees of two or more dental providers.
You must be 65 years old and older and meet the financial eligibility criteria to be eligible for the program.
Get An Affordable Dental Insurance Alternative For Seniors
An additional solution for seniors, however, is a discount plan. Discount plans are accessible for individuals of every age, and comfortably reduce your bill at the dentist by 15% to 60%. One more terrific benefit of discount plans for seniors is that discount plans do not conflict with Medicare or Medicaid. Medicare has restrictions on exactly what varieties of coverage an individual can possess, however discount plans have been developed outside of old-fashioned insurance. These plans have the distinction of providing all the rewards of insurance for seniors without the typical hassles.
What Does Dental Insurance Cover
Most dental insurance plans cover a few basic and major services. These can include things like:
Some dental insurance plans might extend coverage or partial coverage for more advanced services such as endodontics, dentures, implants, cosmetic procedures and more. Its important when shopping for dental insurance to consider each plans coverage details for any anticipated procedures.
Many plans categorize orthodontic treatment as a Class IV service, which are frequently covered from 25 percent to 50 percent. Supplemental dental insurance plans for braces may also involve a separate lifetime maximum that applies to the entire course of orthodontic treatment and is not part of your annual dollar maximum.
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Do I Have To Pay For Dental Care If Im On Medicare
Some types of Medicare Advantage Plans include coverage for basic dental care. Basic dental care includes things like teeth cleanings, routine X-rays, extractions, fillings, and possibly more, depending on the plan. What you pay toward your Medicare plan may vary.
Even if you have a Medicare Advantage Plan that covers basic or routine dental care, it typically will not cover you for major dental bills, such as root canals, implants, gum grafts, etc. This is even more reason to try and maintain your oral health as you age.
High Cost Is A Barrier To Dental Care
Seniors or retirement-age adults often lose their employer-provided dental insurance at a time when their dental needs and costs are increasing. Consider these statistics from the Centers for Disease Control and Prevention :
- About two out of three adults 65 and older have gum disease.
- One in five adults 65 and older have untreated tooth decay.
- One in five adults aged 65 and older have lost all of their teeth.
At the same time, more than half of seniors say theyve had to delay dental care due to the high cost, and 23% of Medicare enrollees say theyve delayed or gone without dental care, according to statistics from the Kaiser Family Foundation.
Overall, the need for senior dental care is clear, but what about dental insurance?
Dental insurance can be a valuable tool to protect you from the high cost of dental care. Like any insurance, deciding whether its worth the cost or not depends on your specific needs.
If you only need twice yearly cleanings and X-rays, youd probably spend more on an insurance premium than you would if you paid out of pocket. But most seniors are likely to need more care than that, making dental insurance a viable way to help offset those costs. For example, 19% of Medicare beneficiaries spend over $1,000 a year on dental care .
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Does Medicare Cover Dental Services For Seniors
Unfortunately, like dental exams, cleanings, fillings, crowns, bridges, plates or dentures. There are some exceptions, such as when a hospital stay is involved, but otherwise you would have to pay out of pocket for any routine dental services. For some of us, those expenses could add up quickly.
Thankfully, there are several options for dental insurance for seniors and those who are Medicare eligible.
Federal Times Highlights Key Dates Deadlines And New Offerings For Open Enrollment
When it comes to federal benefit plans, dental and vision are in a category all their own.
Average health care insurance premiums are skyrocketing. Federal employees and retirees should expect to pay 8.7% more, on average, for health insurance in 2023, the Federal Employees Health Benefits Program said last month.
Yet rates will go up only an average of 0.21% for dental. For vision, rates will decrease by an average of 0.41%.
Part of the reason these rates change independently of standard health insurance offered by the Federal Employee Health Benefits program is because they are, in fact, independent.
Care provided by dentists and optometrists falls under the Federal Employees Dental and Vision Insurance Program. FEDVIP is a standalone voluntary, enrollee-pay-all dental and vision program that offers beneficiaries the option to choose their carrier. In total, FEDVIP provides dental and vision benefits to a total of 7.5 million federal employees, uniformed service members, retirees and family members.
The FEDVIP program shares the same open season dates as the FEHB program, but employees join them separately. The federal government also does not directly contribute to the cost of vision or dental premiums. Beneficiaries pay it all, though with substantial tax savings to employees.
For retirees, it may look like rates increase sharply upon departing from government service, but they dont.
Waiting periods for orthodontic services have been removed.
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Dental Insurance Options For Retired Seniors
There are two main insurance plan options that youll be able to choose from when youre looking for affordable dental insurance as a retired senior citizen: PPO plans, and Dental Health Maintenance Organization plans.
PPO plans typically give you access to a wide range of dentists, and in some cases, you may be able to continue seeing providers outside the network. PPO members pay a monthly premium, and the plan covers a percentage of your costs after youve met your deductible. If you need individual health insurance and already have a dentist that you know and trust, PPO plans can be a good option.
DMHO plans require you to choose a single dentist or dental office as your in-network provider. If you need to see a specialist, like a periodontist or an oral surgeon, your primary dentist will give you a referral authorized by your insurance company. When you have a DMHO plan, you likely wont have a deductible or an annual cost. Instead, you typically pay a copayment for any dental services you receive covered under the plan. This is typically an affordable type of dental plan, and many basic dental services typically dont have a copay.
Our Search For The Best Dental Insurance For Seniors
1. We searched for an extensive list of 24 companies.
2. We evaluated dental insurance companies based on our expert-guided buying criteria: cost of premiums, the number of in-network dental care providers and overall cost savings.
3. We provided you the three best dental insurance companies to choose from.
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Is Dental Insurance For Senior Citizens Worth It
You might be wondering why youd need to sign up for dental insurance if youre covered by Medicare. Well, the truth is that Medicare doesnt cover all of your dental care needs. While it might help with costs associated with a treatment for your overall health, such as a dental exam prior to undergoing a medical procedure, it wont cover trips to the dentist. This means youd need to pay for things like checkups, cleanings, fillings, dentures and implants completely out-of-pocket. All of that can take a serious toll on your budget!
What about Medicare Part C plans that you can purchase to supplement Part A and Part B? Well, you need to be extra cautious when shopping for those plans because they dont always cover dental care either. A better route might be to purchase a separate dental insurance plan designed to cover everything from preventive care to major services. That way, you can rest assured youll get the financial support you need to keep your teeth and gums healthy during your golden years. Shop dental insurance.
Dental Challenges As We Age
People of all ages can get cavities, but seniors have some special dental challenges, including:1
- Higher risk of developing decay around older teeth.
- Greater risk of decay of the tooth root itself, if the gum tissue has receded.
- More and faster plaque build up.
- Daily dental hygiene habits can be tricky if you have mobility, dexterity, or vision challenges.
- Dental care can be harder to access if you have medical or behavioral conditions that get in your way.
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If You Or Your Spouse Are Still Employed Try Getting Coverage Through Work
If youre losing coverage because you left a full-time job, look into getting dental benefits through your spouse. If youre not married or your spouse isnt working but youre still doing some part-time work ask if you can get dental coverage there: workplace dental plans are almost always your best option because employers buy benefits for many employees at once, so they qualify for lower group rates. Also, group plans often feature higher coverage levels, and the company may pay a portion of the costs, making it an even better value. You may also be able to get group coverage through a professional association or other membership group.
Why Is Dental Insurance Important For Older Adults
Taking care of our oral health becomes more important as we age. Older adults have specific needs, such as dealing with gum disease, root decay, broken or lost teeth, and even arthritic conditions that can lead to dental problems. People near retirement age, especially, need to begin looking for a plan to avoid costly coverage gaps, since Medicare doesnt offer dental coverage.
Most dental insurance companies offer an array of plans, ranging from basic preventive-only coverage and discount savings plans to comprehensive traditional packages and gold-level plans. Except for dental discount plans, most programs have at least a six-month waiting period for coverage to kick in, especially for major dental work. That makes finding a new policy before losing any current coverage essential for older adults.
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Learn About Affordable Dental Plans
Seniors can gain access to discount plans for seniors online. Presently there are several distinct plans obtainable through quite a few different websites, like the Careington Care 500 plan. Seniors can check out the plans tailored for their specific locations throughout the country to evaluate which one will be most helpful in meeting their oral care needs. There truly is a plan for every person with just a minor amount of effort, you can identify a plan that is right for you.
How Much Supplementary Health Or Dental Insurance Do You Need
There are a wide variety of supplementary health and dental insurance plans, each with their own level of coverage, but the amount of health insurance you need is a highly personal decision. Only you can decide how much is right for you, but an insurance agent or company may be able to help you make those decisions. Visit the finding an insurance agent or company section of Working With an Insurance Agent or Company to find someone who can help you.
Factors to consider when deciding how much coverage you need include:
- How much can you afford to pay each month? Each year?
- Do you have any other supplementary health insurance through your employer, a parents group plan or a spouse/partner?
- Do you require prescription drugs on an ongoing basis?
- Are you willing to share a hospital room, or do you prefer a private room?
- Do you wear glasses or contact lenses?
- Do you receive medical services from professionals such as chiropractors or massage therapists?
- Can you afford to pay out of pocket for ambulance fees?
- Do you have a chronic illness that requires more extensive medical services than OHIP provides?
- Do you have a pre-existing medical condition? Some supplementary health insurance plans do not cover this. Be sure to shop around to find an insurer who might.
Supplementary Health and Dental Insurance | 101: Getting Started 4
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Best For Special Needs: Cigna
Only available in 23 states
Dental coverage only available with some plans
We chose Cigna as best for special needs because of their personalized plan offerings. While other Medicare Advantage Plans limit coverage to individuals with special health conditions or care needs, Cigna offers special needs plans that include access to a wider range of specialists, along with regular health assessment .
Depending on your health care needs, Cigna offers an increased range of services, whether that is more intensive treatments, personalized care treatments, or more individual specialist attention.
Based on a review of Cignas Model of Care, the National Committee for Quality Assurance has approved Cigna to operate as a Special Needs Plan through 2021.
Cigna offers a health risk assessment that can be used to develop personalized care plans with Cigna Medicare Advantage Plan enrollees and their primary care doctor. The HRA also helps match each enrollee with the health and wellness services that best fit their needs.
Originally founded in 1792 as the Insurance Company of North America, Cigna is now an American worldwide health services organization. They have a full range of plans with premiums ranging from $0 to over $100 each month, depending on your needs and location.
Ways Retirees Can Pay For Dental Care
Since Medicare doesn’t provide dental benefits, seniors must consider other options to cover this need.
Getting dental insurance in retirement is complicated even though seniors are prone to dental health problems. About 20% of adults 65 and older have untreated tooth decay, 68% have gum disease, and almost 1 in 5 have lost all their teeth, according to the Centers for Disease Control and Prevention . Because original Medicare doesn’t cover dental care, seniors who want dental insurance must get it through a Medicare Advantage plan or buy individual dental coverage. Even then, the plans may have restrictions that leave seniors underinsured.
Preventative And Diagnostic Services
At Aflac, we offer a range of standard preventative services like cleanings, x-rays, and topical fluoride. We also provide services for tailored preventative care like periodontal evaluations, nutritional counseling, and tobacco counseling too. This can be particularly helpful when assessing what the best dental insurance for seniors is.
Additionally, we can help provide coverage for fillings and other basic services, but this is only available on certain plans. We recommend chatting with an agent about our basic plans, standard plans, and premier plans.
How Dental Insurance Works
Dental Insurance is affordable for most seniors but it has varying levels of coverage, called class of service, within one policy. You will receive some procedures at no cost beyond your premium but will share the expense of others with your insurance company.
Dental insurance almost always picks up 100 percent of the bill for routine checkups and cleanings. Coverage for common procedures like root canals and fillings are typically covered at 80 percent, although policies with higher premiums cover up to 90 percent. You are then responsible for the remaining 10 to 20 percent of the cost, called coinsurance. Most plans cover higher-priced and more involved procedures at 50 percent, so you should have some savings set aside for what your insurance does not cover. Still, with relatively low premiums, having dental insurance is far less expensive on average than paying cash for all dental procedures.
Orthodontia is another class of service, and typically has a lifetime rather than an annual maximum. You can buy dental insurance that excludes this coverage if it is doubtful that you will need it.
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Typical Dental Insurance Is Not Cheap
A single challenge which unfortunately must be conquered when thinking about dental insurance for seniors is that insurance is often much more highly-priced. The reason for this is that insurance providers realize that seniors are traditionally searching for a significant amount of work to be performed . Frequently, senior dental insurance is not even offered once a person reaches a particular age.