Very few of us are lucky enough to completely escape dental problems throughout our lives. In fact, NIH statistics show that 93% of Americans aged 65 and over have had dental caries in their permanent teeth and 27% have lost all of their teeth. Because of this, dental insurance for seniors can be a valuable investment.
Over half of Americans aged 50-64 worry about how they will afford dental care when they turn 65, according to a 2017 poll. Having a dental plan is one way to help lower and spread the cost of dental work, but with so many different options available, it can be hard to work out which one is right for you. In this guide we hope to make the process a little easier. You’ll find information on:
- How to get low-cost dentures
- Affordable senior dental care
- Medicare dental cover
- The different types of dental insurance available
- The best providers of dental plans for seniors
- Options for dental and vision insurance
Getting the right dental plan in place will give you more control over your treatment costs so you can afford to keep your oral health in check.
Table of contents
- 1 Types of senior dental insurance and discount plan
- 2 Dental insurance for seniors on medicare
- 3 Choosing a provider
- 4 The best dental plans for seniors
- 5 Conclusion
Types of senior dental insurance and discount plan
There are a number of different ways to get dental cover, whatever your age. Dental discount plans are not insurance in the traditional sense, but they are more widely available to individuals and generally more affordable.
Fee-for-service (dental indemnity)
The traditional type of insurance, you pay an annual premium in return for a certain level of cover. A deductible usually applies, and premiums can be higher than with other types of insurance. In return, however, you’ll usually have cover for a wide range of treatments with higher annual caps.
You can visit any dentist you choose with a fee-for-service plan. One drawback is the paperwork; you’ll probably have to pay for 100% of your treatment and then file a claim with the insurer. This type of insurance is most commonly available to groups and through employers, so we haven’t included any examples here.
DHMO (Dental Health Maintenance Organization)
With a DHMO plan you get discounted rates for certain treatments at a particular network of dentists. You may have to choose one primary care provider.
These restrictions are offset by lower premiums, often with no annual limits, no deductibles, and some preventive care included for free. If you need immediate dental cover, you can often find a plan with no waiting period.
Because the insurer has an agreement directly with the dentist, you’ll usually receive the discount straight away rather than having to deal with a lengthy claims process.
DPPO (Dental Preferred Provider Organization)
DPPO plans are similar to DHMO but offer access to a wider network of dentists. You can usually visit an out-of-network dentist too, although you may not benefit from such good discounts.
This added flexibility means premiums are usually higher than with a DHMO.
You can read a more detailed explanation of the different types of insurance available in our full article on dental plans in the US.
Dental insurance for seniors on medicare
Although many Americans rely on Medicare for their health cover, Part A and Part B benefits don’t cover most types of dental care. The only exception is when treatment requires a hospital stay, for example if you have an accident or need complicated surgery. In this case, Original Medicare cover may be valid.
But what if you want cover for things like routine checkups, fillings, extractions, and dentures? There are several ways that seniors on Medicare can protect themselves against the high cost of dental treatment.
Medicare Advantage (Part C) plans
The only way to get Medicare dental coverage for seniors is by purchasing Medicare Advantage through a private insurer. These Part C plans may include additional benefits such as dental, vision, hearing, and prescription drug coverage. The specific benefits, premiums, and co-payments are dependent on the insurance company and can change from one year to the next.
Just like regular dental insurance, Medicare Advantage comes in a variety of forms including those mentioned above. One benefit of this insurance, whatever type you choose, is the annual out-of-pocket limit. This means that if your dental costs exceed a certain amount in any given year, you’ll only pay up to the agreed maximum.
However, Medicare Advantage plans often come with strict rules for getting coverage and receiving treatment. There are also location restrictions for each plan.
If you decide to purchase Medicare Advantage, be sure to check that the insurer offers dental cover – not all insurers do. The alternative for seniors on Medicare is to just purchase a regular dental plan through a private insurer.
Choosing a provider
Our teeth, just like our bones, naturally weaken and soften as we become older. This makes them more susceptible to damage. Gum disease can also be a problem for seniors, and any dental work you had in the past may need repair or replacement.
For all of these reasons, some insurers refuse to cover people past a certain age. Alternatively, they hike their premiums up to protect themselves against the likely increase in dental care needs.
Dental insurance for senior citizens can also come with a myriad of exclusions and restrictions. Things to look out for include:
- Waiting periods: You may not be eligible to claim for certain treatments until a set period of time has elapsed.
- Pre-existing conditions: Treatment for problems that existed before you took out cover may be excluded.
- Missing teeth exclusions: The insurer may not pay to replace any teeth that were missing before you took out cover.
- Dental implants: You’ll usually have to pay a higher premium for dental implant insurance.
- Other exclusions: Certain cosmetic and elective treatments might be excluded altogether.
Comparing dental insurance plans for seniors
It can be hard to work out which insurance offers the best value, since there are so many factors to consider. When looking at the best dental plan for you or a senior relative, you’ll need to balance:
- Premium: The monthly or annual amount you pay regardless of whether you use the insurance.
- Deductible: The amount you must pay towards any treatment each year before your insurer will pay out.
- Co-insurance / co-payment: The percentage or fixed dollar amount that your insurer will pay towards each type of treatment.
- Fixed discounts: Some plans apply fixed discounts which can range from 10% to 100%.
- Complimentary treatments: Certain treatments, like checkups and cleanings, may be included in your plan for free.
If you’re likely to need a lot of treatment it could work out cheaper to pay a higher premium for a plan that offers better discounts and annual limits with a smaller deductible. If, however, you have a good oral health record and mainly need preventive care, a more basic plan could work out more cost-effective.
You may just want the peace of mind that if you did need major dental work, you wouldn’t have to pay the full cost yourself. If your plan includes two or three checkups and cleanings each year, be sure to take advantage of them! These help your dentist spot any problems early on, before more costly treatment is needed.
The best dental plans for seniors
Many insurance providers only cover a few states, or only work through insurance agents and brokers. So for now, we have just included a few providers who offer insurance to the majority of states with the option to purchase direct. Exact policy details may vary between states, so this information should be used as a guideline only.
Most insurers offer the option of adding your spouse or other family members to your plan for a higher premium. There is also the option to purchase a separate family dental plan.
Delta / AARP
Delta dental cover for seniors is available directly through Delta, or through AARP who offer various other benefits to over-50s.
Delta offers an HMO-style plan as well as two levels of PPO cover. With the HMO plan you must choose a primary care provider. The PPO plans let you visit any dentist, but you’ll generally get the best rates with a network-approved provider.
The HMO plan has set co-payments for each type of treatment. There is no cost for an exam and x-rays, a simple extraction is $14, and a complete set of dentures is $365, for instance. There are no exclusions for missing teeth, no deductible, and cover is immediate.
With the PPO plans, you pay a certain percentage of your treatment cost. For a higher premium you get 100% coverage for diagnostic and preventive care, 80% coverage for periodontal care and restorations, and 50% coverage for a number of other procedures including dental implants and dentures (some with a 1-year waiting period). There is also $1,000 dental accident insurance with the top level of cover.
All of these benefits are limited to a maximum of either $1,000 or $1,500 per year with a deductible of $100 or $50, depending on which plan you choose. The video below explains more:
You’ll need to contact the insurer directly to get a personalized quote.
Spirit offers senior dental cover with no age limit and guaranteed acceptance. There is no waiting period for any type of treatment – including dental implants and dentures – but benefits increase over the first three years of the policy.
For example, with one of their policies you’ll get 50% discount on basic and 10% discount on major restorative work in year 1, with a maximum benefit of $1,200. But by year 3, these amounts increase to 80%, 50% and $5,000 respectively. This level of cover starts from around $60 per month for over-65s.
You can add on vision cover for $7 per month, too. Plans come with a $100 deductible – but that applies over the lifetime of the policy rather than per year.
There are three levels of dental savings plans for seniors available from Cigna. The most basic is an HMO plan which only covers preventive and diagnostic services. It’s available from around $19 per month with no deductible or waiting period.
The higher levels of PPO cover include out-of-network cover and restorative care after a waiting period. Deductibles and annual maximums apply. You can see more details in the table below.
|Plan name||Cigna Dental Preventive||Cigna Dental 1000||Cigna Dental 1500|
|Preventive services||100% immediate discount||100% immediate discount||100% immediate discount|
|Basic restorative services||N/A||80% discount after 6 months||80% discount after 6 months|
|Major restorative services||N/A||50% discount after 12 months||50% discount after 12 months|
|Out-of-network coverage?||No||Yes, at different rates||Yes, at different rates|
|Costs based on a 66-year-old female in Georgia|
Given that the level of benefits is comparable to plans from many other providers, it seems that Cigna offers some of the most affordable dental insurance for seniors.
Nationwide Insurance offers five levels of Multiflex PPO dental plan. The basic preventive plan is similar to Cigna’s but costs from around $25 per month.
The other four plans give varying benefits and levels of cover according to the premiums. At the highest level, for around $72 per month you get an 80% discount on preventive and minor restorative services (after 6 months) and 50% discount on major restorative services (after 18 months). A $2,000 maximum and $50 deductible apply per year.
Although this premium is relatively high, the discounts apply to any dentist you choose. This could be useful for people who travel a lot. If this isn’t a benefit you need, a lower level of cover would probably be sufficient.
There are also options for combining dental and vision insurance.
Plans with Avia start from $8.25 per month (even for over-65s). You can visit any of their 40,000+ network dentists and you pay a fixed, discounted price for each of the treatments covered. For example, a regular oral exam is $15 and an extraction is $55 (high compared to Delta).
Avia’s website says they guarantee coverage for anyone who applies and there is no waiting period for treatment.
Despite the low premium, the plan also provides vision and prescription savings. It seems the only downside is that you’ll be hard-pushed to access the full policy details until you’ve actually signed up.
Because of the low premium but comparatively high co-payments, this plan would suit someone who doesn’t anticipate needing regular dental work but wants the peace of mind that they have cover, just in case.
Whether you’re looking at dental insurance for yourself or an older family member, you want to be sure you’ve made the right choice. We hope the information provided here helps you work out what kind of policy you need and what level of cover would suit you.
Remember, balance the premium with the benefits to see how much you’ll actually end up paying per year. And always check the policy details carefully before you sign up.