Things to Consider Before Getting a Dental Plan

Even with Medicare plans, most people are left under-insured. Traditional Medicare doesn’t include dental services. So if you would need a stand-alone dental plan or upgrade to a Medicare Advantage plan if you want to have dental work covered.

Unlike traditional Medicare, which is directly managed by the government, Medicare Advantage plans, aka Part C, are administered by private companies who work with the federal government to provide the other two parts.

According to the Kaiser Family Foundation, about a third of Medicare beneficiaries—or 22 million people—have Medicare Advantage. There is currently an open enrollment period for Medicare Advantage that will run until March 31. Existing beneficiaries can switch their current plan with a new one or give it up and acquire a traditional Medicare plan. However, those with traditional plans can’t change to a Medicare Advantage.

In 2016, about 62% of Medicare Advantage beneficiaries had dental benefits. Meanwhile, 21% of traditional Medicare beneficiaries availed of stand-alone dental plans. Still, most of these are only basic and don’t include more specialized services.

For stand-alone dental coverage, plan holders must pay around $30 a month. On the other hand, people pay $0 for their Medicare Advantage plan premiums, so their dental benefits have no extra fees.

This encourages people to visit their dentist. When they finally pay the bill, they will then realize that the dental coverage helps lessen the dents on their wallets for dental services. In 2016, those with Medicare Advantage only took out an average of $894 from their pockets while those without had to pay around $928.

Even with financial advantages, the coverage is usually minimal. Typical dental plans only offer basic cleaning once or twice a year. Unfortunately, older adults require more than basic dental service. With increasing oral health issues such as gum disease, most people who are aged 60 and up need specialized cleaning.

This is more or less the same for those who haven’t had a visit to the dentist for years. When they finally have their teeth checked, they would most likely need more in-depth cleaning. Higher-level services are simply not covered in most dental plans.

You can’t have everything, but it’s still important to assess a dental plan before availing of it.

Plan Coverage

Before choosing your dental plan, it is important to understand the terms that are being used. Know what services are defined as “basic”. Since a lot of plans don’t include full-mouth x-rays, you also need to see if what types of x-rays are part of the package.

Coverage Terms

It could be a hassle to find out that you’re still not eligible for a service when you need it immediately. Make sure to take note of elimination periods for major procedures. Some may require months or even years before you can avail of certain services.

Price of the Plan

When weighing out options for dental plans, the first thing you’ll probably look for is how much you’ll pay as premium. However, there are other costs that you should also consider such as the co-payments or co-insurance. Also, find out how much the limit for your annual coverage is. Usually, these have caps somewhere between $1K and $2.5K per year.