Medicare advantage dental benefits in Milwaukee (Seniors 65+)

During their working years, most had dental and medical insurance that was provided by their employers. However, upon reaching retirement age, many found they could no longer afford their insurance. Although seniors are automatically enrolled in Medicare when they attain the age of 65, Medicare is primarily medical insurance and doesn’t provide benefits for dental expenses, vision, hearing or prescription drugs.

Approximately 25% of seniors obtain additional insurance through a major insurance company. Another 10% use private insurance companies, and the remaining two-thirds simply stay uninsured and go without needed dental treatments. This can adversely impact their general health since dental health and physical health are intertwined. Medicare Advantage plans are very popular adjuncts to traditional Medicare and they provide coverage for treatments that Medicare doesn’t, such as hearing, vision, and prescription drug costs.

Even without insurance coverage, in 2016, seniors spent more than $28 billion on dental treatment, which was the highest spending growth rate of any demographic, and almost 20% of them spent more than $1,000 for out-of-pocket dental costs. However, the Kaiser Family Foundation reported that nearly half of Medicare recipients hadn’t seen the dentist in the preceding year. The high cost of dental procedures may account for some of this statistic, as is evidenced by the following examples of average costs for dental procedures:

Checkups and cleanings:

• Basic exam–$50 to $100
• Dental X-ray–$20 to $250
• Standard cleaning–$70 to $200

Fillings:

• Silver amalgam–$50 to $300
• Composite–$90 to $450

Extractions:

• Simple extraction–$75 to $450
• Surgical extraction–$150 to $650
• Wisdom tooth extraction–$75 to $3,000 based on the number and complexity of the extractions

Crowns:

The cost of a crown can range from $500 to $3,000 based on the type of material used.

Root canals:

The cost of a root canal can range from $300 to $2,000 based on the location of the tooth and the complexity of the procedure.

What types of options do seniors have for dental insurance?

When an adult turns 65 or becomes permanently disabled, they’re automatically enrolled in traditional Medicare, which is primarily used for hospitalization. It doesn’t cover vision, dental care, hearing or prescription needs. Dental procedures are covered only as a requirement for surgery. This means that Medicare recipients need an option to provide coverage for these types of expenses. Many seniors enroll in a Medicare Advantage plan to meet their basic insurance needs.

Are advantage plans effective for seniors?

A Medicare Advantage plan provides supplemental coverage for vision, hearing, and prescription drugs. These plans have a network of providers that spans the nation, so seniors can use their dental benefits in any part of the country. They maintain low-cost premiums, affordable deductibles, and cost-sharing measures. Providers are reimbursed by the insurance company rather than Medicare, and subscribers will receive an ID card that’s separate from their Medicare ID card. However, dental benefits are limited to annual exams and cleanings, and standard x-rays. Humana, UHC, and Aetna are popular providers of Medicare Advantage plans.

Would a standalone dental insurance policy be better for me?

Standalone dental insurance for seniors can provide more comprehensive dental benefits than some of the other options for seniors, but the benefits are provided according to the pricing structure. Most standalone policies have different price points and premiums. Higher premiums provide more coverage. For example:

 Basic plans

Usually, a basic plan covers basic exams, an annual cleaning, and a limited number of diagnostic x-rays.

 Mid-range plans

A mid-range dental plan usually covers a specific number of emergency treatments, orthodontics, fillings, dentures, standard and specialized x-rays, and inhalation anesthesia. Non-covered services may be entitled to a discounted rate.

 Premium plans

In addition to the above benefits, premium dental plans usually cover:

• Crowns
• Dentures
• Endodontic procedures
• Inlays and onlays
• Oral surgery
• Periodontal procedures

Most private insurance providers have a 100-80-50 tiered rate for coverage, which means they’ll provide 100% coverage for routine exams, 80% coverage for basic procedures, and 50% for complex procedures. You’ll be responsible for paying the balance of these procedures, which may be expensive. Although your private insurance is probably less than your Advantage plan, there won’t be benefits for vision or hearing or prescription drugs.

Would a dental discount work better than standalone insurance for my needs?

Dental discount plans can be an excellent resource for dental benefits in Milwaukee, but these aren’t insurance plans. Rather, they’re membership plans that are provided by private companies. When a dentist agrees to accept a discount plan, they agree to provide a lower rate for their services to plan members. The patient pays an enrollment fee and a monthly membership fee and then pays the dentist directly at the previously agreed upon rate. Discount plans have some advantages over insurance plans, and they’re usually very affordable. Discount plans don’t require:

•  Copays, deductibles or coinsurance payments
•  Waiting period, you receive full discounts immediately
•  Annual limits on office appointments
•  Claim forms or paperwork to complete
•  Restrictions on changing your dentist
•  Exclusions for pre-existing conditions or age

Although a dental discount plan may provide somewhat fewer benefits than traditional insurance plans, they usually have lower out-of-pocket costs for routine procedures such as:

• Checkups
• Crowns
• Dentures
• Extractions
• Fillings
• Prophylactic procedures
• Root canals
• X-rays

Additional options for hearing, prescription, and vision benefits are provided by some discount providers. If you have overall good health and don’t require extensive dental treatments, then a dental discount plan may be the best for you. However, if you anticipate that you’ll need extensive dental work soon, then a standalone insurance plan may be more feasible for your needs. If you’d like us to help you determine your dental benefits in Milwaukee, then call our office and we’ll be happy to help you.

Which type of plan will help me manage my out-of-pocket expenditures?

Many dental offices provide flexible payment and financing options. They realize that even with insurance and discount plans, dental procedures can be expensive. CareCredit is a popular medical financing company that’s available at more than 200,000 providers nationwide. They have an application to complete and an approval process, so not all patients will qualify for financing. Some senior organizations, such as AMAC and AARP, provide a plethora of discounts to seniors, so check their websites for additional discounts that may save you money.

If you need dental care in Milwaukee, then call Lakeshore Family Dentistry and we can help you. We’re skilled in meeting senior dental needs and we’d love to help you regain your good oral health, so call us today. We look forward to speaking with you and working with you.