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Lighthouse Dental Care
88 Ryders Lane, Stratford, CT 06614

Medicare Advantage Dental Benefits in Stratford

Dental care is important at any age, but seniors are at particular risk of developing oral health problems as they age. Older adults are often more susceptible to tooth decay and gum disease, which are often prevented by routine treatment. Unfortunately, many seniors lack access to affordable dental benefits in Stratford after retiring from the workforce. While Medicare provides coverage for medical procedures, dental treatment isn’t included, leaving two-thirds of American seniors without any form of dental insurance. With 10,000 people turning 65 each year, the number of seniors without dental coverage will continue to rise.

Despite the large number of seniors without coverage, overall dental spending is increasing. Spending reached $28 billion in 2016, and adults over 65 represent the fastest-growing spend rate across all demographics. Plus, more seniors are visiting the dentist every year, according to the American Dental Association Health Policy Institute. Six million more seniors saw a dentist in 2016 than they did in 2006. However, nearly half of seniors on Medicare didn’t see a dentist at all last year, Kaiser Family Foundation research showed. Additionally, 19% of seniors who did receive care spent $1,000 or more out of pocket. The following lists common dental procedures and their costs:

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 Options Do Seniors Have for Dental Coverage?

When you turn 65, you’ll be automatically enrolled in Medicare, a nationally sponsored healthcare program for seniors and those who are permanently disabled. Medicare enrollees receive a red, white, and blue ID card to use when they receive medical services. One disadvantage of Medicare coverage, however, is that it doesn’t include benefits for basic dental procedures like exams and cleanings. In fact, coverage for dental treatment is usually only available if it’s required for presurgical clearance or another approved medical expense.

This lack of coverage often leaves seniors looking for affordable dental benefits in Stratford. Nearly 10% of seniors will purchase standalone dental insurance, and a quarter will choose a Medicare Advantage plan to supplement their existing benefits.

How Do Medicare Advantage Plans Work?

Medicare Advantage plans are completely optional supplements to existing Medicare coverage. These plans expand your provider network, allowing you to receive care at facilities that typically would be inaccessible with Medicare. Supplement plans usually have low deductibles, cost-sharing measures, and out-of-pocket maximums, making them quite affordable. While medical expenses are reimbursed by the government with Medicare, costs are reimbursed by a private company with an Advantage plan. Three popular Medicare Advantage providers include Aetna, Humana, and UHC.

Advantage plans often feature low premiums, making them an affordable option for seniors on a budget. Plus, many plans offer benefits for vision care, prescription drugs, and other services. Keep in mind, however, that many Advantage plans only provide benefits for preventive care, including routine dental exams, cleanings, and diagnostic treatment. Extensive procedures may not be covered, making the plans more ideal for those requiring maintenance services only. Those with a supplement plan receive an ID card similar to an insurance card to present to the provider at the time of treatment.

What’s the Difference Between Medicare Supplements and Private Insurance?

While Medicare Advantage supplements can be an excellent option for those requiring maintenance services, a standalone dental insurance plan may be ideal for those requiring comprehensive care. Standalone plans offer varying levels of coverage, and your monthly premium as well as the percentage of treatment covered will depend on the plan you choose. A few examples of standalone plans are listed below:

Basic:

Basic plans usually include coverage for preventive services, like diagnostic X-rays, oral cancer screenings, and dental exams and cleanings.

Mid-level:

With a mid-level plan, you’ll receive a broader range of coverage. These plans may include emergency dentistry, orthodontic appliances, specialized X-ray screening, nitrous oxide, and restorations like fillings and dentures.

Premium:

If you’ll require extensive dental treatment to restore your dental health, a premium plan may be a good option. These plans provide partial or full coverage for advanced dental procedures. Listed below are services often covered by premium plans:

  • Inlays and onlays
  • Dental crowns
  • Endodontic therapy
  • Dental surgery
  • Most types of dentures, including partial and complete
  • Gum disease treatment

Many private plans use a 100-80-50 tiered system to determine coverage. Most preventive treatment, including dental exams and cleanings, are covered at 100%. Routine procedures like fillings are typically covered at 80%, while more invasive dental care is covered at 50%. Bankrate estimated that Americans spent an average of $350 on private plans last year. While private plan premiums are usually lower in cost than Medicare supplements, they do not provide the additional vision, hearing, and prescription benefits offered by a supplement plan.

Can a Discount Plan be an Alternative to Insurance?

Those in generally good dental health may be good candidates for a dental discount plan, which is provided by a private company like DentRite®. With a discount plan, the provider negotiates lower fees with the dentist, resulting in reduced rates for members. Discount plans usually involve an enrollment fee at signup and a small monthly fee. Members present their discount card at the time of service and pay the dentist directly.

Dental discount plans are usually quite budget-friendly and offer a host of benefits over insurance plans. These advantages include:

  • No deductibles, coinsurance, or copay requirements
  • No waiting periods – members can see a dentist right away
  • Members can choose a new provider at any time
  • Discount plans have no claims process or paperwork to fill out, saving you time
  • There are no age limits or exclusions for preexisting conditions

While a traditional insurance plan may have more comprehensive coverage, dental discount programs offer savings on many routine services, including:

  • Dental exams and cleanings
  • X-rays
  • Extractions
  • Dental fillings and crowns
  • Dentures

Another key advantage of discount plans is that they often feature discounts at other healthcare providers, including pharmacies, vision care centers, and hearing aid retailers. If saving on routine dental services is your priority, a discount plan may be right for you. However, you may save more money with a traditional dental insurance plan if your dental health issues are severe. Please contact us if you have questions.

Can a Dental Payment Plan Help Seniors Manage Dental Expenses?

When faced with a large dental expense, many patients look to dental payment plans to help them manage the cost. Provided by third-party lenders such as CareCredit, payment plans allow patients to repay the balance over installments. They often provide low- or zero-interest, short-term financing, and longer-term financing for up to 60 months. While payment plans can be a convenient option, they do have drawbacks, including:

  • A credit check and application process – not every patient will be eligible for financing
  • Many plans have interest rates between 15-20%, which can be costly over time

If you’re wondering what type of dental benefits in Stratford are right for you, know that we’re here to help. Give our office a call with questions, and we’ll help you find the solution that meets your needs. We also recommend contacting your local seniors’ organization or the AARP for further resources.

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Lighthouse Dental Care

88 Ryders Lane, Stratford, CT 06614

(203) 742-1027

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