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Dolson Avenue Dental
75 Dolson Avenue, Middletown, NY 10940

Medicare Advantage Dental Benefits in Middletown

Dental care is essential for seniors, who become more susceptible to tooth loss and gum disease as they age. Despite the importance of regular dental checkups, many seniors find themselves without dental coverage as they leave the workforce and lose employer-based medical insurance. Today, approximately two-thirds of elderly adults lack dental coverage, making it difficult to find affordable care. Plus, 10,000 adults reach age 65 every day in the United States, meaning that the number of those without dental insurance will rise.

Even though many seniors lack dental coverage, recent research from the American Dental Association Health Policy Institute revealed that they are still spending on dental services. Just last year, seniors spent $28 billion on dentistry and are the fastest-growing demographic in terms of dental spend. Seniors are also visiting the dentist more often than ever before, with 6 million more seniors seeing a dentist in 2016 than in 2006. However, many seniors are not receiving dental care despite a rise in spending – almost half of seniors on Medicare did not see a dentist last year. According to the Kaiser Family Foundation, among seniors who did see a dentist, 19% spent $1,000 or more out of pocket. The list below outlines 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 Benefits?

When dental treatment is necessary, many seniors struggle to find affordable options. All adults over 65 or those who are disabled permanently receive Medicare, a nationally funded healthcare program in the United States. Medicare recipients receive a red, white, and blue ID card and coverage for many common medical procedures. However, dental benefits are usually not included – in fact, a dental exam may only be covered as part of another approved procedure, such as a surgery.

Medicare’s limitations leave seniors searching for extended dental benefits in Middletown. A quarter of seniors will opt for a Medicare Advantage supplement while 10% will choose a traditional insurance plan.

What Are Medicare Advantage Supplements?

Many seniors choose to supplement their existing Medicare coverage using Medicare Advantage plans, which are completely optional and provided by private companies. With Advantage plans, seniors have access to an expanded provider network and price protection through cost-sharing, low monthly premiums and out-of-pocket maximums. While Medicare claims are reimbursed by the government, any costs associated with an Advantage plan are reimbursed by the private company. Cigna, Aetna, and UHC all provide Advantage supplement options. Enrollees receive an ID card similar to one you’d use with a traditional plan.

One benefit of an Advantage supplement is that it offers dental benefits for routine services like dental exams and cleanings. The supplements often include savings on vision care, medications, and hearing as well. These plans typically involve low premiums, making them quite affordable. The average cost of a Medicare Advantage plan in 2018 was $420. Keep in mind, however, that the plans usually only cover preventive dental services. More extensive procedures may not be included in the plan’s benefits.

What Is Standalone Dental Insurance?

Seniors searching for comprehensive dental benefits in Middletown may choose a standalone insurance plan as an option. Like Medicare supplements, they are offered by private companies, but they also provide multiple levels of coverage. Your monthly premiums, copays, and coinsurance obligations will depend on the level of coverage you choose. Three typical coverage levels include:

Basic Plans: With a basic plan, you’ll receive benefits for preventive services, including cleanings, routine dental exams, X-rays, and other diagnostic treatment.

Mid-level Plans: The second highest tier of coverage, mid-level plans often cover emergency dentistry, nitrous oxide, restorations like fillings and dentures, and specialized X-ray screening.

Premium Plans: The highest level of coverage, premium plans offer coverage for more advanced procedures like dental surgeries and more intensive restorations. These plans are ideal for those who require extensive dental work. Some of the services covered with premium benefits include:

  • Inlays and onlays
  • Tooth crowns
  • Endodontics
  • Oral surgeries
  • Gum disease treatment

Traditional insurance plans often utilize a 100-80-50% system to determine coverage. Fully covered are routine services, such as exams and cleanings, while basic services are covered at 80%. Lastly, more extensive procedures are covered at 50%. Dental insurance plans tend to be lower in cost than Advantage plans, according to Bankrate. Last year, patients spent an average of $350 on private dental plans. It’s important to note, however, that the plans do not include the additional benefits offered by a supplement plan, including eye care and hearing.

Can I Use a Dental Discount Plan Instead of Insurance?

Another option that can help make dental expenses more affordable is a dental discount plan offered by providers like DentRite®. These plans offer reduced rates on dental services much like insurance, but it’s important to remember that discount plans are not insurance coverage. Instead, the dentist agrees to accept lower fees for services that are pre-negotiated with the discount company. Then, the savings are passed on to members with a small monthly fee. Members also pay the dentist directly instead of filing a claim for reimbursement.

If you’re considering a dental discount plan vs. insurance, there are many advantages that may help you decide. These include:

  • No copays, coinsurance requirements or deductibles
  • No waiting period before making a dentist appointment
  • Members can switch dentists at any time
  • Discount plans have no claims process or paperwork to fill out
  • No exclusions for preexisting conditions or age limits apply

Typically, dental discount plans do not cover as much as traditional insurance, but they can lower the cost of multiple routine procedures. Here are a few examples of discounted services:

  • Routine checkups, including dental cleanings
  • X-ray screening
  • Tooth extractions
  • Restorations like tooth crowns and fillings
  • Root canal therapy

In addition to everyday savings on dental services, many discount plans offer discounts on vision care, hearing aids, prescription medications and more. If you are in generally good oral health and will only need maintenance services, consider a dental discount plan. A traditional standalone dental insurance plan may be a more cost-effective option if you’ll need extensive dental work.

Are Dental Payment Plans a Good Option for Seniors?

When on a budget, dental financing through providers like CareCredit can make large dental costs more manageable. Many plans offer special promotions with zero-interest, short-term financing and long-term financing for up to 60 months. Plus, many dental providers accept these plans. CareCredit, for example, is accepted at more than 200,000 providers across the country. Flexible financing can make managing costs convenient, but it does have some drawbacks:

  • As with any line of credit, an application is required – not every person will qualify
  • Interest rates for payment plans can be as high as 20%, adding to the total cost of your care

Understanding your dental benefits in Middletown can be challenging, but we’re here to help. We recommend speaking with a local seniors’ organization like the AARP if you require additional resources on Medicare Advantage plans, insurance, or discount plans. You can also call our office and speak with one of our team members today.

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75 Dolson Avenue, Middletown, NY 10940

(845) 512-1246

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