Medicare Advantage Dental Benefits in Northern Virginia

What You Need to Know About Dental Benefits and Medicare Advantage in Northern Virginia

Although visiting a dentist is essential for good oral health at any age, seniors are more likely to experience dental issues because of age, chronic health conditions, and other issues. In 2016 alone, seniors spent nearly $28 billion on dental services. The rate of spending for dental services is also increasing faster among seniors than any other segment of the population. According to the American Dental Association Health Policy Institute, the number of seniors visiting a dentist annually increased by approximately 6 million between 2006 and 2016. Sadly, seniors are also the segment of the population least likely to be able to afford dental services because of a lack of affordable dental benefit options. The following is an overview of how seniors can reduce the cost of essential dental services without breaking the bank.

Without dental insurance, even basic dental services can cost hundreds or even thousands of dollars. In fact, a Kaiser Family Foundation survey found that one-fifth of Medicare recipients who visited a dentist during the previous year wound up spending $1,000 or more out of pocket. Below are the average prices for common dental procedures for patients without dental benefits in Northern Virginia. Of course, your exact cost can vary based on the severity of your dental issue, the location of the practice, and the skill and expertise of the dentist.

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 Alternatives Do I Have for Paying for Dental Expenses?

Finding affordable dental benefits can be a challenge for retirees and seniors over the age of 65. For example, most Americans get their dental benefits through their employer, which means that coverage ends once they leave the workforce. Medicare is the primary source of health benefits for adults age 65 and older. Traditional Medicare only covers dental services under very limited circumstances, such as a basic exam required as part of presurgical clearance for a procedure covered under Medicare Part A hospital benefits. This means that 65% of seniors have no coverage for routine exams, cleanings, and basic dental procedures. This percentage is only going to increase in the coming years with 10,000 Americans turning 65 every day. Medicare supplements are the most popular way for seniors to get dental benefits. Approximately 25% of seniors enroll in some type of Medicare Advantage plan. Another 10% of seniors elect to purchase a standalone dental plan from a private insurer.

Does Medicare Advantage Provide Dental Benefits in Northern Virginia?

With an average cost of around $420 per year, Medicare Advantage plans are a relatively affordable way to get dental benefits. Medicare supplements are optional plans that you purchase from a private insurer, such as Aetna, UHC, or Humana, to augment the benefits provided by basic Medicare. Medicare supplements offer significant cost savings, including low deductibles and out-of-pocket spending limits. Provider reimbursement under Medicare supplements comes directly from the insurer instead of the federal government. It also means that you will have two ID cards: your red, white, and blue ID card for your basic Medicare and a separate ID card for your supplement. There are a couple of factors to keep in mind before purchasing a Medicare supplement:

  • You normally must choose your provider from a preapproved list.
  • While most Medicare supplement plans include benefits for vision, hearing, dental, and prescription drugs, the dental benefits are normally limited to routine cleanings, basic exams, and standard X-rays.

What Are My Standalone Dental Insurance Options?

If you are looking for comprehensive dental benefits in Northern Virginia, your best option might be a standalone dental plan. Offered by private insurance companies, these plans normally cover 100% of the cost of routine and prophylactic services, 80% of the cost of minor procedures, and 50% of the cost of advanced procedures and services. Most insurers offer several levels of plans, so you can select the coverage options and price point that work best for you.

Basic Dental Plans:

A basic standalone dental insurance plan will normally cover exams, routine cleanings, and standard X-rays. These prophylactic services may be enough for someone who is in good oral health but not enough for someone with a history of significant dental issues.

Mid-level Dental Plans:

Mid-level dental plans offer expanded services, yet they are affordable for the majority of patients. In addition to the services offered in basic dental plans, mid-level plans may also include coverage for fillings, dentures, emergency services, inhalation anesthesia, orthodontics, and specialized X-rays.

Premium Dental Plans:

If you have a history of dental issues, you may want to consider investing in a premium dental plan. The following are just a few of the advanced dental services and procedures that are often covered by premium dental plans:

  • Oral surgery
  • Endodontic procedures
  • Advanced periodontic procedures and treatments
  • Full or partial dentures
  • Inlays and onlays
  • Crowns.

According to Bankrate, you can expect to pay around $350 per year for a private dental plan. Unlike Medicare Advantage plans, private dental plans normally do not include benefits for hearing, vision, or prescription services.

Do Dental Discount Plans Really Lower the Cost of Dental Care?

If you are primarily interested in routine maintenance and the occasional minor procedure, a dental discount plan may be an option for you. These plans, which are sold by private companies, are not insurance. Plan members pay enrollment and membership fees, which are normally very low, in exchange for paying pre-negotiated discounted rates for basic dental services. Services typically covered by discount plans include:

  • Crowns
  • Dentures
  • Fillings
  • Basic exams
  • Routine cleanings
  • Root canals
  • Extractions
  • Standard X-rays

One of the most popular discount plans is DentRite®. In addition to dental discounts, DentRite® also provides discounts for vision, hearing, and prescription services.

Discount plans also offer benefits not available with insurance, such as:

  • no deductibles or hidden fees;
  • no waiting for your benefits to go into effect;
  • no limits on the number of times that you can use your benefits;
  • the freedom to change providers at any time, and
  • no time-consuming claim forms or administrative paperwork.

How Can I Manage Out-of-pocket Dental Costs?

If you don’t have insurance or a discount plan or you still have out-of-pocket expenses even with your benefits, help may be available. A number of medical and dental providers now offer payment and financing plans. For example, CareCredit offers short-term financing of up to two years and long-term financing of up to five years depending on the amount being financed. Some medical finance companies even offer no-interest promotions as long as you pay your full balance by the specified time. Of course, the accrued interest will be added to your balance if you fail to pay the entire balance by the end of the promotion. CareCredit is so popular that it is accepted by hundreds of thousands of providers across the U.S. Keep in mind that you must meet credit criteria to qualify, so acceptance is not guaranteed. The interest rates for medical financing run anywhere from 15% to 20%, which adds to the final cost of your dental care.

AARP and other senior advocacy organizations also offer resources and guidance on insurance options and discounted professional services for seniors.

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CareCredit is a healthcare credit card designed for your health and wellness needs. Pay for the costs of many treatments and procedures through convenient monthly payments.

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