As seniors start thinking about retirement, many worry about maintaining good health. They can get medical coverage through Medicare and gap insurance but wonder about insurance coverage for dental needs. Most have taken care of their teeth and want to maintain them for quality of life.
Several Medicare Advantage plans offer coverage for basic dental needs, but many people need more oral care. Stand-alone dental insurance is a better option, especially for seniors. Here’s how you can help your senior clients find the dental coverage they need.
1. Identify dental needs
When discussing dental coverage with clients, ask several questions to help them evaluate their oral health needs:
- Do they need one or two yearly exams for a professional cleaning and checkup?
- Do their teeth and gums hurt or bleed?
- Do they have teeth with crowns or root canals?
These answers can help you identify the dental coverage each person needs. It’s important to know, because poor gum health and tooth decay increase the risk of developing heart disease and pneumonia. The Centers for Disease Control and Prevention report that about 68% of adults 65 and older have gum disease.
2. Review plan options
Original Medicare plans do not cover routine dental and vision exams. But some Medicare Advantage plans typically cover dental exams and professional dental cleanings twice a year. However, these plans may have a restricted dental provider network or no network savings. There also may be limitations on coverage, such as fillings, crowns and implants.
Many retirees change Medicare plans each year. When making this change, they lose the benefits they had with their previous Medicare health plan. The new Medicare plan may have new usage restrictions for dental. This won’t happen with a stand-alone individual insurance plan.
In addition, an individual stand-alone dental plan offers more robust benefits that may better meet your client’s needs. As mentioned, seniors and retirees keep their dental benefits with stand-alone dental, even if they change Medicare plans, because they are separate.
Insurance providers like Ameritas also don’t coordinate coverage; they treat all stand-alone individual dental claims as the primary claim. This way, there is no reduction in benefits if your clients have another Medicare Advantage plan, for example.
Stand-alone dental insurance provides seniors and retirees peace of mind. It helps cover costs for exams, professional cleanings and services that help maintain healthy teeth.
Additional plan features to know:
- Coverage levels – Depending on the plan, basic or major dental services for fillings, crowns and root canals are covered at different levels. There may be a deductible or coinsurance amount associated with some services (usually between $0 and $50, but could be more). Ensure your clients understand how the different coverage levels work.
- Annual benefit amount – Most dental plans have an annual benefit maximum for covered services and procedures. Knowing this amount will help clients manage procedure costs and avoid unexpected bills. For example, by safely timing necessary dental work, retirees can maximize each year’s annual maximum benefit (usually between $500 and $2,500 or more).
- Waiting periods – Some dental plans have a waiting period of up to 12 months for more expensive services. However, some individual stand-alone dental plans, such as through Ameritas, offer day-one benefits for many services (especially preventive care). That means members can use their coverage once they’ve paid the premium.
- Network providers – Some dental plans offer access to a dental provider network, so it’s easier for your clients to find a network dentist and receive network savings. In-network doctors and specialists agree to accept a set payment from the insurance company for each covered service. If retirees use an out-of-network dentist, the insurance plan usually covers less of the cost. So it pays to find out if a client’s dentist or specialist is in the dental plan’s network or not.
3. Insurance carrier reputation
When reviewing dental insurance coverage, you and your clients will want to check the reputation of the carrier providing the coverage.
- Ask other agents for recommendations.
- Find out whether current customers are satisfied with the insurance company.
- How many people stayed with the carrier after the first year?
- How long has the carrier been in business and how fast are claims paid?
- Is it an established, financially strong company? This information can often be found on the insurance carrier’s website or social media.
Sources and References:
Centers for Disease Control and Prevention