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Medicare Advantage Dental Benefits in Fairfax

Understanding Dental Coverage and Medicare Advantage in Fairfax

Years of inadequate oral care and even chronic health conditions can take a toll on our teeth as we get older. Seniors typically have the fewest options for affordable dental benefits, yet they are the segment of the population most likely to need dental services. For example:

  • In 2016 alone, dental spending among seniors totaled more than $28 billion.
  • Seniors have the highest growth rate of dental spending of any demographic.
  • The number of seniors visiting a dentist annually increased by 6 million between 2006 and 2016.

Why Is It Important to Have Dental Benefits in Fairfax?

Seniors without dental benefits in Fairfax can easily pay thousands of dollars out of pocket for a single dental visit or procedure. A study by the Kaiser Family Foundation found that nearly half of all Medicare recipients had not received dental care during the prior year. Of the seniors who had visited a dentist, 19% had paid $1,000 or more out of their own pocket. Although the nature of your dental issue and even your location can influence the cost of dental services, the following are examples of what you might pay for common 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 Choices Do Seniors Have for Dental Benefits in Fairfax?

Approximately 65% of seniors go without dental coverage. With more than 10,000 adults turning 65 every day, the percentage is only going to increase in the coming years. There are a couple of reasons for this:

  • Most Americans get their coverage through their employer, which means that their coverage ends once they leave the workforce.
  • Adults 65 and older are automatically covered by traditional Medicare, which only covers dental services under extremely limited circumstances. For example, Medicare won’t pay for a biannual exam or cleaning; however, it may cover a limited exam as part of presurgical clearance for a procedure covered under Medicare Part A hospital benefits.

Unfortunately, seniors have very few options for affordable dental coverage. Approximately one-quarter of seniors receive some dental benefits through Medicare Advantage plans. Approximately 10% of seniors purchase standalone coverage through private insurers.

Are Dental Expenses Covered by Medicare Advantage?

At an average cost of $420 per year, Medicare Advantage plans are an affordable way to expand the benefits provided by traditional Medicare. These are optional plans that you purchase from a private insurer. Humana, UHC, and Aetna are among the most popular supplement plan providers. While the federal government covers the cost of services covered by traditional Medicare, the benefits provided under supplement plans are reimbursed directly by the insurer. In addition to the familiar red, white, and blue Medicare card, you will also receive a separate ID card for your supplement plan. The following are examples of the benefits offered by Medicare supplement plans:

  • low deductibles;
  • access to a network of qualified providers;
  • out-of-pocket spending limits; and
  • vision, hearing, prescription medication, and dental benefits.

The dental benefits offered by most supplement plans are typically limited to basic exams, cleanings, and standard X-rays. This means that you can still incur significant out-of-pocket costs if you need a complicated dental procedure or have extensive dental issues.

Should I Invest in Standalone Dental Insurance?

A standalone dental insurance policy offers the most comprehensive coverage. Most dental insurance plans operate on a tiered coverage system. This means that routine and prophylactic services are covered at 100%, minor procedures at 80%, and advanced or complex procedures at 50%. Most insurers offer several levels of plans with different benefits and premiums, so you can customize your coverage to your needs and budget.

Basic Dental Plans:

If you don’t have or anticipate having any significant dental issues, a basic dental plan may be a good option. These low-cost plans typically cover cleanings, routine exams, standard X-rays, and other prophylactic services.

Mid-level Dental Plans:

If you are looking for expanded coverage, a mid-level plan offers a wider range of services at a price that works for most budgets. In addition to basic prophylactic services, mid-level plans also typically offer at least partial coverage for fillings, dentures, specialized X-rays, inhalation anesthesia, orthodontics, and emergency treatments.

Premium Dental Plans:

Premium dental plans offer the most comprehensive coverage. These plans can potentially save you thousands of dollars if you require advanced dental procedures, such as:

  • inlays, onlays, or crown restorations;
  • periodontic or endodontic procedures;
  • full or partial dentures; or
  • oral surgery.

At an average cost of $350 annually, private dental insurance may be less expensive than a Medicare Advantage plan; however, you will miss out on the additional vision, hearing, and prescription benefits.

How Do Dental Discount Plans Work?

An increasing number of consumers are turning to discount plans as a way to lower the cost of dental and other health and wellness services. Discount plans are sold by private companies, but they are not considered insurance. Providers who accept discount plans, such as DentRite®, agree to accept pre-negotiated flat rates for common procedures. As a discount plan member, you pay an enrollment fee and low monthly membership fee and pay your dental care provider directly for the service. In addition to their low cost, the following are a few of the reasons why discount plans have become so popular:

  • There are no restrictions on the number of annual visits.
  • You can use your benefits at any participating provider in the country.
  • You don’t have to wait for your benefits to go into effect.
  • There are no coinsurance obligations or other fees.
  • Acceptance is guaranteed even if you have preexisting conditions.
  • You don’t have to fill out claim forms or administrative paperwork.
  • You can cancel your plan within 30 days and receive a full refund minus a nonrefundable processing fee.

Dental plans can help you save anywhere from 20% to 80% on a range of common dental services, including crowns, root canals, extractions, fillings, dentures, X-rays, exams, and cleanings.

DentRite® and similar discount plans normally also provide discounts for vision and hearing services and even prescription medications.

Are There Financing Options for Dental Care?

Many dental practices now offer payment plans and financing options. For example, CareCredit is one of the most popular options and is accepted by more than 200,000 providers and facilities across the country. Medical financing companies offer short-term options that allow you to pay smaller balances over two years. In some cases, it may be possible to avoid interest if you pay the entire balance by the end of the promotional period. Keep in mind, however, that the full amount of accrued interest will be added to your balance if you don’t pay the full balance by the end of the promotion period. If you have a larger balance, it may be possible to get long-term financing of up to five years. While financing is often the only way individuals without benefits can afford dental services, there are a couple of drawbacks:

  • Interest rates average between 15% and 20%, so you end up paying significantly more in the long run.
  • Approval does depend on your overall credit history, which means that not everyone qualifies.

If you need more information on insurance options and discounts for dental and other professional services, you can also turn to AARP and other senior advocacy organizations.

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