Dental insurance for seniors: facts and resources to make your decision easier

You probably already know Medicare does not include dental insurance for seniors.

Actually, there are a couple of exceptions, but they are too rare to matter to most.

If you have reached a point in life where you need oral health treatment soon – or expect to need it soon, and you have no coverage or your dental plan does not cover all of the work you will need, then this analysis is for you.

What follows is a discussion detailing each dental plan option available to you on the market today. You will see how each of them affects you as a paying member and a patient.

Read on to learn about the major senior dental insurance solutions. Plans discussed are: PPO plans, HMO plans, indemnity plans and discount plans – an alternative to traditional dental insurance.

4 Senior Dental Plan Types on the Market Today

PPO Dental Insurance Plans: Good Coverage, Higher Prices

PPO dental plans are a popular option for senior citizens due to the freedom they allow plan members in selecting their own dentist. Typically PPO plans are touted for their flexibility compared to HMO plans, and their low cost compared to traditional indemnity plans.

Businesses use them to provide a valuable option to employees, although the annual payments are typically more expensive than other options. PPO plans are available to individuals and families as well.

Preferred provider organizations are managed care organizations with networks of dentists under contract with an insurance carrier. They offer the greatest savings to plan members who select a dentist within the network, but members have the freedom to choose a provider outside of the network.

When seeing a dentist, you the member pay the dentist directly for the services rendered as well as the copay, and are reimbursed at a later date by the insurance carrier.  Occasionally, PPO organizations will pay the dentist directly.

Though dental PPO plans have definite dental benefits for the elderly, be aware this flexibility comes at a price: PPO annual premiums are typically much more costly than other types of dental insurance for seniors. In addition to higher premiums, patients must pay their deductibles before coverage actually begins.

Many seniors looking for coverage on a limited income may find the monthly payments quite cumbersome.

There are also tedious claim forms to be filled out, and patients usually have a lengthy wait to receive reimbursements. In addition, since most PPO insurance plans only cover a portion of the dental fee, patients must make a copay out of pocket. Many choose this type of plan due to the flexibility it offers in selecting a dentist.

HMO Dental Insurance Plans: Affordable Care, Reduced Flexibility

HMO dental plans, also known as dental health maintenance organizations (DHMO) are usually much cheaper than PPO plans and indemnity plans.  Similar to PPO plans, a network of dental providers is under contract with the dental insurance company to provide select services at predetermined prices.

Low cost dental insurance for seniors such as HMO plans are most popular with businesses who use them to insure their employees at affordable rates. But if you are not insured by an employer, you can easily access an HMO policy.

The main advantage of HMO dental insurance for seniors is the low cost compared to DPPO or indemnity plans. Unfortunately, DHMOs impose strict requirements and restrictions on insured members. For example, the dental HMO will not pay for oral health care unless it is rendered by an in-network provider.

Different than PPO or indemnity plans, HMOs assign a member to a panel of dentists and oral health specialists from whom they must choose. You do not have the option of selecting a provider out of network. In fact, if you need to see a specialist, the HMO carrier will only pay for services from a specialist referred by your dentist.

The most unique feature of DHMO companies is the method by which they pay their dental providers. They are paid based on the number of patients they treat and are expected to see a certain number per year. Occasionally you will hear patients complain of being rushed through the process or receiving substandard care.

DPPOs, in comparison, allow providers to spend more time with each patient. Despite obvious restrictions and cumbersome guidelines, many people choose HMO insurance plans due to their low cost in relation to other insurance options.

Dental Indemnity insurance: Traditional Dental Coverage for Seniors

Dental indemnity insurance, also known as traditional insurance, is a type of plan in which the policyholder chooses any dentist he or she wishes. The patient pays the dentist directly for services, and is then reimbursed by the insurance carrier by means of a claims process.

Typically these plans cover 50%-80% of the cost of dental work, and the remaining amount is paid by the patient. Members of indemnity insurance plans often must wait a long time after they file their claim forms to receive reimbursement for services paid out-of-pocket.

For these reasons, this type of dental insurance, for seniors, is simply not the best option.

Group members and employees have the flexibility to choose their dentist, change dentists and see a specialist without a referral.

Despite these freedoms, these plans are less popular today due to their expensive annual premiums, higher deductibles and tiring claims procedures. Indemnity insurance is typically structured to appeal to groups and businesses, so it is not the best option for individuals and families.

Discount Dental Plans: Low Cost Dental Care for Seniors

Discount dental plans are alternatives to traditional dental insurance. Since they are not insurance, these plans charge very low monthly fees – some starting as low as $6.95 per month, require no copay or deductible and carry no annual maximum limits.

Because discount plans are not insurance, it is important to keep in mind you will be responsible for paying the dentist the full discounted fee. There is no payment reimbursement by the plan provider.

Dental discount plans do not require claim forms because there is nothing to process – as a plan member you pay the dentist directly, and that’s it. No other payments required. No waiting for reimbursement checks to come in the mail.

Many seniors who do not have access to employer plans or who cannot afford expensive premiums are turning to discount dental plans. Even if you do have dental coverage but are caught in a long waiting period, this type of plan can easily operate in conjunction with an existing policy.

You may have a preexisting oral health condition that is not covered by your current policy. Because discount plans are not insurance, they have no waiting periods. You can sign up today and be at the dentist in 30 minutes. If you’ve reached your annual maximum, you can use a discount plan to pay for a procedure you have been reluctant to get because of the out-of-pocket expense.

Dental providers have contracted with discount plan providers to provide the same quality dental work at reduced prices. The concept is a familiar one – it’s the same model used by discount clubs like Costco and Sam’s. Dentists have realized that for many people, insurance is not the best option and, in many cases, doesn’t provide all of the coverage they really need. You benefit by gaining access to discounts of up to 60% on routine and major oral health work.

Because of their low cost, many choose to carry this type of plan in addition to regular dental insurance, in case of dental emergencies.