Learn dental insurance basics and save your teeth

Monitoring your oral health isn’t just about good teeth: it can give insight into your overall health. There are many reasons why it’s important that you visit your dentist regularly.

Dental health should be a major concern for seniors. Monitoring your oral health isn’t just about good teeth: it can give insight into your overall health.

There are many reasons why it’s important that you visit your dentist regularly. Aside from monitoring your dental health, checkups are a window into other health concerns. For example, doctors can be tipped off to conditions like diabetes by poor dental health. Also, as you get older you are likely taking more medications and sometimes those medications can be good for one part of your body but also have a negative effect on your oral health.

If not covered by insurance, tooth maintenance and care can leave a gaping hole in your wallet!

Benefits of dental insurance

Dental care is not part of the Original Medicare or Medigap supplement plans. However, some Medicare Advantage Plans come with comprehensive dental coverage. If your Medicare Advantage Plan comes with dental coverage, you may not have to purchase a separate plan. The greatest benefit of dental insurance is that it lets you save money on necessary procedures like teeth cleanings, root canals, crown replacements, and oral X-rays.

Other significant benefits of full coverage dental insurance include:

  • Regular dental checkups: Get regular checkups to ensure that you are not developing cavities, gum disease, or oral cancers.
  • Emergency dental care: Broken teeth, dislodged crowns, and toothaches because of root decay are all painful emergencies that require immediate care. Dental coverage can go a long way in alleviating the financial stress that comes with seeking emergency care.
  • Substantial savings: It is more cost effective to pay for dental coverage than to pay for dental treatments yourself out of pocket as procedures may involve substantial costs.

How dental insurance works

If you are familiar with the basics of health coverage, you’ll understand dental plans. Both have similar processes and use terms that you may already be familiar with:

  • Out-of-pocket maximum: The maximum amount of money you’ll personally spend on dental care before full coverage kicks in. Those who have attained an out-of-pocket maximum can expect full coverage of dental treatments.
  • Deductible: The amount of money that you pay before your dental plan begins to cover part or all the cost of treatments.
  • Copays: Fixed payment amounts made by you for treatments. They represent a portion of the actual cost and could differ for different services like emergency visits, monthly visits, and medication.
  • Coinsurance: The fixed percentage—to be paid by you—of the total chargeable amount for an insured service. This only goes into effect once the initial deductible has been met by you and your plan has kicked in. For example, if the fixed percentage is 10% for a $100 service, you pay $10 and the insurance provider pays the remaining $90.

Advanced procedures may require that your deductibles are met first before your dental plan will start paying for a percentage of the treatments.

What’s covered?

Dental insurance provides three levels of coverage including preventive care, minor procedures, and major procedures. Full coverage dental plans normally cover the following and more:

  • Bridgework
  • Cleaning
  • Denture repair
  • Fillings
  • Fluoride treatments
  • Oral X-rays
  • Root canals

What’s not included?

  • As a rule, full coverage dental plans do not cover cosmetic dentistry.
  • Procedures like gum contouring and teeth whitening are not covered.
  • There are limitations to the amount that insurance plans will pay for braces. Once that limit is reached, you are expected to pay for the remaining treatment.

Most plans come with an annual maximum benefit and once this maximum limit is reached, all expenses must be paid by you. Seniors should compare dental insurance plans before making a final decision.

The good part of dental insurance is that once you are signed up for a plan and paying premiums, all necessary preventive treatments like routine checkups and cleanings are immediately available to you, fully covered.

You can find more information on these types of plans at medicare.gov.

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Page last updated 10/12/2023

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† Blue Shield Medicare Advisers are available April 1 through September 30: 8 a.m. to 8 p.m., weekdays and October 1 through March 31: 8 a.m. to 8 p.m., seven days a week.

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California Physician’s Service DBA Blue Shield of California is an independent member of the Blue Shield Association.

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For Blue Shield Medicare Advantage Plans: Blue Shield of California is an HMO, HMO D-SNP, PPO and a PDP plan with a Medicare contract and a contract with the California State Medicaid Program. Enrollment in Blue Shield of California depends on contract renewal.

 
 
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