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Originally published March 27, 2019, last updated April 3, 2019
The majority of people on Medicare do not have dental coverage, exposing them to potentially high out-of-pocket costs or even health risks if they forgo oral health care, according to a new brief by the Kaiser Family Foundation (KFF).
Of people on Medicare, almost two-thirds (65%), or nearly 37 million people, do not carry dental coverage, according to the KFF brief on the state of oral health for Medicare beneficiaries.
Medicare does not cover routine preventative dental care or more expensive dental services, such as crowns.
About one-third of all Medicare beneficiaries have access to some dental coverage through Medicare Advantage, Medicaid or private dental insurance plans. Those plans, like many private plans for working-age adults, tend to cover most lower-cost preventative services but are not as generous for more expensive services, and are often subject to annual dollar caps on covered service. Older patients acquiring new plans often have a waiting period of a year or so before they can access benefits.
Dental insurance, even for younger patients, is often not seen as a necessity or a good buy — until an expensive procedure is needed.
‘Something to Consider Seriously’
“It’s understandable that people on a fixed income have to weigh whether they can afford $30 or $40 a month in dental insurance premium for what can be limited coverage,” said Brian Hickey, vice president of Insuractive®, which offers Medicare and dental plan reviews and shopping assistance through Medicare MarketPlace®. “But when you look at the health implications of skipping routine dental maintenance and the financial consequences of out-of-pocket procedures, dental insurance is still something to consider seriously.”
But it’s something many are skipping.
The KFF brief found that nearly half of Medicare beneficiaries (49%) have not been to the dentist in the past year — a concerning statistic because of the health consequences. Poor dental care and oral health can lead to edentulism, untreated caries, and periodontal disease, which contribute to adverse health outcomes and high-cost preventable emergency room visits.
Among those who said they needed care but did not go, cost is often cited as top reason for not going to the dentist, the KFF reported. Other reasons included fear of the dentist, inconvenient location or time for an appointment.
A Big Bite Out of Medicare Enrollees’ Budgets
Across all beneficiaries, average out-of-pocket spending on dental care was $469 in 2016, and among those who used any dental services, average out-of-pocket spending on dental care was $922. When you consider that half of Medicare beneficiaries were living on less than $26,200 in 2016, dental care can take a big bite out of their budgets.
For an uninsured patient in Denver, for example, a basic adult cleaning in Denver is estimated to cost $107, according to FAIR Health Consumer, a website that estimates the cost of medical procedures. That expense may be affordable for many seniors without dental coverage twice a year, the frequency recommended by the American Dental Association. But the more costly procedures can be a financial strain. For that same Denver patient, a porcelain crown is estimated at $1,325 — and that’s not including the various steps and other procedures that may be needed to install the crown. Now imagine a patient in need of several crowns, along with their preventative services.
Premiums for Medicare Advantage dental benefits — which are on top of Medicare Advantage premiums — ranged from about $72 per year to more than $720 per year in 2016, according to KFF.
How Medicare Beneficiaries Can Find Affordable Dental Plans
“So many factors can influence the premium you may pay,” said Hickey of Mature Health Center partner Medicare MarketPlace. “Work with an insurance agent who offers multiple plans from multiple companies so you can see the range of policies, premiums and benefits.”
Because Medicare MarketPlace offers private dental plans and Medicare Advantage plans that include dental coverage from multiple carriers, the Licensed Insurance Agents can do the comparison shopping for you and explain the differences, Hickey said.
“Dental coverage can be affordable, and our agents always work hard to find the best plan for each individual’s situation and budget,” he said. “Taking care of your teeth now can prevent health issues and other costs down the road, so we see it as a key part to taking care of our customers.”
For a free review and price quote of dental plans available to you, call Medicare MarketPlace at 1.800.639.0781 to speak with a Licensed Insurance Agent.