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only consumer blog explaining the ins, outs and in-betweens of dental insurance and
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Senior strategies for buying dental coverage

Mar 26, 2013

Senior strategies for buying dental coverage
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Our final post in our March series on senior dental issues looks at ways seniors can find a good dental plan.

Psst…between you and me, these strategies are applicable to any age group. However, these tips are particularly important for seniors because most live on limited incomes and Medicare does not cover dental expenses. In other words, these tips could make the difference between being able to comfortably pay for that tooth that needs a dental crown and having to clean the shark tank at the local aquarium to pay for the teeth you've chattered away in fear!

IMMEDIATE NEED If you have an immediate need to see a dentist, the last thing you want is to enroll in a plan whose effective date won’t begin for three weeks and has a six-month waiting period on the procedure you need. Remember, the effective date isn’t the same as a waiting period. A waiting period is a certain amount of time before specific dental procedures can be utilized – not when the plan coverage begins.

For instance, I may have a Preferred Provider Organization (PPO) plan or an Indemnity plan that began April 1, but I wouldn't be covered for a major procedure like a root canal or a dental crown for 12 months, or until April 1, 2014.  This is not helpful when you have a tooth ache!

Dental Health Maintenance Organization (HMO, or DHMO), PPO, Indemnity or Discount Dental Plan all have different effective dates as well as monthly payment dates and also can vary by carrier. Dental insurance effective dates usually are the first of the following month if the completed application and initial payment are received by a specified date. On the other hand, discount dental plans offer a better option for people with an immediate need and often include plan activation in just one day.

DO YOU HAVE A FAVORITE DENTIST? This is important because no type of dental plan will benefit you much if you have a favorite dentist that doesn’t accept your coverage. If your dentist doesn’t take a HMO plan, you may consider an Indemnity plan.  Also known as “traditional” or “fee for service” plans, they are worth a look because they provide you the freedom to visit any dentist.

PPO plans also include the option of going in- or out-of-network, although they will pay a lower percentage of the expenses if you go out-of-network. For example, going to an in-network dentist may cover 80% of a $100 cleaning, but when visiting an out-of-network dentist that same cleaning may cost $150 and the plan might only cover 50%.

Even the mathematically challenged, like me, can see that visiting an in-network dentist in the above example would have saved $55.

PRICE VS BENEFITS Finding a dental plan with an inexpensive monthly premium is easy, but it’s important that the plan you choose also covers the procedures you need or expect you’ll need in the future. 

Let’s say that you broke a small part of a front tooth a week ago and, savvy person that you are from reading our blog, you think you’ll need a dental veneer. The problem is some dental plans consider veneers cosmetic dentistry and don’t cover that procedure. So while saving money with your monthly premium may help you afford an occasional hazelnut macchiato, if the plan doesn’t cover the dental procedure you need, that expensive beverage may leave you with a subdued, bitter taste – personally and financially.

Dental Insurance Store makes it easy to see what benefits each dental carrier offers by simply clicking the Plan Details link for the plan you are considering. Every plan’s procedures are clearly displayed so you can easily choose a plan that meets your particular dental needs.

*Tip: All our discount dental plans and dental DHMO plans offer veneers as a benefit. You heard it here first.

ANNUAL MAXIMUMS Also known as annual limits or yearly maximums, this is the total amount of money a PPO or Indemnity plan will contribute toward your care in a year. A “year” can either be based on your anniversary date when you joined the plan or the calendar year, depending on the insurance company.

An annual maximum typically ranges from $750 to $1,500. Let’s say you have a plan with a $750 annual maximum and a $50 deductible. You undergo a $500 procedure and after paying your $50 deductible, the plan pays 50% and you pay 50%. (For those of you that were passing notes in math class that means you pay $225 and the plan pays $225.) Six months later you need a $750 procedure and the plan pays 50% of that ($375).

Together the plan has paid $225 for the first procedure and $375 for the second, a total of $600. That means with a $750 annual maximum, the plan will pay $150 for any other dental procedure during the remainder of that 12-month period. Anything above that is your responsibility.

*Tip: If you are a seasoned citizen that suspects you are going to need lots of dental work to regain your smile, DHMO’s and Discount Dental Plans have no annual maximums.

WAITING PERIOD As mentioned earlier, a waiting period is a specified time before certain dental procedures can be utilized through the plan. Waiting periods do serve a specific purpose that benefits both dental carrier and customer: it prevents people from dropping coverage after having an expensive procedure. 

Why should you care? Let’s say your neighbor has a dental plan with a $30 monthly premium and has paid just two months’ premiums before obtaining $600 worth of dental treatment. That means the insurance company will have less money to pay for other members’ oral care, including members like you that may have been paying premiums into that same plan for years.

That in turn, would drive up everyone’s premiums and since we’re all in this insurance pool together, everyone loses.  

PPO’s and Indemnity plans often have waiting periods, generally six months on basic services and 12-months for major services. Also, since waiting periods generally apply to more expensive procedures, this provides you extra time to budget for the copays or coinsurance contained in your plan.

One other note on waiting periods…wait for it… waiting periods are one-time only for as long as you have the same plan. So whether you are new to a plan or have had the same one for years, after the initial waiting period you will never have another one, unless your plan changes or you change plans.

To recap, there are five things to consider when looking for a dental plan:

  • Do you have an immediate need?
  • Do you have a favorite dentist and if so, does that dentist take the plan you are considering?
  • Is price (premium) more important to you or a full range of just-in-case benefits?
  • Does the plan you are considering have an annual maximum? If so, will it be enough if you and your chompers have a bad year?
  • Are you willing to wait during a waiting period or do you need help now?

Thanks for reading this edition of Agent Straight-Talk and joining us for our entire March series.  If you have missed any of the other posts from the month, please check them out here:

Pearls of Dental Wisdom for Seniors

The Whole Tooth About Dentures

Dental Inplants Are Alternative to Dentures

 And remember, “Wear a smile – one size fits all.” Email us at

Copyright 2013 Bloom Insurance Agency, LLC©

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