For senior citizens, dental insurance plans vary widely. Each planned is designed differently, and these differences can be very confusing. There can be vast differences in the amount of coverage offered and out of pocket expenses.
Most regular dental plans fit in to one of the following categories, although individual details might differ. A direct reimbursement plan is a program that reimburses patients a preset percentage of the amount that is spent on dental care. The category of treatment does not matter. It allows a patient to choose a dentist and provides an incentive for economically smart solutions. It also encourages good oral hygiene as prevention will keep treatment costs low. UCR programs stands for Usual, Customary, and Reasonable. These programs also allow their members to choose their own dentist. They pay a percentage of a dentists fee so long as that amount does not go beyond the plans fee limit based on reasonable or customary fees. These limits do not necessarily reflect the actual fees dentists in your area are charging. These fee limits vary widely and are not government regulated.
A Schedule of Allowance or Table of Allowance program assign a dollar amount to a list of services that are covered. The plan will pay that amount for the covered service, regardless of what the dentist actually charges. The difference between the plan amount and the dentists fee is paid by the patient. A Capitation Program pays a monthly fixed amount to a contracted dentist per patient or family. The dentist in return agrees to provide certain treatments at no charge, or for a small copayment. There is no necessary correlation between the amounts of money the dentist is paid and the value of the services rendered to the patient during any payment period.
Because our dental needs change as we grow older, some companies offer specific dental insurance plans for seniors. Traditional plans charge from $40 to $50 a month in premiums. These rates vary depending on the company and the plan. They cost more than HMOs, but allow the patient to choose their own dentist. With a traditional plan, you pay out of pocket for the services, and then get reimbursed anywhere from 50 to 80 percent of the cost. For seniors on fixed incomes, this is not usually the best choice.
HMOs and Managed Care Plans offer individuals 65 years old and older inexpensive insurance coverage. They are less expensive than traditional plans, but have limited options. Before choosing to enroll, you need to find out which dentists and procedures in your area are covered. Medicare Advantage Plans are an addition to standard Medicare coverage, providing extra coverage for dental as well as hearing and vision.
AARP members can be eligible for a group policy at a low premium. These plans are for seniors who lose their dental coverage when they retire. Coverage is limited for the first twelve months after enrollment. After that time, more is covered including dentures, major restorations, and gum disease treatment.
One affordable option for seniors dental insurance plans is discount dental plans. These plans are not dental insurance, and as such are not state regulated. However, they do offer savings of up to 60% on routine dental work. Members pay a monthly fee to be a part of the plan, and then pay a small discounted fee when services are rendered.
Especially for seniors, dental insurance and discount plans can be confusing. It is important to recognize the differences between plans, and between insurance and discount programs. Plans that are not insurance are not state regulated, and their terms can vary substantially.