Dental Plans: Be Aware

Medicare & Dental

Apparently, Medicare does not believe that teeth are part of one’s body. (Well, of course, they aren’t part of some people’s bodies.) Why do I say that? It is because Medicare does not provide dental coverage.

Advantage Plans & Dental Coverage

If that is true, you may ask, how is it that some Medicare plans can advertise that they cover dental? Medicare Advantage Plans, which are different from Original Medicare, do, in some cases, have minimal dental coverage. However, there are two general issues with dental coverage in Advantage Plans. Even if your Advantage Plan includes dental, the problem is finding a dentist in the network. For example, in one particular Advantage Plan, there are only two dentists in an entire service area in Texas—a hundred miles apart!

The second problem with typical Advantage Plan dental coverage is the coverage itself. Generally, the plan provides for no more than an exam, a set of x-rays, and a cleaning. Need a filling, a crown, or even some teeth pulled? Well, pull out your wallet because your Advantage Plan won’t be covering those procedures—and nearly nothing else.

In addition, not everyone can get an Advantage Plan. To acquire one, the individual needs to have Parts A and B Medicare, to live in the service area of the plan, and to be free of End-Stage Renal Disease. But, again, even if you get an Advantage Plan, don’t plan on that being your dental plan.

Dental Option: To Pay or to Pay Less?

Whether you have Original Medicare, or not, you need to be aware of your dental options. The first option is laughably obvious: Pay for all of your dental procedures from your own pocket. Of course, that is not an attractive option for everyone, as some dental procedures can run into the thousands. (For example, one enamel crown can run about $1,000! Add a root canal to that, and you could be looking at an additional $1,500!)

Dental Plan Premiums, Deductibles, Waiting Periods—Oh My!

Another option is a traditional dental plan. But keep in mind that all plans are not created equal. They vary in regard to premiums, deductibles, waiting periods, and annual maximum benefit.

Premiums for a traditional dental plan (not a discount plan) can begin around $20 (or so) per month and climb to around $60 per month for plans in East Texas. What causes the difference in premium? Annual (referring to a policy year, which generally ends on December 31 each year) maximum benefit is one primary cause.

Dental Plan Annual Maximum Benefit

What is “annual maximum benefit”? Good question! (I’m glad you asked.) It is the maximum benefit the plan will pay per year.

For example, a Humana dental plan in East Texas may have a $23 monthly premium (monthly premiums cited in this article are for one individual), but the plan will only pay for $1,000 of approved dental work per policy year, while a UTC plan in the same area may charge around $45 monthly premium (depending on the insured’s age) because it covers up to $2,500 of approved plan benefit, along with some vision coverage. A Cigna dental plan in the same service area has a monthly premium of $33 for a policy year maximum benefit of $1,500, with no vision coverage.

Comparing Dental Plans: Apples & Oranges

As you can see, shopping dental plans can be like comparing apples with oranges. You may choose a plan based on the lowest premium, but keep in mind that $1,000 worth of dental work doesn’t go nearly as far as it used to reach; as mentioned earlier, one crown could wipe out that amount for the year.

Adding to the difficulty of comparison are waiting periods, deductibles, and networks. Let’s touch on deductibles first.

Some plans have no deductible for preventive care, which includes semi-annual exams, a set of x-rays, and two cleanings per year. (But some plans do have a deductible for these services or at least a monetary coverage limit.) However, beyond your preventive care, you may need to pay a $50 or $100 annual deductible (money you need to pay before you receive a benefit from your dental plan).

Dental Plan Waiting Periods?

Then there are waiting periods. What is a waiting period? It is the amount of time you need to have your plan in place before you can obtain a particular benefit from the plan. In other words, it is the amount of time you need to pay premiums before you receive a benefit.

For example, some plans have no waiting period for preventive care (but some plans do have a mandatory waiting period). However, the plan may have a six-month waiting period before you can access basic restorative services, which could include non-routine x-rays, routine teeth extractions, and fillings. The plan may have a twelve-month waiting period before it will pay for major restorative services, including periodontal (deep cleaning), crowns, root canals, wisdom tooth extraction, bridges and dentures or partials.

Even Dental Plans Network

In comparing plans, make sure you find out if the plan in which you are interested has a network. If so, find out if your dentist is in the network. If a dental plan is a network plan, and your dentist is not in the network, plan to either find another dentist (one which is in the network) or pay out of pocket for all of your dental costs. (In that case, why would you even have a dental plan?)

Dental Discount Plans

An alternative to the traditional dental plan option is a discount dental plan. While the discount dental plan cannot be called insurance (as it does not work in the same way as a traditional dental plan), the discount plan seems to be gaining popularity because it has no deducible you have to spend through before getting benefits, there is typically no annual maximum benefit, there are no waiting periods, and the monthly cost (some plans at $9.95 monthly per person) is far lower than traditional plan premiums. However, discount dental plans do have a network, so make sure you are satisfied with the network. If you want to use a particular dentist, make sure he or she is in the network. If your dentist is not in the network, you will need to choose a dentist (one in the network) in order to take advantage of the plan benefits, because the key to a discount dental plan working for you is using a dentist in network. But if you do, the plan can work out quite well for you and, potentially, save you money over a traditional dental plan.

A discount dental plan has negotiated costs with dentists in their network. With a good discount plan, you may save, on average, around 70% per dental charge (with some dental procedures saving less and some saving more). To get a feel for how they work, you can look at some discount dental plans here, where you can view networks, the discounted costs of procedures, the monthly charge to have the plan, etc.

Smiling All the Way to the Dentist

Hopefully, this information will enable you to make an informed decision on your dental plan. Perhaps this article will lead you to save enough money on dental that it will make you smile all the way to the dentist. (Argh! Sorry.) Anyway, here’s to happy hunting for your best dental plan.


Sandra McphailSandra Mcphail
23:10 01 Aug 24
Dirk ColemanDirk Coleman
17:40 25 Jul 24
I had a lot of questions about signing up for Medicare. John patiently listened to my questions and then gave me a... thorough explanation of what to expect and how to proceed. He was very easy to work with and promptly returned my calls and emails. I highly recommend John if you have questions or concerns about Medicare, supplemental insurance, or drug plans.read more
Wes SmithWes Smith
23:36 15 Jul 24
John Claeys has the highest standards conducting business. His knowledge and attention to detail makes every client... informed and comfortable with what they are purchasing. Exceptional service.read more
Don McCartyDon McCarty
00:36 07 May 24
Very helpful, friendly, and knowledgeable. Plan pricing was accurate, and I was kept informed throughout the process.
Susan BleuerSusan Bleuer
11:28 02 May 24
John Claeys is a great insurance agent. He is very pleasant and professional to work with and will get you the best... insurance at the lowest price. He is quick to return phone calls and resolve issues. We highly recommend him for your insurance needs.read more
Rick RogersRick Rogers
16:14 01 May 24
If if spent a week studying the options for Medicare and all of the choices that go along with it, I’m sure that I... would still be uncertain about what to do. John does a great job of explaining all of the options, including the advantages and disadvantages of each. I recommend him highly without any reservations.read more
Shari BrockShari Brock
22:12 18 Apr 24
John sat down with both of us and explained everything and answered any questions we had. He researched for the best... plans for us. Highly recommend!!read more
Eric GuvernatorEric Guvernator
03:16 16 Apr 24
With all the endless solicitations I had received as I approached my 65th birthday, I had never expected to feel so... comfortable and relieved to have John guide me seamlessly through the process. I couldn’t have asked for a finer experience. Not really having a clue going into our meeting, I left having confidence that I was gifted with the perfect plan as well as an advocate in my corner.I continue to get timely explanations and guidance anytime I send a question on Medicare material.If like me you are approaching this monumental deadline, contact John and let him handle this important process. You will not be disappointed.read more
Judi CarrollJudi Carroll
23:28 15 Apr 24
John answered all my questions and found me a great plan at an affordable premium.
Lynn SmithLynn Smith
20:41 15 Apr 24
The change to Medicare and supplemental health insurance can be terrifying. John Claeys and The Claeys Group Insurance... Services made the process unbelievably simple. John is incredibly knowledgeable and up to date on all of the latest requirements. He explained the process and my options in a very simple and concise way and easily helped guide me in making the best decision for my situation. I cannot imagine navigating this medicare system without him. I also feel confident that he will safeguard and watch my situation in the event of future changes. Knowing that he is watching out for me going forward is the best part of all!read more
Tena BoneTena Bone
18:06 15 Apr 24
John Claeys has been very thorough with every detail of this important decision for me and my future Healthcare. He has... such a sweet and caring spirit. I can't imagine using anyone else for my insurance needs.read more
Dollene BrownleeDollene Brownlee
15:26 10 Apr 24
John was very helpful explaining different Medicare options
January ShubertJanuary Shubert
13:50 08 Apr 24
Excellent customer service. Professional and knowledgeable. Received what I needed and wanted at a reasonable price.
Melton TimmonsMelton Timmons
23:05 05 Apr 24
John is a great person first. As an agent he is very knowledgeable of the products and services he offers. For every... question I had, he provided answers and solutions. I am very comfortable with him and if you need a capable agent, please contact John Claeys.read more
Rosa MartinRosa Martin
21:53 05 Apr 24
John is a very knowledgeable person in his profession. He has helped my husband, my sister, and myself to find the best... affordable insurance for each of us…He made navigating through Medicare a breeze for me. He is willing to help in any way and any time of the day.Thank you John for all your help.read more
Johnny CoffmanJohnny Coffman
16:33 05 Apr 24
He explained the ins and outs of how Medicare works and clarified the confusion. Highly recommend John Claeys!
Mark BleuerMark Bleuer
22:48 03 Apr 24
John is very professional and courteous. His knowledge and attention to detail is exemplary. I can highly recommend... Claeys Group Insurance. He does a great job.read more
sheila Rhynesheila Rhyne
14:58 03 Apr 24
I have had excellent customer service.Claeys insurance company has helped me for several years now and he does a... wonderful job setting me up with the right insurance that fits my needs .I really appreciate the job he does and Thank you again.read more
Scott GillScott Gill
00:34 03 Apr 24
Highly professional with attention to detail. Felt like John was genuinely interested in matching my needs to the... various options.read more
Karen DeemKaren Deem
21:02 02 Apr 24
John was very pleasant and professional. Medicare can be very confusing. He had all the answers for me.
Beth HamillBeth Hamill
17:52 02 Apr 24
I am so thankful for John's help and kindness...he explains everything so clearly and I feel confident that he is... truthful and finding the best plan for me.read more
Margie FisherMargie Fisher
22:38 13 Feb 24
My husband and I have used John's services for several years, as do many of our friends. At no time has his... recommendations let us down. He is kind, patient in making sure we understand our choices and was there for any and all questions afterwards. He would be our ONLY choice when it's your turn to use his insurance services. He will not let you down. What a professional! 🙂read more
Jerry JonesJerry Jones
02:27 08 Feb 24
John was very helpful in guiding me through the medicare choices. He explained everything thoroughly and answered all... my questions.read more
marvitta hallmarvitta hall
23:31 07 Feb 24
Tonda SammonsTonda Sammons
21:26 07 Feb 24
Judy CraftonJudy Crafton
20:54 07 Feb 24
Mr. Claesy, was a pleasure to work with on just a short time table, my not paying attention to dates for Medicare... changes! We really appreciated his response and meeting personally with us. We highly recommend him for your insurance needs. Thanks again for doing a wonderful service.read more
Dannie SkipperDannie Skipper
20:50 07 Feb 24
John was very helpful in selecting insurance companies for Roy. He demonstrated that he was very knowledgeable about... what was available and what was needed. He made recommendations, provided details, and gave good advice to us. He was flexible and did what we asked of him to complete the process of selecting the best insurance companies for the situation. We are grateful for his help and pleased with the results.read more
KevinKevin
14:47 24 Jan 24
John is a very knowledgeable subject matter expert and is thorough in his approach. He takes time breaking down and... explaining what can be a somewhat complex subject and helps makes it easier to understand! John always has the best interests of his clients guiding his recommendations. We have found John's advice to be extremely helpful and would recommend him to anyone seeking health insurance.read more
Laura BogenschutzLaura Bogenschutz
18:06 21 Jan 24
John Claeys is the best! He has helped my husband and I tremendously with our Medicare and supplement coverage! He... breaks it down to where you can understand it! We would be so confused without John!! Thank you John for being there for us!!read more
Thompson FamilyThompson Family
15:46 18 Jan 24
John Claeys is one of the most knowledgeable individuals on Medicare and supplemental insurance plans you can ever... find. Not only is he very personable he also stays involved from year to year to ensure you have the best policies for your current needs.read more
Ingrid FauskeeIngrid Fauskee
23:21 17 Jan 24
I just got a Medicare plan through John Claeys. I was getting a lot of mail about Medicare and was so confused. Some... friends told me about John so I emailed him and he contacted me right away.. He was amazing! He went through everything with me, he explained every detail and was so patient with all my questions . So grateful to him for all he did. Thank you John.😁read more
John Claeys helped me understand the in's and out's of Medicare. He found the best insurance and prescription plan to... best suit my needs at an affordable price.Thank you John!Laurie Boriskieread more
Marsha AllenMarsha Allen
16:55 24 Oct 23
My experience with John was definitely 5 Star! He explained everything thoroughly, and simply. He answered all my... questions regarding Medicare completely. I would absolutely recommend John, without reservation.read more
Linda WilliamsLinda Williams
10:08 12 Jul 23
I had a 5 star experience and would recommend him. Always returning my calls promptly, very helpful and informative,... listened to what my needs was regarding my Medicare. I truly felt comfortable with John's help to navigate through the maze of Medicareread more
Cindy KulakCindy Kulak
14:51 18 Jun 23
John is very knowledgable, honest and ethical in helping clients evaluate Medicare options and get enrolled. He made... the process extremely easy for myself and my husband.read more
js_loader

by:

Leave a Reply