Paying for Dental Care--Something to Chew On

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March 6, 2012

Most people would agree that regular dental cleanings are important. Regular cleanings can detect and treat minor dental issues before they become major, more costly issues. The question is not should you have regular dental cleanings, but how to pay for them.

The cost of dental cleanings and other dental care can be very expensive. You can pay for dental care services out of pocket or you can purchase dental insurance to cover all or part of the cost. The decision to purchase dental insurance or pay out of pocket depends on your individual circumstances. Can you afford to pay an unplanned $100 or $1,000 expense out of pocket or is making monthly, known payments a better fit for you?

In addition to paying for dental care out of pocket or purchasing dental insurance, you can also purchase a discount dental plan or receive free or subsidized care through the Medicare and Medicaid programs. Let's review these options.

Employer Provided Dental Insurance…
  • Usually cost less than private dental insurance you would purchase yourself. Also, employers may pay all or part of the dental insurance premium

  • Can be paid with tax-free money if part of a Section 125 plan, saving you even more money than if you purchased coverage as an individual

  • Pays a maximum benefit amount, for example, the first $1,500 of dental expenses incurred in a 12-month period. You are 100% responsible for any dental care cost above this maximum, until the start of the next 12-month cycle

  • Can be used along with an employer-sponsored health care flexible spending account (FSA). If you expect to have dental expenses that are greater than your dental plan’s maximum annual limit, you can set aside tax-free money in a health care FSA to pay these expenses. This option will save you money because you will be paying these expenses anyway—why not pay them with tax-free money.

Individual (Private) Dental Insurance…

If your employer does not offer dental insurance or a healthcare flexible spending account, consider purchasing individual coverage. All of the major dental insurers (Delta Dental, MetLife, United Concordia, etc.) offer individual dental insurance plans. Also, some major health insurers (Aetna, Cigna, and HumanaOne) offer individual dental insurance plans. You can log onto these insurer’s web sites to view dental plan options and rates.

Discount Dental Plans…

Discount dental plans are not dental insurance plans. Discount dental plans provide discounts of 10% to 80% for covered dental services after you pay an annual fee. And just like dental insurance, not all dental services are covered. These plans are available to individuals and families. They can also be used along with dental insurance.

Several national insurers like Aetna and Cigna offer discount dental plans. Plans offered by major insurers usually have larger national networks of participating dentists than their smaller counterparts, who tend to have smaller regional networks of providers.

Medicare Provided Dental Coverage…

Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions or dentures.

Medicare Part A will pay for certain dental services that are considered medically necessary, such as a dental exam before or after organ surgery and jaw reconstruction following an accident.

Some Medicare Advantage Plans (Medicare Part C) may offer some dental insurance coverage for routine dental care. Check your plan documentation. Also, Medicare eligible patients may purchase individual dental plans from a private insurer, through AARP, or as part of a Medigap policy.

Medicaid Provided Dental Coverage…

Medicaid provides health care coverage to low income and disabled people. State Medicaid programs are required to cover dental care services for Medicaid recipients under age 21. There is no requirement to cover dental services for individuals 21 and over but some states do.

For more information about dental care services provided by Medicaid, check out these web sites.

  1. https://www.cms.gov/MedicaidDentalCoverage/

  2. https://www.cms.gov/MedicaidDentalCoverage/Downloads/dentalguide.pdf

Dental care can be expensive. Purchasing dental insurance through your employer or directly from an insurer, or purchasing a discount dental program may save you money on dental care services. Also, you may be eligible for help with dental costs through the Medicare or Medicaid programs. Explore all of your options for help with dental care costs.

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