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Filling the Biggest Hole in Your Retirement Health Care

Last update on: Dec 27 2018

The biggest gap in your retirement medical insurance probably is one you hardly think about and that gets little attention. Among the many needs not covered by Medicare is dental care. You also won’t find dental coverage in Medigap (Medicare supplement) policies. Unless problems with your teeth and mouth are related to an accident or certain diseases, you won’t receive help from Medicare.

Apparently, few retirees know about this gap or do anything about it. While 80% of children and 54% of working adults have some kind of dental coverage, only 30% of seniors do. According to one survey, half of Americans ages 65 and older didn’t visit a dentist at all in the last year.

There are a number of private options for obtaining dental coverage, but unlike prescription drug, Medigap, and long-term care policies, these options aren’t regulated by or associated with Medicare in any way.

You might not think you need help paying for a couple of teeth cleanings a year, and you probably don’t. It’s the other potential treatments for which you might want some coverage. In many areas, root canals and crowns incur charges of about $1,000 each. Costs can be higher or lower, depending on where you live. Dentures, implants, and other treatments that are routine among seniors are more expensive. You might not want to reach into your pocket to pay the retail cost of such treatments when you need one or more of them.

You have two basic options for dental care coverage: dental insurance and dental discount plans.

I suggest you consider a discount plan instead of dental insurance. Most of the time a discount plan controls your out-of-pocket costs better than insurance.

Dental insurance premiums vary around the country, but the premiums typically are around $500 annually. (Age isn’t a factor in determining premiums.) For this premium you’re covered for two cleanings and exams annually and usually for periodic x-rays. In addition, the policies will cover many other dental treatments you might need.

The limits and fine print in the coverage, however, reduce the policies’ benefits. There’s usually an annual coverage limit of between $1,000 and $1,500. (You can increase the coverage limit a bit by paying a higher premium.) No matter how much dental care you need, the insurance won’t pay more than the annual limit. You also will have a copay or coinsurance on most treatments that are covered, usually of 20% to 50% of the cost.

Also, some important dental treatments might be excluded entirely, especially cosmetic treatments, so check the details before signing up for a plan. In addition, expect a waiting period of 12 months to 18 months for many types of care beyond the routine cleanings.

The good news in dental insurance is that the insurer negotiates prices with the providers, so your charge will be less than the dentist’s price to patients who aren’t covered.

Essentially with dental insurance you’re prepaying for two annual cleanings and a few other services.

A better option to me is a dental discount plan. These usually have annual premiums of around $100. Again the cost varies around the country.

The discount plans negotiate with a network of dentists in your area. If you have your dental work done at one of the network dentists, you’ll pay substantially less than the dentist’s “sticker price.” The discounts can be substantial. I reviewed several plans in my area, and the discounts are 40% to 50% on a range of services, and sometimes are higher. There’s rarely a waiting period for a discount plan.

In addition, usually you can opt an annual premium of around $200 annually and receive some basic services for no charge, such as one or two annual cleanings and periodic x-rays. So, you’ll have coverage similar to that of insurance for a lower premium.

Your regular health insurer or Medigap insurer might offer or be affiliated with one or more dental insurance or discount plans. Plans in your area also can be found at or the National Association of Dental Plans web site at  There also is an insurance plan affiliated with AARP and administered by Delta Dental Insurance Company. Check the AARP web site for details.



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