The number one, most important thing for seniors to remember about dental coverage is that Medicare does not cover dental services. This can affect you in two ways – first, if your only insurance coverage is Medicare, dentists will treat you like a self-pay patient, and will charge you the full fee for each procedure. Second, many Medicare supplement plans only cover services that Medicare pays for. If you call the customer service department for this type of supplement plan, they will often tell you, “We follow Medicare guidelines,” or “We pick up the remainder after Medicare pays.” Those supplement plans that do cover dental services tend to only cover basic or preventative services (meaning no crowns, bridges, dentures, etc).
Prior to purchasing any dental policy, be sure that you’ve read and understood all of the exclusions and waiting periods that apply to the policy. Many policies will not cover major services if certain criteria are not met. For example, a “missing tooth exclusion” means that if the tooth was extracted/missing prior to the start of the policy, the plan may limit the types of replacement they will cover, or they may not cover any treatment that replaces that tooth (this includes implants, bridges, removable partial dentures and, in the most extreme cases, even complete dentures).
It also never hurts to step back and ask yourself if you really need dental insurance. If you have strong teeth, and only see your dentist for cleanings (or, at the other end, if you have a full set of dentures and only see your dentist for adjustments), you may be wasting more money on monthly premiums than it would cost to pay for these services outright. Also, make sure that you see a dentist that is contracted with your insurance, if at all possible. If you are trying to choose between two different insurance companies, ask your dentist’s biller which companies they are contracted with – using a contracted dentist can save you hundreds of dollars on major services.
The bottom line is that you are your own best advocate. Don’t be afraid to ask questions so that you understand exactly what you are getting for your money. If you are having major work done, ask your dentist to send a pre-determination request to your insurance – your insurance will mail a copy of your benefit information to you and to your dentist, explaining what your benefit would be for the specific procedures your dentist is planning for you, or if they need any additional information to make the benefit determination. While this is not a guarantee of payment, these can be very useful if you need to appeal a denial. If you receive an explanation of benefits that you don’t understand, call your insurance company or your dentist’s office and ask them to help you understand the billing jargon that was used.
While understanding your dental insurance won’t always make your dental visits enjoyable (after all, a root canal is a root canal regardless of who pays for it), not knowing what your insurance will cover will certainly make your visit more painful.