Dental costs can take a huge bite out of seniors’ finances, even if they have Medicare.
In all, 65 percent of Medicare beneficiaries, or 37 million people, have no dental coverage, according to recent data from the Kaiser Family Foundation.
The federal retiree health-care program doesn’t pay for cleanings, fillings, crowns or dentures — all of which are services seniors are likely to need.
Those who do have dental care coverage have obtained it through private Medicare Advantage plans, Medicaid and other private plans, including workplace retiree coverage and individually purchased dental insurance, Kaiser found.
Medicare beneficiaries who went to the dentist in 2016 shelled out an average of $922 in out-of-pocket costs, according to Kaiser.
Regular visits to the dentist can help you stave off health complications and even higher costs.
“Oral health affects your physical health, and in that turn, it can lead to higher expenses for medical services,” said Gretchen Jacobson, associate director with the Kaiser Family Foundation’s program on Medicare Policy.
Twice-yearly cleanings tend to be fairly predictable in terms of cost, and consumers may not need coverage in order to get them.
For instance, the cost of a simple cleaning for an adult averages around $129 for patients in Manhattan, according to FAIR Health Consumer, a site that estimates the cost of medical procedures.
Patients who are uninsured or who are seeing a dentist that’s out-of-network may expect to shell out $210 for this service, FAIR Health found.
Specialty dental work tends to hit patients in their pocketbooks.
For instance, the cost of getting a ceramic or porcelain crown over metal can run up to $2,000 for patients who see out-of-network dentists or who have no insurance, according to FAIR Health.
“You’ll want insurance for those higher costs, including fillings, crowns and dentures,” said Jacobson.
Dental insurance can help lighten the load of costly procedures, but it doesn’t prevent patients from shelling out large sums.
Kaiser gave the example of a 72-year-old patient who received treatment for tooth decay, three fillings and two crowns. This same patient received additional periodontal maintenance six months later.
Without insurance, he’d be shelling out an estimated $4,300 that year, Kaiser found.
However, even with dental coverage via Medicare Advantage, this same patient would be on the hook for up to $3,300.
That’s because insured patients often are still on the hook for deductibles and coinsurance — in which the client is responsible for a percentage of costs — and annual caps on what the plan pays.
Considering the fact that deductibles and other costs can be high, dental coverage may only be worthwhile if you plan the details of your care, said Carolyn McClanahan, a physician and director of financial planning at Life Planning Partners in Jacksonville, Florida.
Consider that Medicare Advantage enrollees with access to dental benefits are shelling out an additional premium, averaging about $284 a year, according to Kaiser.
Retirees need to become empowered consumers to get the most out of their dental care. Here’s where to begin, according to McClanahan.
Understand your coverage: Whether it’s offered to you through a retiree health plan or as an add-on to your Medicare Advantage plan, get a solid understanding of your deductibles, applicable copayments and coinsurance.
Know whether your dentist will take your plan: Your insurance won’t help you much if you’re paying more because your provider is out-of-network.
Build up your emergency fund: Nobody plans for tooth decay. Consider that surprise implant or crown to be an emergency expense, and save accordingly, McClanahan said.
If you have a health savings account, you can’t fund it if you’re on Medicare. However, you can tap it to pay for dental and other qualified medical costs on a tax-free basis.
Get second opinions: “Some dentists are more aggressive than others,” said McClanahan. “If someone is recommending really expensive work, get a second opinion.”