A Guide to Dental Insurance for Seniors

Why you can trust Insure.com

Quality Verified

At Insure.com, we are committed to providing the timely, accurate and expert information consumers need to make smart insurance decisions. All our content is written and reviewed by industry professionals and insurance experts. Our team carefully vets our rate data to ensure we only provide reliable and up-to-date insurance pricing. We follow the highest editorial standards. Our content is based solely on objective research and data gathering. We maintain strict editorial independence to ensure unbiased coverage of the insurance industry.

Many seniors, when they turn 65 and become eligible for government-funded Medicare, are surprised to learn that the health insurance program does not provide coverage for routine dental care or procedures.

Unfortunately, that has resulted in a major gap in care for older adults in the U.S. that could have serious health-related consequences.

In a study released in February of 2023, investigators from Brigham and Women’s Hospital in Boston found that as many as half of older adults lack dental insurance and nearly half of older adults receive no dental care.

As a result, there is a marked increase in older adults losing all their teeth after the age of 65, which puts them at a higher risk of poor nutrition and lower quality of life, among other health concerns.

“Loss of teeth can have a number of negative downstream effects,” Lisa Simon, a lead researcher with Brigham’s Department of Medicine, said in releasing the study. “It’s associated with many geriatric conditions, including frailty and cognitive function.” Simon is both a dentist and a medical doctor.

Cost is usually the primary reason seniors no longer receive ongoing dental care and may skimp on vision and hearing care. And it’s understandable. Out-of-pocket expenses “can run into the hundreds and even thousands of dollars for expensive dental treatment, hearing aids, or corrective eyewear,” according to KFF, a health-care research organization formerly known as the Kaiser Family Foundation.

The good news is there are dental insurance plans that can significantly lower the cost of taking care of seniors’ teeth and gums.

Key Takeaways

A number of studies point to the direct link between oral health care and a wide range of diseases and health concerns for older Americans.
Dental insurance plans can help reduce the cost of caring for a senior’s teeth, gums and mouth.
Plans start in the $20 to $35 per month range and usually cover 100% of preventative dental care.
To find the best insurance, it’s important to compare copay rates, deductibles and yearly maximum benefits.

What is seniors’ dental insurance?

Simply put, dental insurance for older Americans provides coverage to address the continued need for oral health care as people head into their retirement years.

It comes in various forms but is typically offered at three to four coverage levels:

An economy or minimal coverage plan, the most basic and least costly coverage.
A mid-range plan that will cover a wider range of procedures and pay a greater percentage of costs.
Top-tier plans that cover pretty much all basic services and a large portion of more expensive procedures, such as crowns and oral surgery.

Under each plan, procedures are typically broken down into three categories: “preventive,” which refers to such procedures as cleanings, fluoride treatments, oral examinations and X-rays or radiographic images; “basic,” which includes such things as cavity treatments, replacing fillings, simple crowns and minor surgeries, such as draining an abscess; and “major,” which includes the more involved procedures such as root canals and dentures.

Dental insurance doesn’t usually cover cosmetic procedures, such as teeth whitening, veneers and bonding. They may also exclude some types of orthodontia such as clear aligners, but once again, coverage varies from plan to plan and will require further investigation.

Dental insurance companies usually have networks of dentists they work with. Some may allow you to see any dentist you like, but using an in-network dentist offers significant savings.

One important note: Most dental insurance plans have a waiting or probationary period before you are eligible for benefits for any major work such as crowns or root canals. Waiting periods vary from company to company and by plan level.

The importance of good dental care for seniors

The benefits of maintaining good oral health care as you age are well known, yet a large percentage of older adults stop going to the dentist.

Treating a dental problem once it has developed into a major concern is not only painful but expensive. And since many seniors are on a fixed income, paying for that care can be a difficult burden.

Taking a bite out of your wallet

Average cost of routine dental procedure

Procedure	Cost
Cleaning	$98
Examination	$55
Filling (silver amalgam)	$146
Ongoing gum disease treatment	$164
Root canal	$1,109
Crown	$1,213

Source: American Dental Association, 2020 Annual Fee Survey

In its most recent study, KFF found that the average yearly out-of-pocket spending on dental services among Medicare beneficiaries was $874 and that one in five spent more than $1,000.

It’s a cost aging adults can’t afford to ignore. As mentioned, the link between dental health and a number of very serious conditions is compelling.

Nearly one in five adults aged 65 or older have lost all of their teeth, according to the Centers for Disease Control and Prevention.
Cancers of the mouth (oral and pharyngeal) are primarily diagnosed in older adults.
People with chronic diseases, such as arthritis, diabetes, heart disease and chronic obstructive pulmonary disease (COPD) are more likely to develop gum disease.

Linking dental care and health

Teeth are linked to a wide range of health issues among seniors

Untreated tooth decay – Nearly all adults (96%) aged 65 years or older have had a cavity, 1 in 5 experience untreated tooth decay

Gum disease – A high percentage of older adults (68%) have gum disease

Tooth loss – Nearly 1 in 5 adults over 65 have lost all of their teeth

Oral cancer – Cancers of the mouth are primarily diagnosed in older adults

Chronic diseases – Seniors with chronic diseases (diabetes, arthritis, heart issues, chronic obstructive pulmonary disease) have a greater likelihood of gum disease

Dry mouth – Medications taken by large numbers of seniors can cause dry mouth, resulting in reduced saliva flow and greater risk of cavities

Source: Centers for Disease Control and Prevention

Further medical studies have shown that bacteria present in gum disease can travel through the body and cause inflammation in the heart’s vessels and infect heart valves.

Health concerns aside, it’s a legitimate question to ask if a senior dental insurance plan is worth it. If you only go for twice-yearly cleanings, X-rays and an oral exam, the cost may be hard to justify.

However, as the American Dental Association notes, older adults are prone to a wide range of complications including dry mouth caused by medications, which increases the need for regular dental visits.

How do seniors’ dental plans work – and how much do they cover?

Like health insurance, there are a variety of dental insurance plans. Prices may differ depending on the company and level of coverage chosen. However, clients typically pay a set monthly premium.

As mentioned, most plans will cover basic preventative procedures, such as once- or twice-yearly oral exams and cleanings and X-rays for annual exams.

More involved procedures like root canals, crowns and oral surgeries may be fully or partially covered, depending on the plan chosen.

Some plans will charge a set deductible per procedure, while others might provide a set dollar amount benefit – say $200 toward the cost of a certain procedure. Top-tier plans might pay a certain percentage of the cost of a procedure – for example, 70% to 90%.

One other consideration to take into account is that dental insurance plans often come with a yearly cap. In other words, they might have a maximum for yearly benefits, say $500 to $3,000 per calendar year.

The more comprehensive the plan, the more you can expect to pay monthly.

How much does seniors’ dental insurance cost?

It can be difficult to provide a straightforward answer to the question of how much dental insurance will cost you.

A general guideline is that lower-level plans are priced in the range of $20 to $35 per month, mid-tier plans in the range of $35 to $45 per month and premium plans in the range of $45 and up.

But price alone won’t tell you the full story. You will need to dig a little deeper to find out exactly what each plan provides.

Additional factors may include:

Copay: This is how much you would pay per visit to the dentist or per procedure.
Coinsurance: This is the percentage of a procedure that you pay.
Benefit maximum: This refers to how much the plan will pay for dental care over a period of time, such as annually.

What is the difference between a seniors’ dental insurance plan and a dental discount or savings plan?

Dental insurance plans are one of several options available to seniors to help meet and cover their dental needs.

While dental insurance plans typically offer a more comprehensive set of coverages and payment schemes, here are some options that can be considered:

Dental discount or savings programs: These programs typically charge an annual fee and provide discounts negotiated with a dental care network. A dental network is a group of dentists contracted with a dental insurance carrier or savings program that provides dental care at set negotiated fees. Discounts might range from 30% to 40% off such care as cleanings, exams, fillings and crowns. Members pay the discounted fee out-of-pocket.

Medicare Advantage: Seniors can enroll in a Medicare Advantage program, which is a Medicare plan offered by a private insurer. It may include added benefits such as dental coverage. Some Medicare Advantage programs can be paired with dental insurance to provide more comprehensive coverage.

Medicaid: This joint federal-state program provides dental coverage in participating states for people who meet certain income and asset requirements.

How do you choose the right dental insurance plan for your needs?

The type of plan you select will come down to a variety of factors, including what you can afford.

To pick the right plan for you, the National Association of Dental Plans says to start by asking yourself a few questions:

Is it critical for your out-of-pocket expenses to be predictable and low? If your monthly income is fixed, then you may want to insulate yourself against any unforeseen dental costs.
Do you have a greater tolerance for cost sharing? In other words, can you afford to pay some of the costs of your dental procedures as they come up in exchange for lower monthly premiums?
Is a large dental care provider network important to you or are you willing to accept a smaller pool of providers in exchange for lower costs?
Do you want the freedom to continue to use your preferred dentist, even if they are not in the insurance company’s partner network?

One final tip in helping select a dental plan is to talk to your current dentist before shopping. Dentists can give you an indication of the dental care you’ll likely need in the future based on your history and current oral health.

Sources:

Centers for Disease Control and Prevention, Facts About Older Adult Oral Health
Journal of the American Dental Association, Tooth Loss Among Older Adults

Mel Duvall

Contributing Researcher

Mel Duvall is an award-winning senior business writer and communications professional. Mel also served a three-year term on the Mount Royal University Journalism Committee.