En español | Like many older Americans, 79-year-old Phyllis Tabbi of Stoughton, Mass., lacked dental insurance. So she found herself putting off visits to the dentist. "I was on a fixed income, so I let some things slide," she says. For example, a crown might be pushed back a few months until she had the $1,000 to pay for it.
According to a recent study by Boston-based discount dental service provider Universal Dental Plan, nearly half of Americans age 65 and older did not visit a dentist in the previous year, the number one reason being cost.
The consequences of that decision can be dangerous. Poor oral health increases one's risk of heart disease by 180 percent, risk of stroke by 300 percent and risk of respiratory infection by 500 percent, the study found. Then there's the obvious: gum disease.
Dental insurance often isn't a viable route for older adults. Those on fixed incomes often can't spare the $30 a month that, according to the Dallas-based National Association of Dental Plans, is a typical premium. Plus there are other costs such as deductibles and copayments.
Some seniors opt to pay out of pocket, like 67-year-old Barbara Perry of Bowie, Md., who is uninsured. "Unless I was having major procedures done every year, I would have paid three or four times in premiums what I spent on the work I needed."
Reduced rates for members
But there's a third way, which people like Tabbi are turning to: discount dental plans. For monthly fees of $10 to $12, these plans give them access to discounted dental services.
"Discount dental plans work like a Costco membership," says Edan Barshan, president of Universal Dental Plan. In return for the monthly fee, you can choose among a network of dentists who will give 10 to 60 percent rate reductions for certain services. That $1,000 crown might only cost $600 for a member of a plan.
Unlike dental insurance, which may not cover preexisting conditions, you can shop for a discount dental plan knowing you need a root canal and select the plan that offers the cheapest price, says Buddy Johnson, chief executive officer of national discount dental provider DentalPlans.com. "You could sign up today and go to the dentist tomorrow," he says.
When a plan makes sense, when it doesn't
If you have insurance and know you'll need extensive work done in a given year and it will fall below your policy's spending caps, a discount dental plan might not make sense, says Mark A. Cesarano, a health and welfare consultant with the Philadelphia-based employee benefits firm the Savitz Organization.
But "if you've been on top of taking care of your teeth and you just want to have some protection for if the worst case happens, then a discount card can be something that works for you," Cesarano says.
And if you've already hit your insurance plan's coverage ceiling for the current year and would have to put off a procedure until next year to get coverage, or if your budget simply cannot bear the cost of insurance, a discount plan might be your best option. "Discount plans can be a big help in managing a more limited budget," says Evelyn F. Ireland, executive director of the National Association of Dental Plans.
As with any important financial decision, do your homework first. Find out what providers in your area are on the plan and what procedures are covered. Make sure that costs and benefits add up to a net plus for your particular situation.
What discount plans offer
Dental discount plans differ in several ways from dental insurance plans:
• Discount plans generally cost less than traditional dental insurance.
• You have to pay for the service in full, or negotiate a payment plan with the provider. And "you are not going to get a reimbursement for any portion of the procedures that they have done," says Ireland.
• There is no claim paperwork to fill out, since there is no reimbursement.
• There are generally no restrictions on how many procedures you can get at a discounted price in a given year. Insurance, however, typically limits coverage to about $1,200 to $1,500 annually.
• Discount plans generally run for one year, so you can switch plans as your needs change. If you have a dentist already, you should ask whether he or she will accept the plan. Otherwise, you'll need to find a provider who does.
• A number of discount dental plans include elective services, which are often not covered by insurance plans. Cosmetic dentistry, for example, is almost always excluded by insurance, but cosmetic procedures like tooth whitening are included in many discount plans' schedules of services.
• Discount plans may throw in freebies. "Many come packaged with vision plans, hearing plans or chiropractic plans," says Johnson.
For Tabbi, the advantages of the dental plan are big, so big that she is leading seminars in senior housing centers in her town for others who want a less-costly way to take care of their teeth. The greatest thing about belonging to a discount dental plan, she explains, has been having access to a fee schedule so she knows what every procedure will cost. "There are no surprises," she says.
Tamara E. Holmes is a Maryland-based journalist who writes about health, wealth and careers.
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