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The Dental Care Shortfall for Older Adults

Aging teeth and gums can lead to big dental bills, ones that aren't often covered by Medicare

Dentist pointing to the dental x-ray on a screen while patient in the chair watches.

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En español | When Jo Calk, 70, of Lincoln City, Ore., broke a tooth last year, she never considered seeing a dentist. Instead, she took matters into her own hands. “The sharp points of the still-intact metal fillings were painfully ripping into my tongue, so I borrowed a diamond file from a friend and sawed off the edges,” she says. “At least it doesn’t poke me anymore.”

Like many seniors, Calk says she had to give up dental care in order to get by on her fixed income. If you’re over age 65, maybe you can relate. In surveys, more than half of older Americans say they have not been to the dentist in the past year, and they cite cost as the top reason. 

Calk went to the dentist faithfully twice a year for most of her adult life, when she was covered by employer-sponsored health insurance. She says she was shocked when she retired and learned she had to start paying those costs herself. She gave up going to the dentist about a year after she retired, when she realized she was going through her savings too quickly.

Medicare has never covered most routine dental care, and Medicaid offers extremely limited coverage that varies by state. A few Medicare Advantage plans do offer dental benefits, but most don’t even come close to covering the cost of expensive procedures such as root canals, gum surgery and implants. 

The unfortunate irony is that older Americans lose their dental coverage precisely at the time when they need it most. Aging takes a toll on teeth. Gum tissue naturally recedes as you age, exposing roots to decay, and a lifetime of crunching and grinding wears away tooth enamel. In addition, many medications cause dry mouth, which raises your risk of gum disease, tooth decay and infection.

About 1 in 5 Americans age 65 or older have untreated cavities, and 2 in 3 have gum disease, according to the National Center for Health Statistics.

Forgoing dental care can have serious long-term consequences, says Stephen Shuman, a dentist at the University of Minnesota School of Dentistry who leads the Gerontological Society of America’s oral health group. Poor oral health affects your ability to speak, eat healthy foods and feel confident in how you look. More importantly, perhaps, taking good care of your teeth can decrease your risk of serious problems such as heart attack, stroke and poorly controlled diabetes.

Amber Willink, a health services researcher at Johns Hopkins Bloomberg School of Public Health, has analyzed the economic impacts of the lack of dental coverage for seniors. She says putting off care will likely cost you money — and pain — down the road.  “Chances are, you are going to end up in the ER in absolute pain or dealing with an infection,” she says.


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How to hold on to your smile on a budget

Before giving up on dental care altogether, consider the following cost-cutting strategies:

Ask for a discount 

If your dentist recommends a particularly expensive treatment, negotiate on cost before you get the work done. Many dentists will reduce your bill if you pay up front, says Matt Messina, a spokesperson for the American Dental Association. He recommends being honest with your dentist about your financial situation: “Have a thorough exam and have us put a plan together for you. Or we may be able to treat you in steps and phases so you have time to save up.”

Visit a dental school clinic 

Dental students, supervised by a licensed dentist, get hands-on experience, and you save 20 to 70 percent off most procedures. Search for a program in your area on the American Dental Association website.

See a dental hygienist

Forty-two states now allow dental hygienists to treat patients without the specific authorization or presence of a dentist, and the cost savings can be significant. Check the specifics of how and what they can treat in your state.

Use free or low-cost dental providers 

Some nonprofits and government-funded health clinics provide free or reduced-cost dental services (often based on income). Their services are in high demand, so expect a wait. Your local health department or United Way can connect you to programs in your area. Or try the Find Care tool at ToothWisdom.org, a nonprofit dedicated to connecting people to affordable dental clinics.

Sign up for a dental savings plan 

These non-insurance dental plans negotiate discounts of from 10 to 60 percent on dental costs. You pay a small monthly fee to join, and you get the discounts as long as you use a dentist that accepts the plan. Search for plans in your area at DentalPlans.com

Shop around

Prices for dental services can vary by hundreds of dollars, even in the same community. Look up average prices in your area at FAIR Health, a national nonprofit dedicated to bringing transparency to health costs, and then call a few dentists for quotes. If you live in a community with a high cost of living, driving to a less expensive area can boost your savings.

Search for coupons or deals

Some dentists offer specials for new customers on daily deal websites like Groupon or through direct-mail coupon packs. A typical deal may include an exam, cleaning and X-rays for $40 to $60, a fraction of the typical cost.   

Practice prevention

Taking care of your teeth daily — and yes, seeing a dentist on a regular basis — is the most cost-effective way to reduce your dental care costs. “The earlier we catch something, the less expensive it is,” Messina says. “The cheapest cavity is the one you never get, and the next cheapest is the one we catch early.” Seeing a dentist for regular cleanings and checkups can save you money in the long run — and it may just save your smile.

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