Garden State Dental of Toms River
1200 Hooper Avenue, Toms River, NJ 08753
When you reach age 65 or you meet other conditions, you’ll be given Medicare as your medical insurance. You are automatically enrolled when you apply for Social Security benefits. Medicare is the national health insurance program administered by the Centers for Medicare and Medicaid Services. Medicare Part A covers inpatient expenses while Part B covers outpatient medical services, such as doctor visits. Part A and Part B are known as Original Medicare. Original Medicare does not offer dental benefits unless you have a medically necessary reason to have dental work done, such as an oral exam before an organ transplant. For many retired individuals, this leaves them without the coverage they need for dental expenses.
Seniors have special dental needs which makes coverage essential. Common problems retirees experience include tooth loss, gum disease and ill-fitting dentures because of bone loss. These problems can make it difficult to eat or socialize, affecting their health and quality of life. Senior citizens who are Medicare beneficiaries have several options to receive dental benefits in Toms River, including purchasing a Medicare Advantage plan, considering a discount plan or buying private dental insurance. For more information, call us today.
When you become eligible for Medicare, you’ll be able to choose one of the Medicare Advantage plans, also called Medicare Part C. The plans offer at least the same benefits as Medicare, although they may offer supplemental benefits. Private companies approved by Medicare offer the Medicare Advantage plans. When you subscribe to one of these plans, the insurer will replace your Medicare Part A and Medicare Part B and give you a new card to access services. They may also offer dental, hearing and vision benefits. Most also offer prescription drug benefits. Dental coverage varies among plans; some may cover preventative care only while plans with higher premiums may include basic restoration services, such as fillings and dentures. Typically, there is a cap on benefits you can receive each tear.
According to the Kaiser Family Foundation, 34 percent of Medicare beneficiaries choose Medicare Advantage coverage. The majority of seniors choose UnitedHealthcare, Humana and BCBS, which are Blue Cross and Blue Shield affiliates, plans. In return for lower Medicare Advantage monthly premiums, plans usually have higher deductibles and limit your choice of doctors and hospitals. Even if your doctor accepts Original Medicare, it does not guarantee they will accept your Medicare Advantage plan. Nearly everyone age 65 or older has access to at least one HMO or local PPO plan and many have access to multiple plans.
For more comprehensive dental benefits in Toms River, consider buying standalone dental insurance from a private company, broker or agent. While benefits vary, most plans make it easy for you to get the preventative care you need to maintain your dental health. Many plans follow a 100-80-50 policy. Preventative care is 100 percent covered, basic services, such as fillings, have 80 percent coverage, and plans offer 50 percent coverage for more expensive procedures, such as getting a crown. Insurance plans will ask you to pay coinsurance or copay after you reach your deductible. Coinsurance is a fixed percentage you pay for treatment while co-pays are a fixed dollar amount you pay for each service. Your deductible is the amount you must pay out of pocket before your coverage kicks in. Most insurance companies don’t make you pay for routine procedures that are 100% covered, so they don’t count towards your deductible.
When choosing your plan, consider your choice of dentists, your out-of-pocket expenses, and how the company pays for your care. Some allow dentists to file claims on your behalf while others expect you to pay upfront and they will reimburse you. Also, consider your oral health when selecting a dental plan. Typically, you can expect more coverage from higher-priced policies. For example:
Basic insurance will cover routine exams, x-rays and dental cleanings. If you’re in excellent dental health, basic plans offer the ideal way to manage routine dental costs. Your dentist can catch problems early, when they are inexpensive to treat.
Mid-priced plans typically partially cover fillings and other services, including orthodontic work, anesthesia, and root canals. These plans offer the most benefit to individuals with average dental health who don’t want occasional dental issues to break their budget.
Premium plans may cover dentures, onlays, gum disease treatment and oral surgery,among other things. These plans are good for people with poor oral health who need help to manage their significant dental care costs. Very rarely will premium plans offer coverage for cosmetic dental work, such as teeth whitening.
Insurance companies offer Dental Health Maintenance Organization plans, Preferred Provider Organization plans and Fee-for-Service plans, DHMO are the most affordable, but you must choose one dentist in the network and see him or her for referrals to specialists.
Private companies sell plans offering a discount on dental services. Discount plans are not insurance; they offer a straightforward discount on services. Everyone is accepted as long as they pay a small enrollment fee and their affordable monthly or annual membership fee. You’ll visit a dentist who accepts your discount plan and pay the discounted fee. You can change dentists at any time. There are no claim forms or waits for reimbursement.
Dental savings plans, or discount plans, have several advantages over insurance for dental care and Medicare Advantage options. These include:
Typically, discount plans let you save on:
If you choose DentRite® or a similar discount plan, you may have prescription drug, vision and hearing discounts included with your annual fee. You would have to visit participating providers to use your discount. For example, DentRite® offers discounts on eye exams, glass and contact lenses and LASIK vision correction. They also offer discounts on prescription drugs which can be beneficial to seniors who do not have Medicare Part D or an Advantage plan which includes Medicare Part D benefits.
Many dental practices offer financing options and payment plans for seniors and their other patients. Popular dental credit companies, such as CareCredit, offer short-tern financing for unexpected expenses. Everyone may not qualify for financing and the interest rates will vary. CareCredit usually runs promotions where you pay no interest for several months as long as you make the monthly payment. If patients cannot pay off the balance during the promotional period, normal interest rates will apply. This will add to the total cost of care.
AARP and other senior organizations frequently offer discounts on insurance, discount plans and more. Dental benefits in Toms River are important for retired persons as there’s no age limit on wanting a nice smile.