Dental Insurance for Seniors in California

Posted: January 17, 2024

As an older adult, you face increasing odds of developing dental issues like gum disease and tooth decay. Your likelihood of requiring implants or dentures is also higher, so you need a dental insurance plan that caters to these changes. Dental insurance plans for seniors in California are designed to meet your unique needs.

Various options are available to you, from Medicare to dental discount plans and independent providers. One example of these providers is Blue Shield of California, which has been providing the state’s residents with health insurance since 1939. Health for California can help you find the right dental plan if you are a senior looking for new dental insurance coverage.

The Importance of Dental Insurance for Seniors

Growing up, our parents always told us to take care of our teeth, and these words of wisdom still ring true for us in retirement age. Dental coverage makes regular oral care affordable and encourages seniors to take preventive and proactive steps needed for their overall wellness. It is especially helpful in emergencies for painful tooth conditions or for loose or lost teeth. Common dental concerns for older adults include:

• Age-related dental issues: Tooth decay, gum disease and dry mouth are common complaints among older adults. Insurance helps cover treatments for these issues.
• Overall health: Research suggests that poor oral health may be linked to many systemic conditions, including heart disease, stroke and diabetes. Thanks to insurance, getting preventive care helps you control your health better.
• Financial benefits: Dental procedures can be expensive. Dental insurance gives you peace of mind, knowing you can go to the dentist when needed without taking on extra financial strain.
• Dentures: Insurance often provides denture coverage for seniors to restore their appearance and let them eat in comfort.

Which Dental Plan to Choose

Seniors are free to choose whichever dental plan best fits their unique needs. For example, if you wish to visit the same dentist you’ve seen for several years, going with the PPO plan might offer the flexibility you need. On the other hand, if you’re looking for a dental plan on a budget, finding a provider in your area that accepts HMO plans might be worth the change. Consider these factors as you shop around for dental insurance:

• Network restrictions: Most plans will require you to use a dentist within their network to avoid higher costs or no coverage.
• Waiting periods: Some plans have waiting periods for certain procedures, often major services. Check these details before you enroll for coverage.
• Coverage limits: Annual maximum benefits are common practice, meaning you may pay out of pocket if these limits are low.
• Preventive care: Taking care of your teeth includes preventive care like exams and cleaning. Full coverage of these essentials can encourage you to undergo regular checkups, where dentists can detect potential issues early.

Dental Insurance for Seniors in California

You have endless choices for your dental coverage. From government programs to stand-alone options, it all depends on your needs and budget.

Medicare Advantage Plans

Private insurers offer Medicare Advantage Plans Part C with dental coverage. This ensures dental coverage in addition to the original Medicare benefits.

Your coverage will vary by plan but will typically include preventive services, such as cleanings, and basic procedures like fillings. Some plans cater to your needs by offering major procedures and denture coverage. Monthly premiums sit at around $18.50, depending on your level of coverage.

Stand-Alone Dental Insurance Plans

Stand-alone plans are separate from Medicare. They often offer similar coverage with deductibles, copays and coinsurance. These plans will also have an annual maximum benefit.

Dental Discount Plans

Dental discount plans are not dental insurance. They are membership programs that give patients discounts on dental services. These discounts only apply to dentists in a participating network. Membership fees are low, and your savings are only applied at the point of service.

Medicaid Dental Coverage

California’s Medicaid program offers various dental benefits for eligible low-income seniors. These plans cover services like exams, X-rays, cleanings, extractions, dentures and more. Premiums generally do not apply, and you may have low copays for dental services.

Blue Shield Senior Dental Plans

Blue Shield offers multiple dental plans through Health for California for seniors:

Dental Standard HMO

Health maintenance organization (HMO) plans are designed for predetermined dental costs and lower monthly insurance premiums. The dental standard HMO plan encourages preventive care and regular dentist visits for seniors, including diagnostic exams and X-rays, restorative procedures and denture services. It also has no deductible or annual maximum for services.

However, dental standard HMO plans work only with a list of preapproved providers, making choices more limited. You may also need a primary care provider’s referral to see a dental specialist. Use Blue Shield’s finder tool to discover dental standard HMO providers near you.

Enhanced Dental PPO 1500

A preferred provider organization (PPO) plan can have higher out-of-pocket costs with a deductible but provides a larger pool of dentists to choose from. Like with an HMO plan, PPOs do offer in-network dentists who can keep costs lower but still have the option to stray outside this list.

You may also be eligible to receive a partial reimbursement from out-of-network dentist services through filing a claim. There is no referral or PCP needed to receive specialist care. Use the PPO finder tool to find a covered dentist near you.

The Enhanced Dental PPO 1500 plan is one of Blue Shield’s most popular plans for individuals and families with predictable copays.

Enhanced Dental PPO 50/2000

Blue Shield offers the Enhanced Dental PPO 50/2000 plan, which covers dental procedures like exams, fillings and cleanings. This plan allows you to choose from a wider network of dentists with lower out-of-pocket costs. It has a $50 deductible for in-network dental procedures and a $2,000 annual maximum per member for both in-network and out-of-network dentists.

You get full coverage for network diagnostic and preventive services, 80% coverage for basic services like oral surgery and 50% coverage for major services like dentures, bridges and implants.

Contact Health for California Today

At Health for California, we understand how choosing a dental health care plan can be overwhelming — especially if it’s all new to you. Our team has ample experience in finding the right dental insurance for retired people and older adults. We aim to make the process of finding the perfect plan to cover what you need quick and easy.

Contact us for answers to your questions or to request a quote.