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Medicare Advantage Dental Benefits in Virginia

Did you know that nearly two-thirds of seniors have no dental benefits in Virginia? Lack of affordable dental care has been a longstanding problem for Americans over 65, who often don’t have employer-based medical insurance. Dental services are essential for seniors as they age since they are at risk for multiple dental health problems, yet they’re often the segment of the population without access to affordable care. With 10,000 people reaching age 65 each day, the number of seniors without dental coverage likely will increase.

While millions of seniors lack dental insurance, dental spending among this demographic is on the rise. Last year, over $28 billion was spent on dental services for seniors – and adults over 65 represent the highest growth rate in dental spending across all segments. The American Dental Association Health Policy Institute reported that in 2016, 6 million more seniors visited the dentist than in the previous decade.

Despite the fact that more seniors are visiting the dentist overall, those on Medicare are still lacking in dental benefits. The Kaiser Family Foundation reported that more than half of recipients didn’t see a dentist in 2016, and of those who did, 19% spent at least $1,000 out of pocket. The list below reveals some of the typical prices of dental procedures:

Checkups and Cleanings:

  • Basic exam–$50 to $100
  • Dental X-ray–$20 to $250
  • Standard cleaning–$70 to $200


  • Silver amalgam–$50 to $300
  • Composite–$90 to $450


  • Simple extraction–$75 to $450
  • Surgical extraction–$150 to $650
  • Wisdom tooth extraction–$75 to $3,000 based on the number and complexity of the extractions


The cost of a crown can range from $500 to $3,000 based on the type of material used.

Root Canals:

The cost of a root canal can range from $300 to $2,000 based on the location of the tooth and the complexity of the procedure.

What Dental Insurance Options Are Available for Seniors?

All Americans are automatically enrolled in Medicare once they reach age 65. Medicare is a nationally funded medical insurance program available for seniors and those who are permanently disabled. Enrollees receive a red, white, and blue ID card to present when receiving services. Medicare covers many routine medical procedures but does not cover dental care, including exams and cleanings. In fact, Medicare Part A coverage for dental treatment may only apply if the dental exam is necessary for another procedure, such as presurgical clearance.

With limited options for dental services through Medicare, many seniors are looking for affordable dental benefits in Virginia. Nearly a quarter of seniors will enroll in Medicare Advantage plans while 10% will opt for a traditional insurance plan.

What Is Medicare Advantage?

Completely optional and provided through a private company, Medicare Advantage plans supplement your existing Medicare coverage and offer expanded benefits. Enrollees will be able to select healthcare providers through a larger network, and they’ll also receive some price protection through low premiums, cost-sharing measures, and out-of-pocket maximums. Unlike traditional Medicare where the government reimburses healthcare expenses, Medicare Advantage purchases are reimbursed by the insurance provider. Popular Advantage supplement providers include Humana, UHC, and Aetna.

These plans often provide benefits for vision and medication as well. Advantage plan participants receive an ID card similar to those provided with insurance programs. They’re also quite affordable – the average cost of a Advantage plan in 2018 was approximately $420 annually. It’s important to note that most dental benefits included with Advantage plans are limited to cleanings, dental exams, and other diagnostic services. More complicated treatment like surgeries and restorations may not be covered – a comprehensive standalone plan may be a smarter choice if your dental health problems are extensive.

Is Standalone Dental Insurance Necessary?

Standalone dental insurance plans are a good option for seniors desiring more comprehensive dental benefits in Virginia. Insurance companies provide standalone plans, which are usually available with different levels of coverage. The premiums you pay and the amount of coinsurance or copay costs will depend on the type of plan selected. Here are examples of popular plans:


Preventive care and diagnostic treatment, including X-rays, exams and cleanings, are often covered under a basic plan.


These plans offer more enhanced coverage, including specialized X-rays, inhalation sedation, orthodontics, and emergency dentistry. The plans also may cover dentures, fillings, and other restorations.


A premium plan offers the highest level of coverage, including partial to total coverage for advanced dental treatment like surgeries and complicated restorations. If you’ll require extensive dental treatment to restore your smile, a premium plan may be right for you. Services often covered under a premium plan include:

  • Inlays and onlays
  • Dental crowns
  • Endodontic treatment
  • Oral surgery
  • Full and partial dentures
  • Periodontal procedures

Many private plans utilize a “100-80-50” tiered system for dental coverage, meaning most routine services are covered at 100%, basic treatment is covered at 80%, and more complicated treatment is covered at 50%. According to Bankrate, the average cost of private dental plans is approximately $350, which is slightly lower than Medicare Advantage programs. However, a private insurance plan won’t include the additional hearing, prescription or vision benefits.

Are Dental Discount Plans a Good Alternative to Insurance?

Offered by private companies just like standalone insurance plans, discount plans can help you save on dental costs; but, it’s important to remember that they are not insurance. Instead of paying premiums each month, dental discount plan members will pay a monthly fee and an enrollment charge when signing up. Discount plan companies negotiate lower fees with dental practices and then pass the savings to customers. You’ll present your discount card at the time of service and pay the dentist directly.

Discount plans offer several benefits over traditional insurance, including:

  • No copays, coinsurance costs, or deductibles
  • No waiting period before receiving services
  • You can change dentists at any time
  • There are no limits to dental appointments – visit as often as you wish
  • With no claims to file, there are no forms to fill out
  • Unlike insurance, dental discount providers do not have exclusions for preexisting conditions or age limits

While an insurance plan may have more comprehensive coverage, discount plans are a great way to save on routine services. Some of the discounted procedures include:

  • Dental examinations
  • Teeth cleaning
  • X-rays
  • Teeth extractions
  • Some restorations, including dental crowns and fillings
  • Root canals

One popular dental discount provider is DentRite®, which offers savings at vision centers, hearing aid providers, and more. Generally, those in good dental health who will only require dental exams and cleanings are good candidates for a discount program. If you will require extensive dental work, private insurance may be a better option. Contact our office if you have questions.

How Can I Manage My Dental Expenses?

Keeping dental costs manageable is a concern for many seniors, and dental payment options can make large expenses more budget-friendly. One example, CareCredit, is accepted at more than 200,000 healthcare providers throughout the country. Many payment arrangements offer interest-free, short-term financing and long-term financing for larger expenses. Long-term financing can be up to 60 months. While a payment option may make sense if you’re unable to pay the full balance upfront, financing does have some disadvantages to consider:

  • Like any form of credit, there’s an application process – not every person will be accepted.
  • Some payment options have interest rates between 15% and 20%, contributing to the total cost of care.

Still have questions about Medicare supplements, discount plans, or flexible financing? We recommend contacting your local seniors’ organization or the AARP, which will have resources about medical services. You can also contact our office if you have questions – we’re always here to help!

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