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Retirees Face Costly Dental Bills

By Bob Moos, The Dallas Morning News 

 

June 18, 2007

 

Dental dilemma

Peggy Meuljic, 63, was on a fixed income when she discovered she needed dentures, which were estimated to cost several thousand dollars. Through the Senior Source of Dallas , she found treatment she could afford.

 

Peggy Meuljic never worried about dental bills during her working life. Her employer covered most of them. Then she retired and discovered she was on her own. That was also about the time her dentist told her she needed dentures. 


"Let's just say I wasn't smiling," said the 63-year-old Dallas woman. 


Peggy Meuljic, 63, was on a fixed income when she discovered she needed dentures, which were estimated to cost several thousand dollars. Through the Senior Source of Dallas, she found treatment she could afford. Her only income was $800 a month from Social Security. The dentures were estimated to cost several thousand dollars. 


Like Ms. Meuljic, millions of seniors retire each year and lose their employer-provided dental insurance just when they most need it. Medicare doesn't cover routine dental care. Nor does Medicaid pay for adults' dental work in Texas and most other states. 


"The lack of public benefits comes as a shock to most people," said Linda Niessen, a professor of geriatric dentistry at the Baylor College of Dentistry in Dallas. One in five seniors can afford private insurance, but the rest pay out of pocket or put off dental visits, according to Oral Health America. "For someone on a fixed income, dental work can easily become too costly," said Robert Klaus, the advocacy group's president. 


Thanks to the Senior Source of Dallas, Ms. Meuljic found affordable care through a community dental program. The Community Dental Care clinic in East Dallas fitted her with dentures for $535, and she now pays only $25 per visit. 

Mr. Klaus predicts that older adults' dental needs will gain attention as tens of millions of boomers retire in the next 10 years. 
"This is the first generation to benefit from widespread fluoridation in water," he said. "They expect good dental care." 

Dr. Jason Frazier and dental assistant Rosa Bahrevar work on 85-year-old Delores Recovo’s teeth at an East Dallas community care clinic. Many seniors on low incomes turn to clinics such as this one for dental care. 

Still, the lack of public benefits requires older adults to be savvy about finding dental care that matches their budget, consumer advocates say. 
These are the options the experts recommend. 


Pre-retirement planning 
The first step for seniors is to get their teeth and gums in tiptop shape before retiring, said W. Mark Donald, a dentist and spokesman for the Academy of General Dentistry. Evidence is mounting that poor oral health can contribute to medical problems such as diabetes and heart disease. 

 

"Arrange for any major dental work before losing your employer-paid insurance," he said. "Talk with your dentist and schedule those bridges and crowns." Because many dental insurance plans limit benefits to $1,000 or $1,500 per year, Dr. Donald suggests starting several years before retirement.


Group insurance 
Group dental plans are available through credit unions, professional associations and, most recently, AARP. Health maintenance organizations and preferred-provider organizations are the most common kinds of dental insurance, said Evelyn Ireland, executive director of the Dallas-based National Association of Dental Plans. 

 

Dental HMOs are more affordable, she said. Out-of-pocket expenses usually are limited to set co-payments, and HMOs typically don't cap the care they pay for a year. But consumers often must stay within an HMO's network of providers, Ms. Ireland said. 


PPOs offer more flexibility, but at a price. Those plans typically pay 100 percent for preventive care, up to 80 percent for fillings and 50 percent for crowns and root canals, she said. Consumers who use dentists outside the network shoulder a bigger share of the cost. 

 

AARP has teamed with Delta Dental Insurance Co. to provide group dental insurance to AARP members in Texas and other states. Members may choose between two plans that help pay for most dental services immediately and the others after a 12-month waiting period. Monthly premiums in Texas run from $34.35 to $45.65, depending on the plan. 


Individual insurance 
People who don't buy a group insurance plan may purchase an individual policy, Ms. Ireland said. As the senior population grows and Internet marketing expands, more companies have jumped into the individual insurance market. Premiums for an individual are 11 percent to 25 percent higher than under group coverage, according to the National Association of Dental Plans. The trade group's Web site – www.nadp.org – contains a state-by-state listing of the companies that write individual coverage. 

 

Ms. Ireland advises shoppers to be on the lookout for any coverage exclusions. "If you've had an employer-sponsored plan, don't expect your new individual plan to cover the same services, at least not for the first year," she said. 


Discount plans 
These aren't insurance policies. The plans charge a monthly fee, usually $10 to $12 for an individual, and provide discounts on a range of dental procedures. 
Discount plan members still pay out of pocket for their dental work. "Before signing up, you should make sure your dentist accepts the discount plan you're considering," Dr. Niessen said. "A lot of dentists don't." 


Medicare Advantage plans 
Though traditional Medicare doesn't cover routine dental care, a growing array of private Medicare plans may. The private plans combine Medicare's basic benefits with additional health care coverage and, often, savings on dental work, hearing aids and eyeglasses. 

 

A Humana plan, for example, pays 75 percent of the cost for exams, cleanings and X-rays, 50 percent for extractions and 25 percent for fillings. The private plan's premium costs the same as traditional Medicare's – $93.50 a month. "It's another option for anyone 65 or older, though you should always read the fine print to see what's covered and what's not," Dr. Niessen said. 


Dental colleges 
Older adults make up a third of the 22,000 patients treated each year at the Baylor College of Dentistry, which is part of the Texas A&M Health Science Center. The Dallas dental school's clinics offer discounts on a broad range of dental services. The undergraduate clinic charges less than half of what private dentists do for some procedures. But the college screens prospective patients to make sure their dental needs suit its teaching needs, said Dean Hudson, associate dean for clinical affairs. 


Clinic patients should also expect the work to take longer than in a private dentist's office, he said, since students are under the watchful eye of faculty. The clinics have a loyal following. Ken Giddens, who's 75 and lives in West Tawakoni, has gone to the Baylor College of Dentistry for all his dental care since 1959. "It's been a good alternative to insurance," he said. "I may be in the chair for a few hours, but I usually get out of there with no more than a $60 bill." 


Community clinics 
Community dental programs also deliver low-cost and high-quality care to seniors on limited incomes. The largest in the Dallas area is Community Dental Care, funded largely with public and private charitable dollars. Older adults can make an appointment at six of its nine clinics. City of Dallas, Collin County and Garland residents 60 and older whose annual income is less than $20,420 (or $27,380 for couples) pay $25 per visit and, in a few cases, lab fees. 

 

Dental work

Dr. Jason Frazier and dental assistant Rosa Bahrevar work on 85-year-old Delores Recovo’s teeth at an East Dallas community care clinic. Many seniors on low incomes turn to clinics such as this one for dental care.


Other clinic patients, whose yearly income can't exceed $30,630 (or $41,070 for couples), pay about half of the rate at a private practice. The United Way agency treated 1,400 older adults last year, said executive director Paul Hoffmann. "Many of our seniors hadn't been to a dentist in 30 years," he said. "By the time they come to us, they often need major work, such as dentures." 


Donated dental services 

A final option for the uninsured is to apply for help through the Texas Dental Association's Smiles Foundation. The foundation's Donated Dental Services program uses volunteer dentists and labs to care for people who have to put next month's rent ahead of a bridge or crown.


Patients, who must be 55 or older or have a permanent disability, receive an average of $2,500 worth of treatment, said case manager Judith Gonzalez. "People without insurance will delay care until they can't bear the pain anymore," she said. "We try to spare them from that." 


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