Dental coverage options for seniors said lacking
Maintaining oral health often requires planning, prioritizing in retirement
Erica BullockMarch 2nd, 2023
Some dental professionals here say many of their patients over 65 have prioritized oral health for much of their lives, but maintaining oral health in retirement becomes a challenge for those who must pay out of pocket for care.
Currently, retirees have limited options available to help pay for dental visits and treatment, says Dr. Rob Pinon, owner of Pinon PLLC, which does business as Lakeside Dental, in Greenacres.
Pinon says Lakeside Dental is a private dental practice that accepts both Medicaid and Medicare and also offers information about financing dental treatment through companies such as Sunnyvale, California-based LendingClub Corp.; Plantation, Florida-based Dentalplans.com; and Costa Mesa, California-based CareCredit.
Medicare, the federal health insurance program for those 65 years old and older and some younger people with disabilities, doesn’t cover most dental care, including cleanings, fillings, tooth extractions, dentures, dental plates, or other dental devices.
Medicaid provides health coverage to low-income individuals through the state and federal government. According to its website, most states provide emergency dental services for adults, but less than half of states provide comprehensive dental care.
Josh Cochran, founder of Spokane-based Dr. C Dental Partners, says, “Cost is by far the number one barrier of older adults seeking dental care.”
Data provided by the Arcora Foundation, a Seattle nonprofit formed by Delta Dental of Washington, states that more than 580,000 Washington state adults over 65 indicated they didn’t have dental insurance in 2020, and about 12% of adults over 65 reported not getting needed dental care in 2021.
Cochran says there are statewide and local efforts to increase retirees’ access to dental care and to reduce the financial burden of treatment.
Cochran says, “Most dentists around this area in Spokane County and Kootenai County … offer some sort of membership plan, and that’s a great way for folks to save money.”
He says some other options seniors have to pay for dental care include purchasing independent dental insurance plans, flexible spending accounts, and health savings accounts.
Retirees here also can get limited and discounted dental treatment through public health clinics, such as CHAS Health and Eastern Washington University’s dental hygiene clinic.
To maintain access to dental care in retirement, financially independent seniors need to save and plan for dental expenses just as they would save for medical expenses, Cochran explains.
Sheila Fritts, marketing director at Fairwood Retirement Village, says it’s common for residents at Fairwood not to have any dental coverage and to pay out of pocket for dental care. As a result, those older adults tend to be conservative in their treatment plans, she says.
“I don’t know of a single resident that has the coverage they need to get dental treatment,” Fritts says. “It’s almost the same as planning for retirement that you have to account for the fact that you’ll be paying out of pocket for a lot of things.”
Even though some retirees will struggle to pay for routine or unexpected—and often expensive—dental treatment, Fritts says many of Fairwood’s residents’ dental visits are to maintain good oral health.
Fairwood residents Barbara Hooper, 85, and Margaret “Mogie” Sabine, 81, agree and both say they had routine dental visits growing up and prioritized oral health from a young age.
Hooper says, “I grew up where it was habitual to always visit the dentist, at least for cleanings as a kid, twice a year.”
As retirees, both women say they’re still taking good care of their dental hygiene and will seek discounts with dental clinics or pay in cash for dental visits because dental insurance premiums are too expensive.
Sabine says, “I’ve never had dental insurance, I’ve always just paid for it, but I’m one of those lucky people that have never had a root canal type of problem.”
Pinon, of Lakeside Dental, says seniors comprise about 20% of his patients, and he expects their numbers will continue climbing as people move to the region to retire.
Cochran estimates that a third of his patients are over 65 years old.
“We see seniors who come in regularly and we’re able to serve them and they’re living great, active retirements,” he says. “We see the people who come in sporadically, and sometimes we’re able to help them and sometimes we’re not.”
When the practice isn’t able to help, the primary reason is financial, he says. “They don’t have a system to help them afford it.”
Both Cochran and Pinon say there currently is no dental specialty to treat seniors. Cochran adds that, until funding is made available for older adults to pay for their dental care, there likely won’t be any specialized services for retirees.
He says, if advocates within the dental industry can get funding for a geriatric specialty, then services will be created for that demographic.
Cochran says he’s aware of two dental advocates, the Washington state Dental Association and the Arcora Foundation.
“There’s Arcora … they’re an advocacy group that provides money, but they’re not going to be able to fund dental care for seniors,” he says. “They can just fund small projects and move our industry to increase awareness.”
Additionally, Cochran says that paying for treatment is the biggest challenge to care for retirees, but besides costs, there are other barriers older adults face when seeking dental care, including transportation and a lack of a centralized records database for the entire health care industry.
Cochran also notes that the dental industry only has enough dentists to meet the local demand, which comes from half of the general population. He says increasing access is the ultimate goal, but if the other half of the population suddenly started to seek dental care, there wouldn’t be enough dentists to meet their needs.
Currently, there also is a shortage of dental hygienists, dental assistants, and administrative employees.
“We have enough dentists, but we don’t have enough team members in those three areas to provide care to the current people who are going to the dentist,” Cochran says. “We know that if we’re seeing this many people who don’t have the means, what about the 50% of people who aren’t coming in? I suspect a large percentage of those don’t have the means either.”