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Real-life example · Dental & vision
James needs a crown: how the dental math works
Available under 65 and 65+
James, 69 · Original Medicare · second year with his dental policy
Original Medicare doesn’t cover routine dental care, so James has a dental policy. This year he has two cleanings at $120 each, then his dentist says he needs a crown that costs $1,200. His policy has a $100 yearly deductible and a $1,500 yearly maximum.
What happened
Follow the money
Cleanings: $240 total
Crown: $1,200
The year’s bottom line
Who paid James’s $1,440 in dental bills
The takeaway
Dental policies pay a percentage of each bill after a small yearly deductible: more for preventive care, less for bigger work like crowns. James still has $668 of his $1,500 yearly maximum left if something else comes up this year.
These are illustrative examples with made-up names. Dollar amounts come from one sample plan design and are shown only to explain how the benefits work. Your actual benefits depend on the plan and options you choose, your state, and the terms, limitations, exclusions and waiting periods in your policy.
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This page is educational and is not an offer of coverage or a recommendation of any specific policy. The policies described are individually underwritten supplemental (indemnity) insurance. They are not major medical coverage, not Medicare Supplement insurance, not long-term care insurance, and not “minimum essential coverage” under the Affordable Care Act. Benefits, benefit amounts, riders, availability and eligibility vary by state and are subject to the terms, limitations, exclusions, waiting periods and pre-existing condition provisions of the actual policy and its outline of coverage. Senior Benefits Hub is an independent insurance agency; licensed since 2013. Not affiliated with or endorsed by any government agency.