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Dental Coverage for Seniors in Alberta

dental coverage for seniors in alberta

In the case of most adults, their income streams may become limited after retirement. This change in their financial situation may affect their capacity to pay for specific amenities like healthcare services.

In particular, oral care is an essential aspect of an older adult’s health that must be treated with utmost importance. However, being unable to pay for basic dental services can affect the oral health and, by extension, the overall well-being of older persons.

Fortunately, the government of Alberta has taken steps to oversee the welfare of older adults, founding the Dental and Optical Assistance for Seniors programs for their support. The Dental Assistance for Seniors was created to fund the dental coverage for seniors in Alberta.

At Seasons Retirement, we encourage our residents to take up an excellent oral hygiene routine, care for their dental necessities, and visit their physicians regularly to maintain excellent oral health.

This piece will go over the details of the Dental Assistance for Seniors program, the essential services it covers, eligibility requirements, and how to enjoy the benefits.

Dental Assistance for Seniors

In Alberta, older adults are offered assistance to pay for certain services that help improve and maintain their dental health. Eligible candidates are provided up to $5,000 of dental coverage, renewed every five years.

It is worth noting that this dental benefit doesn’t accumulate. If the $5,000 is not completely expended over the five years, the remaining funds will not carry over into the next 5-year period.

Dental coverage for seniors is based on a Dental Assistance for Seniors Program Fee Schedule, which specifies the maximum coverage fee and the frequency of coverage for eligible dental services.

Before receiving a dental service or treatment, your loved one needs to ask their service provider to tender a pre-authorization – also called a cost estimate – to the Alberta Dental Service Corporation. This is done to confirm whether the needed service falls under the dental program and determine its cost.

Below are some of the basic dental services covered by the Dental Assistance for Seniors in Alberta:

  • Diagnostic services (examinations and x-ray scans)
  • Restorative procedures (fillings, trauma, pain control)
  • Preventive processes (polishing and scaling)
  • Tooth extractions
  • Root canals
  • Treatment for gum diseases (periodontics, root planing)
  • Dentures (replaceable prosthodontics, full and partial primary dentures)

Also, certain dental services are not covered by this program, and they include:

  • Dental crowns
  • Fixed dental bridges
  • Dental reconstruction (braces and orthodontics)
  • Dental implants
  • Fluoride treatment
  • Teeth whitening and cosmetic procedures
  • Inlays and Onlays (gold or gems)

If an older adult is charged more than the program can cover by their dental health providers, they must settle the outstanding payment on their own.

Frequency Limitations

As mentioned earlier, the number of times your older loved one can use the Dental Assistance for Seniors program for specific dental services is stated in the fee schedule.

That said, an older adult can continue receiving dental services from their dental health supplier, even after exceeding the times specified under the fee schedule. However, the older person will have to cover the costs upon receiving these services.

Eligibility Requirements for Dental Assistance for Seniors

As with other government benefits, dental coverage for seniors in Alberta has specific requirements that older adults must meet to qualify. These eligibility criteria include:

  • They must be at least 65 years of age.
  • They must currently live in Alberta and have lived for a minimum of three months before applying.
  • The older adult must be a citizen of Canada or a permanent resident of the country.
  • They must have submitted a filled Seniors Financial Assistance programs application form.
  • Their annual income must fall within the program’s limits.

Income Requirements

To qualify for full dental coverage, a single older adult’s annual income must be between $0 and $29,285. If their yearly income falls between $29,286 and $31,675, they will get partial coverage for their dental services. Any single older person with an annual income above $31,675 will not be eligible for dental assistance in Alberta.

For couples, their annual household income must fall within $0 and $58,570 to enjoy maximum dental coverage. They will get partial dental coverage if their yearly income is between $58,571 and $63,350. Finally, a couple who earns over $63,350 yearly is not qualified for dental assistance in Alberta.

3 Steps To Submit Dental Claim in Alberta

To receive Alberta health seniors’ dental benefits, your older loved one must file dental claims and submit them to the Alberta Dental Service Corporation. The following are steps to claim dental assistance:

1.    Speak to the dental service provider

When your older relative visits a dental clinic, they will need to tender their Alberta health card and inform the dental provider that they are an eligible candidate for the Alberta seniors benefit dental coverage.

The dental service provider is expected to confirm your loved one’s eligibility by submitting a pre-authorization to the Alberta Dental Services Corporation.

2.    Payment for services

After confirming your loved one’s eligibility, the dental provider can bill directly or submit a claim to the benefits administrator directly.

If direct billing is available at the dental clinic, your older one will only have to pay for the cost of services not covered by the program.

3.    Submit a reimbursement claim

If their dental service provider doesn’t accept the direct billing method, your loved one may have to pay the total cost of all services. In this case, they can submit a complete claim form containing their personal health number for reimbursement.

Patients must submit all dental claims to the Alberta Dental Services Corporation within a year of incurring the dental expenses.

Out-of-province or Out-of-country Claim

Note that all services under the Alberta blue cross dental coverage for seniors must be performed by a local dental health provider in the province. So, if an older adult receives dental services outside Alberta or Canada, there’ll be no payment reimbursement, even after submitting a reimbursement claim form.

Conclusion

The government of Alberta has made provisions for funding the oral care of older adults in the province. The dental coverage for seniors in Alberta allows older adults to enjoy a post-retirement life free of financial troubles and health worries.

Your parents and grandparents can find satisfaction and a place to call home in our retirement communities in Alberta. We offer a range of senior living options to older adults.

Discover Life at Seasons. Book a Personal Visit Today.