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SeniorDentalCareProgram If you are 65 or older and on a fixed income, you may be eligible for professional dental care at a reduced fee. PennsylvaniaDentalAssociation Pennsylvania Dental Association3501 North Front StreetP.O. Box 3341Harrisburg, PA 17105(717) 234-5941(717) 234-2186 (fax)www.padental.org A r e y o u 6 5 o r o l d e r ? o Y e s o N o N a m e___________________________________________ A d d r e s s_________________________________________ C i t y____________________ S t a t e_____ Z i p___________ P h o n e #________________________________________ T O T A L a n n u a l i n c o m e $___________________________ C u r r e n t d e n t i s t ’ s n a m e ( i f a p p l i c a b l e )________________________________________________ D o y o u h a v e : ( c h e c k a l l t h a t a p p l y ) o N a t u r a l T e e t h o P a r t i a l s o F u l l D e n t u r e s L i s t t h e d e n t a l w o r k y o u m a y n e e d t o h a v e d o n e .__________________________________________________ ____________________________________________________________________________________________________ M a r i t a l s t a t u s : o S i n g l e o M a r r i e d D o y o u h a v e a n y o t h e r d e n t a l i n s u r a n c e ? o Y e s o N o “ I c e r t i f y t h a t I d o m e e t t h e e l i g i b i l i t y r e q u i r e m e n t s s t a t e d w i t h i n a n d t h a t I a m n o t e l i g i b l e f o r d e n t a l t r e a t m e n t o n a p u b l i c a i d p r o g r a m o r p u b l i c i n s u r a n c e p l a n . ” S i g n a t u r e____________________________ D a t e___________________________________________________________ P l e a s e d e t a c h r e g i s t r a t i o n f o r m a n d m a i l t o : P e n n s y l v a n i a D e n t a l A s s o c i a t i o n - S e n i o r D e n t a l C a r e P r o g r a m – P . O . B o x 3 3 4 1 – H a r r i s b u r g , P A 1 7 1 0 5 r e v 1 1 0 9 Cmmns State Representative Jesse White Capitol offiCe: 102B East Wing ã P.O. Box 202046Harrisburg, PA 17120-2046 Phone: (717) 783-6437 ã Fax: (717) 780-4781 DiStRiCt offiCeS: Cecil: 3855 Millers Run Road P.O. Box 285 ã Cecil, PA 15321Phone: (724) 746-3677 ã Fax: (724) 746-3799 Burgettstown: 1425 Burgettstown Plaza #5Burgettstown, PA 15021 Phone: (724) 947-4422 ã Fax: (724) 947-5386 Canton Township: 2403 Jefferson Ave. ã Suite C Washington, PA 15301 Phone: (724) 222-4192 ã Fax: (724) 222-4194 WeBSite: www.pahouse.com/white SeniorSenior Dental Care Program? What types of dental care areavailable through this program? Participating dentists have agreed to reducetheir fees for all dental services. This includesexaminations, cleanings and all other dentalprocedures.Eligible people are encouraged to take advan-tage of the program for regular, preventive dentalcare. Regular dental care is necessary for everyone whether they have dentures or retain all or someof their natural teeth. Regular examinations are thebest way to prevent potential oral health problemsfrom developing. Who is eligible to receive carethrough the program? In order to be eligible, a patient must: n Be a Pennsylvania resident n Be 65 or older n Not be receiving federal, state or other dentalhealth assistance n Not have private dental insurance n Have a total annual household income of lessthan $14,500 for a single person, or less than$17,700 for a married couple. (All forms of income apply, i.e., Social Security, pension,black lung benefits, etc.) How do I fnd a participating dentist? Mail in the attached registration form orregister online at www.padental.org by click-ing on the patients link on the left side of the screen. If you have a current dentist, andhe/she is a participant in the PDA Senior Den-tal Care Program, you will be referred to thatdentist. If you do not already have a dentist, orif your current dentist does not participate inthe PDA Senior Dental Care Program, you willbe referred to a PDA member dentist in yourarea who participates in the program. You willreceive a letter with the dentist’s name, addressand telephone number. It is up to you to makethe appointment by calling the dentist’s office. Besure to tell the receptionist that you are a patientin the PDA Senior Dental Care Program. How much of a reduction will begranted? All dental fees differ, so reduced fees forpatients in the PDA Senior Dental Care Programalso will vary. However, all participating dentistshave agreed to offer a discount from their usualfee for patients who meet the program’s eligibility requirements. The minimum discount a patient canexpect is 15 percent. Doctors are not reimbursedfor their costs by the state or the PDA. Financialarrangements are handled privately between thepatient and the dentist. The amount of the discountand financial terms should be clearly understoodby the patient and discussed with the dentist priorto beginning treatment. What is the quality of dental care? You can expect the same standard of care andcourtesy that are part of the traditional dentist-patient relationship.Your oral health affects your entire life. Goodnutrition, clear speech and a pleasant appearanceare important to your physical and mental well-being. All depend on healthy teeth and gums.Your dentist’s goal is to help you keep yourteeth for your entire life. Even if you should lose your natural teeth, your mouth still needs regular,professional care.If you wear dentures, your dentist is the only person qualified to provide denture services.Professional training enables a dentist to evaluate your total oral health and its relationship to yourgeneral health. In addition to a broad medicalbackground, every dentist studies oral anatomy,facial structure, general and oral pathology, psy-chology and dental materials. All of his or herexperience is used to provide you with dentalservices. What is the The Senior Dental Care Program offers reduced cost dental care to eligible senior citizens by dentists who are members of the Pennsyl- vania Dental Association (PDA). More than 1,000 PDA members have volunteered to participate in this program. Pennsylvania Dental Association
