New Year... New “Insurance”
By Bill Kuttler, DDS
January 14, 2019

While daily news continues the debate regarding health care and medical insurance options, for a variety of reasons, as the calendar is ready to turn to a new page, we get more calls pertaining to dental benefit plan selection, i.e. what some people call “dental insurance."  

When an employer has purchased a plan that provides dental coverage for you and/or your entire family, it is usually a great deal for you.  You are gaining a benefit that is usually tax free and that helps pay for dental services at a reduced cost for you.  In most cases, that qualifies as a “no brainer” – take it!

However, when you either are asked to pay for the company plan yourself or you decide to shop for coverage on your own, that may be a very different situation.  I would suggest that you then need to be asking a series of focused questions before making a purchase.  What’s the difference?  Company plans are based on a large number of individuals, many of whom either won’t use the plan or have minimal needs.  In that case, those premium dollars help cover the people who have significant issues that involve much more expense.  As long as your premium costs are low, you win!

If you are looking to purchase an individual plan, the insuring company can probably assume a few things: You’ll use the plan by having regular visits to your dentist, and that you probably have a history of significant dental expenses (otherwise why would you be looking to purchase the coverage?)  Therefore, your premium will probably be significant, and your benefits may well be fairly limited.  That’s why you need to ask the following questions:

  • How much is the monthly premium?
  • Does it just cover you or does it also cover your entire family -- and how is the term “family” defined?
  • What is the annual maximum benefit -- either for each person that is covered or for the entire covered “family” if that’s who the plan is for?
  • What is the annual deductible and again, is it for each person covered or for the “family”?
  • Is it a graduated plan?  By that I mean will it provide more benefits and / or higher payments in the second year than the first, etc.?
  • Is there a waiting period before you receive any coverage other than preventive or basic services and, if so, how long is it?
  • Can you continue to see your current dentist without incurring any financial penalties?
  • Is the coverage different for IN network dentists versus OUT of network dentists?  (This question is very similar to the previous one, but the answers may be different.)  If the coverage IS different, which category does your current dentist fit into?
  • What percentages are paid for the following different types of treatment:
  • Diagnostic services such as examinations and x-rays?
  • Preventive services such as cleanings?
  • Minor restorative services such as tooth-colored fillings?
  • Major restorative services such as crowns and replacing missing teeth with either fixed bridges, partial dentures, or implants?
  • Is there a pre-existing exclusion clause.  For instance, if you are already missing a tooth, will the plan cover the replacement costs or deny them based on the fact that you were missing it before the coverage began?

Once you have the answers to those questions, you can begin to make an informed decision about whether or not you want to purchase the plan.  Some of the variables may be how great is your risk of needing significant treatment and will that type of treatment be covered?  If you are a current patient of ours, you could ask us for some approximate fees for treatment you are considering and compare those fees to the coverage you would receive.  If you aren’t, you could ask your existing dentist.  If you have generally gone to your dentist every six months, and you’ve had very few problems, then compare the cost of those two visits to what your premium would be and how much the deductible is.  Your decision might suddenly be very obvious!

In general I’ve advised most people to investigate a health savings account (HSA) if they qualify for it.  Most of the time if they deposit the amount of the premiums in it, over the years they are likely to come out way ahead.  Even if they don’t qualify for an HSA, most people could probably open a “dental savings account” and still be ahead.

Of course every situation is different, but asking the right questions may save you a large amount of money and hassle.  Good luck with the process.  HAPPY 2019!

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