As always, that depends. However, in general, if you happen to be 40 plus
years of age, and you visit your friendly Dental Professional after an
extended sabbatical from your last visit, then chances are they will likely
find a considerable amount of work to be done, that of course could be
quite costly! A real dental plan, not a discount plan, can make those out-of-
pocket (OOP) expenses much more palatable. For the most part, I will
always recommend the “Delta Dental” direct with Delta at only $30.90
monthly per adult. By far, this plan offers the most “bang for the buck!”
Covers up to $2K in annual covered expenses, pays 80% on any covered
“basic” services after 6 months, and 50% of any “major” services after a 1-
Year wait. Of course, you get your “free cleanings” right away, and up to 2
times annually. One very important point, if it’s really been a while since
your last visit, then a more aggressive cleaning such as a “deep cleaning”
may be needed. This “deep” cleaning will NOT be a covered expense.
However, you should receive the “discounted rate” that will help curb your
OOP expense if you are visiting an IN-Network dentist. Here’s the bottom-
line, dental plans are not designed to cover everything, and it’s always
good to know how to best utilize your dental plan.
3 Key Points to remember:
- Always get a pre-authorization if possible.
- Make certain that your cleanings are scheduled for a
minimum 6 months apart. - Make sure the X-Rays they always love to do, are actually
covered under the “timeframe” that Delta (or your plan) lays out in
your benefits schedule.
The above recommendations are not always feasible, particularly if
you need an emergency root canal and are in severe pain. However, a
potential crown that is non-emergency, a pre-authorization is highly
recommended. As to the x-rays they always love to do, my general rule of thumb, if you are in pain, and that’s why you are there, then I believe they have the right to run the x-rays and may result in some additional OOP expense. Sometimes you just have to grin and bear it.
Other important points to keep in mind:
Yes, there are waiting periods on most “Individual” dental plans as
compared to a lot of “Group” plans. However, your “Individual” plan is
not tied to any job, and so therefore you don’t need to start over every
time you change jobs.
“Immediate services” plans are certainly available. These are plans
that pay out limited benefits more immediately with no actual waiting
periods. However, you will pay a considerable higher monthly
premium for those plans, and you just might wound up paying more in
the long run!? In general, I do not recommend this type of plan.
Kids are covered for Free under the ACA-ObamaCare plans. Ages 0-
18 kids are covered at zero monthly premium cost and have unlimited
benefits. If you have children that are on a Blue Cross plan, this is
something you need to take advantage of. Just shoot me an email if
you need the details on the “Pediatric Dental” program that Blue
Cross has imbedded in all their ACA plans. ALWAYS stay In-Network whenever possible. This way you will get your maximum discounts and reduce your OOP expenses. Delta Dental has now waived the $10 Application Fee. Also, you only
pay for the first month’s premium.
So, to sum it all up, yes, a dental plan can be well worth it and to your
financial advantage when properly utilized. I generally look at it like this,
my two free cleanings just about pay for the annual premium cost. So, if I
need a filling, or a crown, or worse yet a root canal at any time in my future, then it’s really nice to know I’ve got a plan that helps defray these potential
expenses considerably.
This is a new addition to the “What the Health?” newsletter that I will try to
keep brief and to the point. Hopefully, this may help shed a little light on a
somewhat complex health insurance world