Dental and vision

[LinCella]

When I retire next month I lose my employer paid dental and vision. Has another considered either insurance? I'm just having an implant finished up so that's taken care of and then only "anticipate" cleanings twice a year. Vision is another matter as I'm diabetic and require a retinal specialist, not sure if this is covered under any vision insurance. I can continue with employer dental for $95 a month for two years but all I get is $1700 annually to cover whatever needs to be done. That $95 could give me immediate relief elsewhere.

Any thoughts would be appreciated.

 

[2B]

A retinal specialist is covered under your medical insurance. Glasses are not covered through medical so if they are prescribed by the retinal specialist you'd have to pay for them separately.

Our optomitrist charges a lower fee for people without insurance. They also run frequent sales on frames that vision insurance doesn't get. They pretty much showed me I was wasting my money on vision insurance without saying it.

On dental, you'd need to look at the coverage and what you get for the premium. Price negotiations would probably get you pretty much the same costs. For you, you'd be paying $1,140 annually to maybe save $560 if you need extensive dental work. Most years I just pay for two cleanings. Major work like crowns are rare.

I personally don't plan on having either form of insurance in retirement.

 

[mpeirce]

(Just got back from the dentist 15 minutes ago...)

Even when I was working I self insured our dental. It was more expensive to pay for the dental "plan" than to just pay directly for my wife and son's biannual cleanings and checkups.

Just make sure you have some money set aside for unexpected dental expenses that might come up.

 

[travelover]

Most here self insure for expenses that they can easily cover. That would include dental and optical care.

 

[W2R]

Like mpierce, I never had optical/dental insurance even when working. It just wouldn't pay off for me. And as travelover says, many of us (including me) self insure for these expenses in retirement. I had to have an implant this year too, but regard it as one of those unexpected infrequent expenses like having to replace the water heater or HVAC. It's always something.

Some additional thoughts are that (to me) it is also worth quite a bit to not have to deal with insurance companies at all or to get upset over their payouts or lack of same. But then, you may or may not feel that way.

My dentist gives me a hefty discount for not having insurance.

It might be worth checking to see if your regular medical insurance would cover your retinal specialist.

 

[RetiredAndFree]

Our dental plan is $25 a month per person for Delta Dental's premium plan, which gives us access to more dentists than their basic plan does. A monthly of $95 seems pretty high, so you might want to consider looking around for less expensive coverage.

I have fabulous health overall, but not in my mouth - I've been getting fillings since I was a young child, and those are now turning into crowns, root canals and worse (don't ask) now that I'm older. The value in having a dental plan to me, is that Delta negotiates the rate so I don't have to. I'm not at all confident that I'd be able to negotiate a better rate, and to be honest, I don't want to have to haggle with someone who's going to be putting needles in my mouth!

We have vision 'automatically' included with our medical premiums (via Kaiser), but if we did not, I'd likely self insure since those costs are far more predicable than dental is.

 

[Texas Proud]

Since you have had an implant, you can see that the amount paid by dental 'insurance' is pretty low...

I am paying $20K for my DW's teeth and the insurance is paying about $1.5K...

I paid $4K for my teeth and also got the same...

Paid $2K for wisdom teeth extraction for one kid... waiting to see what the insurance pays...

For me, this was the one year where they spent more than my premium... but this is only the first time it has happened...

I am thinking about continuing with ours in COBRA as they have not yet finished with my DW's implants....

 

[bamsphd]

We have had dental insurance through work and now through COBRA and have come out slightly ahead on dollars.

However, COBRA will expire next year. In my state two companies are offering Dental on healthcare.gov. My dentist is currently considering becoming a preferred provider with one of them. I'll talk to him at my appointment this Friday. If he has decided to join I'll probably sign up, because otherwise I'll be subject to waiting periods. If he is not joining, I may run out COBRA, but will then self insure.

The main advantage of dental insurance is the insurance company does the price negotiation. Given that the maximum yearly coverage is only $1,000/person on the plan I'm considering, I can certainly afford to self insure.

 

[ziggy29]

Dental and vision are rarely a good deal for folks who can afford to self-insure and who don't get employer-subsidized coverage. That said, if you know you have costly procedures like crowns and implants coming soon, it might be worth keeping COBRA until those procedures are performed and those claims have been paid.

 

[audreyh1]

Most here self insure for expenses that they can easily cover. That would include dental and optical care.

+1

 

[MRG]

Never paid for vision, dental was included when I w*rked. Went on COBRA when I retired this year and kept dental. The dental is a wash for me, it's premiums equal my 2 biannual cleanings, checkup and xrays. Any other work, mainly crowns is capped at 1k year.

The thing that's a rip off for me are the exclusions. I grind, go through a gaurd every 2 years. They cover 0% of a $500 appliance that saves thousands in dental work. So for me it's not worth the premium. YMMV.

MRG

 

[Animorph]

Dental providers don't seem to have the crazy price structure of medical providers. I regularly use a dentist that is out of network and sometimes pay an extra buck for it when his price and the insurance allowance are a little out of step. I'm happy to self insure as long as I'm not getting ripped off.

 

[ziggy29]

Dental providers don't seem to have the crazy price structure of medical providers.

This is usually true. No dentists I know of charge 3-4x as much to cash customers who don't have insurance, while this is fairly common with medical. In fact, some dentists will offer discounts of 5-10% to cash customers because they don't have to deal with the insurance bureaucracy or wait for reimbursement.

 

[pb4uski]

When I retire next month I lose my employer paid dental and vision. Has another considered either insurance? I'm just having an implant finished up so that's taken care of and then only "anticipate" cleanings twice a year. Vision is another matter as I'm diabetic and require a retinal specialist, not sure if this is covered under any vision insurance. I can continue with employer dental for $95 a month for two years but all I get is $1700 annually to cover whatever needs to be done. That $95 could give me immediate relief elsewhere.

Any thoughts would be appreciated.

Since DW and I are in good dental health and typically only have one exam and two cleanings a year and dental insurance would cost much more than the out of pocket cost for that we have declined to carry dental insurance and are self-insuring.

Our medical insurance includes an annual eye exam for a co-pay of $20 and we self insure for glasses.

Would visits to your retinal specialist be covered under your health plan rather than vision?

 

[Texas Proud]

This is usually true. No dentists I know of charge 3-4x as much to cash customers who don't have insurance, while this is fairly common with medical. In fact, some dentists will offer discounts of 5-10% to cash customers because they don't have to deal with the insurance bureaucracy or wait for reimbursement.

Our new dentist is not in network.... but will give a 5% discount if we pay by cash or check on the day of the service... the good thing is that they will also file the claim for us and either pay us back or hold the money for the next time...

 

[HappyOutsourced]

Congratulations on your soon to be retirement!
Here's my experience with dental insurance. I kept a policy on myself when I retired. I had not had a crown in years and probably not even a filling! But I had a tooth that bothered me from time to time. My dentist never found anything wrong with it. Well, about 4 years after I retired, my sweet, very conservative, cost-conscious dentist retired. The guy that replaced him wanted to do an overhaul on my mouth so I changed dentists and started going to a friend. He immediately found that the sensitive tooth was abscessed - I hadn't even mentioned having a problem . He said I needed a ROOT CANAL! That's when I found out how rinky dink my insurance policy was.
He sent me to an endodontist who charged somewhere in the 1100 to 1300 dollar range. He broke my existing crown and said he could not save the tooth. I think I had to pay $150 deductible plus half plus extra because he was out of network - which was a very limited network I found out. I paid him about $750 out of pocket. I went back to my dentist friend who wanted to send me to another endodontist but I didn't want to pay another guy for being unsuccessful too. I was resigned to having it pulled. Well, bless his soul, my friend-dentist said that if I were willing, he would attempt to do it and if he could not, he would not charge. Fortunately the open enrollment period for the year for dental insurance where my husband retired rolled around. I quickly signed up for the additional insurance . The advantages of that were - my dentist was in their network so I got discounts, I got the full $1000 calendar year coverage even though I joined in July, and I found my old insurance had a carry-over feature from years where I hadn't used it much. So I was able to coordinate the full $1000 in benefits with what was left of the current year's limit and the some carry-over for a total of $2000 coverage! The bad part was that in order to have insurance where my husband had worked, I had to have insurance on my husband as well. (He rarely ever, ever even has a cavity.) So my 2 policies paid for the second attempt ( which was successful) and the new crown. So for $300 extra to cover my husband and me for 6 months I was able to get $1000 in dental work plus I used up some of the carryover from my old insurance. Over the next 4 years, I've kept both insurances and have tried to use up the yearly allowances to redo some work and get set for old age. Hopefully, next year I'll drop the old inferior policy.
My point is, if you and/or your spouse have a lot of old crowns and fillings, be prepared! I hope this dental work lasts me the rest of my life but I think if I get into this situation again I'll check into adding AARP's insurance for a while. But I think you have to have it a year or so before using it on fillings and crowns.
Good luck - want me to tell you about our unexpected medical costs? heehee
To make a long story short, just remember most accidents happen at home. Don't get overly excited about what you're going to do for the day, dance a little jig and fall down the stairs due to exuberance of being retired like I did.....

 

[LinCella]

Other than this unfortunate implant, I haven't had dental issues in years. As a diabetic though I will probably have issues with bone loss in my jaw so who knows down the road. I haven't checked out the retinal specialist through my insurance - I'm changing to Blue Shield upon retirement - but will call the customer service line. He's not that expensive, but I haven't had - knock on wood - to do anything other than a check-up twice a year.

It pains me that COBRA dental is $95 a month! My implant is ending up costing $6k and they reimburse $1700? Is that 1980 pricing? So I sock away the $95 instead or check out the Delta plans, though I don't think implants are covered.

The vision thing is less a worry to me unless I need laser later, but I have no idea what that costs.

Thanks for all your advice. My only worry about self-insuring is I'm a terrifically bad saver! Obviously, in retirement I need to change that.

Breaking out the dental floss now...

 

[ziggy29]

It pains me that COBRA dental is $95 a month! My implant is ending up costing $6k and they reimburse $1700? Is that 1980 pricing? So I sock away the $95 instead or check out the Delta plans, though I don't think implants are covered.

$1700 a year is more than most dental plans will pay out in a year (most are $1000-1500). Though my wife's church-sponsored insurance plan (which I won't have) will pay up for $2800 a year.

I'm seeing dental plans on the Exchange for about $30-40 per month. They seem to have about a $1000-1500 annual limit also and the typical coinsurance (0% for preventative, 20% for minor routine services and 50% for major services). It starts to get a little tempting at that price point, but I know there's no free lunch here and there may some limitations or claims hassles here that might make it not worth doing.

My wife had an implant a few years ago (on an upper front tooth), and I believe it cost $4500 total. Some of that was the implant, some of it was the extraction and some of it was in the form of a special "denture" she wore outside the house. Our dentist was able to schedule the work and "code" it such that the work was spread (in terms of cost) fairly evenly over the course of two calendar years. As a result our insurance actually paid a little more than half of the total cost.

In any event, I think $95 a month ($1140 a year) for a plan that will never pay out more than $1700 is a ripoff unless you have a specific condition that causes you to max out your dental coverage every year.

 

[Texas Proud]

$1700 a year is more than most dental plans will pay out in a year (most are $1000-1500). Though my wife's church-sponsored insurance plan (which I won't have) will pay up for $2800 a year.

I'm seeing dental plans on the Exchange for about $30-40 per month. They seem to have about a $1000-1500 annual limit also and the typical coinsurance (0% for preventative, 20% for minor routine services and 50% for major services). It starts to get a little tempting at that price point, but I know there's no free lunch here and there may some limitations or claims hassles here that might make it not worth doing.

My wife had an implant a few years ago (on an upper front tooth), and I believe it cost $4500 total. Some of that was the implant, some of it was the extraction and some of it was in the form of a special "denture" she wore outside the house. Our dentist was able to schedule the work and "code" it such that the work was spread (in terms of cost) fairly evenly over the course of two calendar years. As a result our insurance actually paid a little more than half of the total cost.

In any event, I think $95 a month ($1140 a year) for a plan that will never pay out more than $1700 is a ripoff unless you have a specific condition that causes you to max out your dental coverage every year.

It is not as straight forward as what you put down....

We have 4 people in our family... it pays 100% of normal exams... they cost about $150ish each... so 150 X 4 X 2 = $1200...

Now, if you do not go twice a year then the analysis is different....

 

[RE2Boys]

All my work with a retinal specialist was covered as a normal medical procedure under my health plan. Since the retinal work, even my semi-annual check-ups with an opthamologist is covered as medical, except for getting a prescription for new eyeglasses, gotta pay $30 for that.


My son is having four wisdom teeth removed next month and it is covered as a medical procedure, not a dental procedure. Check with your insurance carrier as this may vary with different policies.

 

[ziggy29]

My son is having four wisdom teeth removed next month and it is covered as a medical procedure, not a dental procedure. Check with your insurance carrier as this may vary with different policies.

The key is getting the doctors and the insurance company to accept coding this might be as a precautionary treatment to avoid maxillofacial and TMJ problems down the road, which are *sometimes* covered by health insurance, especially for minors.

 

[Brett_Cameron]

I have retiree-benefit dental insurance for a family of 4. I pay half the premium. My part is $643 dollars a year.

It will pay up to $1,500 per year per person for cleanings and repair work including oral surgery, crowns, implants, fillings, and bridges.

I have found that dental expenses in excess of the $1,500 limit are a huge chunk of health care expenses as my own teeth degrade.

The dental insurance premium is well worth it to me in my situation. YMMV

Edited to add:
My vision premium is $123/year. For that we get contacts or glasses once per year per person plus coverage for exams. Again, well worth it.

 

[47]

Good luck on your impending retirement.

You may want to check out the Dental plan offered through Costco. If you are Costco member you can look under services, and you need to figure out if they offer it in your state. It costs about $250/year for a family of 3.

It covers cleanings 100% and pays out a specified rate for everything else. Last time I checked there is no cap on payments! If you are going the self insured route, I would still think this would make sense. You just need to make sure that you are okay with some Dentist in the plan. Although it is through Delta, it is one of the more restrictive networks -- so it is a much smaller selection of dentists.

If the retinal specialist care that you are talking about is more of a preventative check-up rather than anything currently active, it will be fully covered as part of medical in the ACA plans. You need to get your Primary physician to order that as part of the annual check-up visit and notate it as preventative screening.

============= added

ACA has some provisions for children's dental and vision. Check the new ACA plans in your state to see what is available and what is covered. It's possible that you may have to only worry about the adults in your family.

http://www.washingtonpost.com/natio...0183e2-3108-11e3-8627-c5d7de0a046b_story.html

 

[ziggy29]

You may want to check out the Dental plan offered through Costco. If you are Costco member you can look under services, and you need to figure out if they offer it in your state. It costs about $250/year for a family of 3.

This is currently only available in California.

 

[47]

This is currently only available in California.

My bad. I realized too late that Costco offers it only in CA.

But the insurer is Deltacare USA, and it seems to be available in most other states too. You can go to Delta website and poke around, or Google Deltacare HMO, or Deltacare USA and look for it. It may be just a bit more expensive than from Costco, but not by much.

As with any insurance offering it is all mangled up by state and county with no uniformity. While searching for it I found the following link. Not sure which outlet this particular brochure belongs to -- but the coverage information should be pretty close to the "generic" Deltacare offering.

http://www.deltadentalins.com/utae2012/dc-highlights.pdf