Dental Insurance

[rodi]

We've maintained our dental insurance, through Cobra, since I retired last June. I'm reaching the end of the COBRA coverage.

I talked to our dentist to find out if they have any deals for cash payments, at time of service. It's a 5% discount of "full price". I asked if our current insurance was paying them full price or a negotiated rate... Current insurance pays a lesser, negotiated rate.

The office only takes PPO providers, not HMO. (Higher reimbursement rates.) I like this dentist - our family has been using them since 2002 and I'd prefer not to change providers.

The kids get a very limited dental coverage through their exchange purchased medical insurance, but it does not cover this dentist - so the office has been billing that provider, getting rejected, then billing my COBRA plan.

I've been pricing PPO plans that cover this dentist. It looks like I can get a PPO plan for less than my current premium, but it has wait periods for things we'll likely need. (6 month wait on fillings, 1 year wait on crowns). To get an "immediate coverage" plan it's significantly more (double the premium of the other plan, and about $50/month than my current plan for the family.)

I need dental insurance because my husband and older son have "soft" teeth and tend to need a lot of work... ongoing. (My younger son and I have pretty indestructible teeth, thank goodness.) My biggest concern is having my copay/balances be based on negotiated rates...

What have you all done? Is dental insurance a rip off or a good idea?

 

[REWahoo]

After going off COBRA I was unable to find any dental plan I considered to be worth the premium. Our long-time dentist gives us a 10% discount on most services, more on big ticket items if we pay cash, like the implant DW had last year.

 

[MichaelB]

We tried dental insurance for a year but I never saw the advantage. It had limits on yearly total payouts and didn't cover things that were expensive or complex (like implants).

The total value of the coverage was more than the year premium, but not significantly more, and heavily geared to fillings and crowns. If it doesn't cover the risk of unlikely but costly medical needs it's not really insurance.

 

[W2R]

The dental insurance at my former workplace was not worth the premiums and paid very little of one's dental costs.

My dentist gives me a hefty discount for not being insured, though.

 

[rodi]

I was hoping the dentist would give me a decent discount... but it doesn't sound like it.

I can see going w/out once older son is launched. But given his history (despite being a good brusher/flosser) I think I'd get value.

Hmmmm. Maybe I just get insurance for him.... Off to go price that.

 

[BrianB]

We're in the same position - COBRA expiring and no good insurance options seem available. Both DW's dentist and my dentist offer just 5% off the "list" price, which results in non-insured patients paying more than the insurance company!

My dentist is part of a Twin Cities group (multiple locations) and they offer this discount plan:
Park Dental Care Packages | ParkDental

It works out that we would be pre-paying for discounted cleaning & x-rays (the $495 annual fee), then getting 15% off most everything else we need. I've seen other discount plans that don't come near to this. What do you think of these prices? We've always had dental insurance so I don't know if this is a good deal or not.

 

[MRG]

I've been going to my dentist since '92, not going to change anytime soon. I had the same issue after COBRA, my dental insurance wasn't very good on it either. Basically prepay for 2 cleaning and 1 xray. Both that plan and others are all the same in my area, strict limits on yearly spending so a crown is 80% my issue 20% insurance then their max yearly benefit kicks me out.

Best I can do there is get the 5% and pay with my Fidelity AMEX adding in the next 2%. DW gets 3 cleanings per year and has no fillings. Me, victim of an idiot children's dentist who treated my adult teeth as deciduous. Most of my molars are crowns due to his total incompetence.

 

[Cobra9777]

We dropped dental insurance shortly after I retired. The premiums were slightly more than the uninsured cost of regular 6-month checkups for DW and myself. Plus there was a 20% copay. So now, our total cost for routine care is 25% lower, and we'll use those ongoing savings to self-insure against occasional non-routine procedures.

We both have good teeth and no history of expensive procedures. My one experience was a crown several years ago. IIRC, the total cost was around $1200. I paid a $200 deductible plus 50% co-insurance. The $500 that insurance paid is not going to bankrupt us. And if something like that only pops up every few years, we're definitely better off without dental insurance.

It was interesting to learn that people are getting discounts for paying cash with no insurance. As far as I know, we're not getting any such discount. I need to make a phone call. Although there's no way we're changing dentists. We've been seeing the same guy for over 20 years. The whole staff is top notch and treat us like family.

 

[utrecht]

If a dentist charges $200 for something....but negotiates the rate to $50 with the insurance company, and gives a cash customer a $5 discount to $190.....isnt his "real" price $190? Who is paying him his supposed list price of $200?

 

[utrecht]

We lost our dental insurance when we retired even though we still have employee health insurance until Feb. We all have good teeth and mostly just need cleanings, but havent been to the dentist for about 9 months.

How much is a standard check-up and cleaning with a new dentist? I think they usually want to do X-rays on your first visit also right?

 

[youbet]

If it doesn't cover the risk of unlikely but costly medical needs it's not really insurance.

+1

The dental insurance we had while I was working covered a couple of annual checkups at 100% and then went 80/20 with a $2k annual max. IOW, it paid for what I could afford anyway and hung me out to dry when expensive issues came up like needing an implant and a crown in the same year. (Ouch!)

I'd buy reasonably priced "catastrophic" dental insurance with, say, a $1k deductible and a $20k max. But, the low annual max benefit policies I've shopping since retiring aren't, as you say, insurance. They're just a pre-pay of a couple checkups and, IMO, not worth the premiums.

 

[youbet]

If a dentist charges $200 for something....but negotiates the rate to $50 with the insurance company, and gives a cash customer a $5 discount to $190.....isnt his "real" price $190? Who is paying him his supposed list price of $200?

The same people who pay "rack rates" at a hotel. Or pay full sticker for a car. Etc.

 

[Texas Proud]

If a dentist charges $200 for something....but negotiates the rate to $50 with the insurance company, and gives a cash customer a $5 discount to $190.....isnt his "real" price $190? Who is paying him his supposed list price of $200?

The negotiated rates are not like medical charges where you get such a big discount....

I would bet a $200 item would not be below $150....


I think that insurance can pay off if you have enough people on it... I had it last year and plan to get it next year... paying myself this year, but putting off X-rays... for me, with 4 people, the premiums will pay for the well care cost for the year with little OOP.... that cost is close to a full year premium... so any other payout for a crown etc. is when I get more than I pay in... but as long as we all go twice a year I am at break even on premiums...

 

[youbet]

as long as we all go twice a year I am at break even on premiums...

It's amazing the insurance company can offer a policy where the amount they know they are going to pay is less or break-even with the premiums. Is the deal that family size is not considered? That is, singles, couple or small families are subsidizing large families because all pay the same premium?

 

[sheehs1]

I had always had dental coverage. After looking at it last year I realized I paid $500 a yr in premiums for $1,000 of coverage. There were deductibles but I forget now what they were. Jeeeezzzz… So I dropped it this year. When I went to my long term dentist, he did the X-rays for "free". My office visit and cleaning cost me about $100. I can handle that twice a year. Luckily my teeth are strong. Last time I had a cavity was due to pregnancy 30 years ago. I think it depends on how ones teeth are, what kind of coverage one can get, etc.

 

[hnzw_rui]

I'd buy reasonably priced "catastrophic" dental insurance with, say, a $1k deductible and a $20k max. But, the low annual max benefit policies I've shopping since retiring aren't, as you say, insurance. They're just a pre-pay of a couple checkups and, IMO, not worth the premiums.

Anyone offering a plan like that? I'd get that one, too.

 

[W2R]

If a dentist charges $200 for something....but negotiates the rate to $50 with the insurance company, and gives a cash customer a $5 discount to $190.....isnt his "real" price $190? Who is paying him his supposed list price of $200?

My dentist gives me a 15% discount due to being uninsured, so a $200 charge for his services would cost me $170.

I assumed that all this is done as a tax write off, and that nobody pays list. But what do I know? All I know is that I get a discount.

I don't know how to get a discount without negotiating one, which I did fifteen years ago. I haven't really negotiated with him since then.

The last permanent crown I got from him was $1200, and I was feeling unusually cross and fussed about the price, which I haven't done at all in many years. He lowered it to $800 but I think that was his cost, and that that price was just for that one crown. He and I get along and he knows I pay cash each time before I ever leave the premises.

 

[rodi]

It's amazing the insurance company can offer a policy where the amount they know they are going to pay is less or break-even with the premiums. Is the deal that family size is not considered? That is, singles, couple or small families are subsidizing large families because all pay the same premium?

Having just shopped prices I found that most plans offer individual, individual + 1, and "family".

The same price for 1 kid vs 10 kids under the quotes I saw.

A single parent with 1 child, or a couple with no kids pay the same rate. (individual + 1)

 

[Texas Proud]

It's amazing the insurance company can offer a policy where the amount they know they are going to pay is less or break-even with the premiums. Is the deal that family size is not considered? That is, singles, couple or small families are subsidizing large families because all pay the same premium?

No, family size is considered....

You have to remember that a good number of people do not go to the dentist on a regular basis.... I would bet 50% or more go once a year or less.... so we are not the norm.....

 

[Bamaman]

My company's retirement package didn't include dental insurance. And I've had a couple of root canals and caps paid out of pocket @ $850 each.

Our state's Blue Cross Blue Shield is actively seeking new customers for dental coverage--$50 deductible per person and $1500 max per year coverage. 80% coverage on root canals and caps. Price per month is $33 per person.

I signed up for the insurance, and coverage starts 11/1/2015. Being mid 60's in age, it's worth being insured.

 

[pb4uski]

....I need dental insurance because my husband and older son have "soft" teeth and tend to need a lot of work... ongoing. (My younger son and I have pretty indestructible teeth, thank goodness.) My biggest concern is having my copay/balances be based on negotiated rates...

What have you all done? Is dental insurance a rip off or a good idea?

We have gone without dental insurance since I stopped working and our employer coverage lapsed. However, we generally only have a check-up once a year and cleanings twice a year and x-rays occasionally, so the cost of just buying the services is less than what the insurance would cost.

Is it feasible for you to buy a dental policy for DH and older son who have periodic issues and then just go without insurance for you and younger son? Not sure if that would save anything or not.

 

[rodi]

I wish I could get that deal, Bamaman.

 

[Amethyst]

Have you checked other dental practices to see what discount they are offering?

Mr. A. is getting an implant next month. Our insurance covers about 40% of the dental office's "full" cost for surgery, implant, and crown - total, about $3200.00 with insurance. Four hundred dollars of the $3200.00 is for nitrous, which the insurance doesn't cover - but the doctor strongly urged it, because the extraction will be a rough one.

If we didn't have insurance, or if our insurance hadn't started contributing toward implants, we would have received a 25% discount off the surgery, implant and crown. (It seems a little silly to even have a "full" price since apparently, no one pays it. It reminds me of JCPenney "sales.").

Amethyst

 

[mn54]

Have you checked other dental practices to see what discount they are offering?

Mr. A. is getting an implant next month. Our insurance covers about 40% of the dental office's "full" cost for surgery, implant, and crown - total, about $3200.00 with insurance. Four hundred dollars of the $3200.00 is for nitrous, which the insurance doesn't cover - but the doctor strongly urged it, because the extraction will be a rough one.

If we didn't have insurance, or if our insurance hadn't started contributing toward implants, we would have received a 25% discount off the surgery, implant and crown. (It seems a little silly to even have a "full" price since apparently, no one pays it. It reminds me of JCPenney "sales.").

Amethyst

I am sure the $400 charge is for IV sedation, not nitrous. No one has brought up going to a dental school for any extensive, expensive dental work. If you live near a dental school and you have more time than money, I would definitely consider going there for any crown and bridge work, implants, etc.

 

[rodi]

I have not explored changing dentists and would prefer to keep this one. He's a good dentist who has the right balance of pushing you to do work that needs to be done, but not pushing cosmetic or extra work on you. Talking to friends - that's less common than you'd think. (Example: Former coworker got talked into changing out all his silver fillings for porcelain even though he had no issues with the old silver ones. Work that was lucrative to the dentist, but not necessary for oral health.)