Dental Insurance FWIW

Midpack

Give me a museum and I'll fill it. (Picasso) Give me a forum ...
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Jan 21, 2008
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Location
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I started dental, hearing & vision insurance last May (when I turned 65) with Manhattan Life though I suspected it might not be worth the premiums. I finally looked at the details, and turns out it was about a breakeven. I had two cleanings & exams, and X-rays last year. Neither dentist accepts reasonable and customary reductions (patient pays).

  • If I had no insurance last year, it would have cost me $718.
  • With insurance it cost me $743.68 ($456.56 out of pocket & $287.12 in premiums), insurance paid $261.44.
Manhattan Life only covers 60% in year 1, 70% in year 2 and 80% thereafter.

I just had a cleaning & exam, and I'm scheduled for a crown later this month, so I expect my dental insurance will be worthwhile though there's a $1000/year cap (higher available) and I assume I'll exceed that and pay a good chunk out of pocket.

Just sharing for those wondering about retiree dental. The jury is still out for us, we may self insure but so far it's been about a wash so we'll see how it goes.
 
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Our dentist has started a discount plan for those like us without insurance. Their "discounts" are as good as what the insurance had been paying except for general exams, which are not free. In all, these "insurance" plans for vision, dental, etc are simply not worth it. For Part D drugs, we take the lowest cost coverage and simply use GoodRx.com. Another example where the discount program beats buying coverage, except they force you to take Part D.
 
Our dentist has started a discount plan for those like us without insurance. Their "discounts" are as good as what the insurance had been paying except for general exams, which are not free. In all, these "insurance" plans for vision, dental, etc are simply not worth it. For Part D drugs, we take the lowest cost coverage and simply use GoodRx.com. Another example where the discount program beats buying coverage, except they force you to take Part D.
Our current dentist plans to offer their own discount plan, but I'm not sure they have yet. We'll be interested.
 
Our dentist has started a discount plan for those like us without insurance. Their "discounts" are as good as what the insurance had been paying except for general exams, which are not free. In all, these "insurance" plans for vision, dental, etc are simply not worth it. For Part D drugs, we take the lowest cost coverage and simply use GoodRx.com. Another example where the discount program beats buying coverage, except they force you to take Part D.

Here in our rural area we have a shortage of dentists so they don't participate in any discount programs. Only two dentists in our county of 16,000. Guess I will be stuck paying for an insurance once RE.
 
I finally looked at the details, and turns out it was about a breakeven.
Mine is same with megacorp's plant through Metlife. Breakeven for routine, and a little discount of 30% for bigger stuff. I could pay more for a bigger discount, but I don't know when that stuff will happen.

My dentist's costs are a bit less than yours, Midpack. He basically accepts assignment to the plan's payout. That's very nice. He bought the practice from my previous dentist who made me cough up the difference. However, my insurance costs more than yours so perhaps he considers the assigned payout to be sufficient.

Overall, it is worth it.
 
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We looked at it post retirement eight years ago. We did not buy. The reason was the limitations. All of the expensive items, root canals etc, only paid out at 50 percent and with an annual maximum.

So, looking back eight years we were well ahead to self insure. Who knows what the future will be.
 
Our dentist has started a discount plan for those like us without insurance. Their "discounts" are as good as what the insurance had been paying except for general exams, which are not free. In all, these "insurance" plans for vision, dental, etc are simply not worth it. For Part D drugs, we take the lowest cost coverage and simply use GoodRx.com. Another example where the discount program beats buying coverage, except they force you to take Part D.

Our dentist retired so we were forced to look for another. We basically interviewed our neighbors and went to the one with the best overall personal reviews, in our opinion.

What we also found out and that was key, was he too offered a plan like you mention. Here is the overview that sold us.

$225 per family member FOR THE YEAR. (So $450 for Me and DW)

Inclusions Per Person:

2 cleanings and checkups for the year
1 set of X-rays per year

20% off all other services, Crowns, Fillings, Etc. All prices are published so no surprises.
 
I started dental, hearing & vision insurance last May (when I turned 65) with Manhattan Life though I suspected it might not be worth the premiums. I finally looked at the details, and turns out it was about a breakeven. I had two cleanings & exams, and X-rays last year. Neither dentist accepts reasonable and customary reductions (patient pays).

  • If I had no insurance last year, it would have cost me $718.
  • With insurance it cost me $743.68 ($456.56 out of pocket & $287.12 in premiums), insurance paid $261.44.
Manhattan Life only covers 60% in year 1, 70% in year 2 and 80% thereafter.

I just had a cleaning & exam, and I'm scheduled for a crown later this month, so I expect my dental insurance will be worthwhile though there's a $1000/year cap (higher available) and I assume I'll exceed that and pay a good chunk out of pocket.

Just sharing for those wondering about retiree dental. The jury is still out for us, we may self insure but so far it's been about a wash so we'll see how it goes.

I'm in a similar situation. I pay $303/year for a plan from the ACA exchange. It has a $60 deductible, pays 50% for non-preventative procedures and caps out at $1000. Probably isn't worth the money in years when I only have cleanings. It might make it worth it in a year with a cavity or crown. But barely, I'm guessing. I'm still waiting to see how the claim pays out for the cavity I had filled last month. My plan is a PPO, so the dentist does accept the negotiated price for services.

When I asked my dentist's office about 2021 coverage last month, I was told to look into just getting a Discount Plan from either Aetna or Cigna -- they accept either. These discount plans run $75-$90 per year to sign up. But they may just be wanting me to move away from them having to file and wait for claims. It may not be to my advantage.

But it's still difficult to know whether that discount plan discounted amount will be less or more than the negotiated price discount + the coverage of the PPO plan.

Sigh. Nothing is simple in healthcare. I'll make a decision after the last claim clears and I can see the full years' math.
 
My retiree dental insurance covers two cleanings, two exams and one x-ray for each of us every year, plus 80% of any corrective work without any benefit maximum, for $77 per month. We always get all of the exams, cleanings and x-rays every year, which total $540 per year ($45 month). So, essentially, we end up prepaying all the preventative stuff and paying $32 per month for the pure insurance function (i.e. - 80% coverage for any fillings, root scaling, extractions, etc. that we might need). It's not the best deal, but it's not bad.
 
We've been satisfied with our plan.
For out-of-network dentists (our favorite doesn't participate in any plans) they cover 90% of "Reasonable and customary" fees for
  • all preventive work (cleanings, exams, X-rays)
  • 50% of basic restorative (fillings, extractions)
  • 50% of major restorative (bridges, dentures)
  • 50% of orthodontia
Deductible is $50 per person
Annual maximum benefit is $1,000 per person

Premium is $33/month for both of us.
 
I'd probably just pay myself, but there is one good reason I'm using dental insurance.

Keep on the Megacorp plan.

Megacorp's plan for health is crazy expensive. But it is a really good plan. DW and I are on her plan. But if the SHTF, we can switch to Megacorp's. I only have to keep one of dental, vision, or health to have access to all in the next open enrollment.

Since dental is break-even right now, this is just a little peace of mind and another option in the crazy confused world of medical insurance.
 
Dental and vision are the least cost effective of the various types of health insurance since they insure small risks. Our insurance brokers (when I was buying insurance for various companies) would say these coverages were not truly insurance, just shuffling money around. We typically paid for the coverage as a way to make our benefit plans more effective.

I suspect when the time comes we will seek out discount plans as folks have mentioned. Also eliminates the hassle of dealing with claims, etc.
 
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Over the past four years, we've paid about $1,700 out of pocket and $1,400 in premiums, for a little more than $3,000 total.

If we didn't have the insurance, we would have paid over $4,500 to the dentist, so it has definitely been worthwhile.

Also, our dentist makes it easy. He files the claims and collects the insurance, then bills us directly for the difference.
 
I sat down today and created a spread sheet of my dental costs for 2019 and 2020 (my 2 years of retirement). I've been using dental insurance from Guardian purchased on the ACA exchange. But it's also available for the same price off the exchange. I just did it that way since I was already using the exchange for health insurance.

My spreadsheet compares what I've paid for 2 years of fairly minimal services (cleanings, exams, 1 set of x-rays, 1 filling) to what it would cost if I just purchased a Dental Discount Plan from either Aetna or Cigna. I included costs of deductibles and insurance premiums and the up-front cost of the discount plans in my calculations.

If one can trust the published "savings examples" posted on the Aetna/Cigna sites, I would have saved a little over $100 per year by using one of the discount plans. $200+ for the 2 year period.

I think for 2021, I will venture over to the side of just buying a discount plan (prices are about $130 for the year) instead of the insurance which is about $330 for the year.

My dentist does not offer their own discount plan and actually recommended I go with the discount plan over my current insurance. Saves them time and saves me money, it seems.
 
Looked into dental insurance, including with the dentist. ALL seemed to be more-or-less of a prepaid dental care plan. IOW, you get all the routine stuff plus some level of non-routine care with severe limits. SO, for someone with average needs, it comes out about the same. If you have several repairs or a couple of crowns in a year, the coverage runs out quickly. SO, we've gone naked and cut down on routine visits. YMMV
 
Way back when I was between jobs and Cobra had run out, I looked into several different true insurance plans as well as discount plans. I also discussed with the main billing/insurance person at my Dentist. First, for discount plans - always check with the dentist office first. They told me that their office is showing up on a number of discount plans for which they're not affiliated - meaning they wouldn't accept the discount plan. For the insurance I finally settled on (from Aetna) which completely covered preventative and 50% major/minor work. For most years, the total cost would have been a wash. But that's OK - I wouldn't buy insurance for a "wash", but for the unexpected. Still, for dental insurance these days there is often a maximum annual benefit - even my current insurance through work has that. Anyway, the story ended because I got a new job with insurance after only one month's premium was paid to Aetna, so never got to test it out...
 
Every year when I price out the plans and benefits it doesn't seem to be worthwhile.
Typical quotes run the about 70-$90/month for 2 of us and max out at $1000 each in coverage plus some have waiting periods for any major work So even if I need significant work I am liable for everything over $1000 which is ridiculously low for dental care. We probably have broke even in the several years with very little usage compared to a few years of heavier needs by not purchasing insurance.

However I have a story from this week.
I have been having a sore gum near one of my bridges which I attributed to a piece of popcorn hull being lodged in there. After a week of tenderness and no relief I decided to go see my dentist,
Sure enough she was able to dislodge 3 small pieces. Good news!
Now for the bad news. Being thorough they decided to take a few small x rays of the area and discovered a small decay in that same area.
Of course it is under the end tooth of the 3 tooth bridge and to fix it the bridge must be removed and redone.
$6310 quote!:facepalm:
So even if I paid approx $800/year in premiums it would only cover $1000 max per year for a net improvement of only $200 out of the $6310.
I may need a second opinion:(
 
Every year when I price out the plans and benefits it doesn't seem to be worthwhile.
Typical quotes run the about 70-$90/month for 2 of us and max out at $1000 each in coverage plus some have waiting periods for any major work So even if I need significant work I am liable for everything over $1000 which is ridiculously low for dental care. We probably have broke even in the several years with very little usage compared to a few years of heavier needs by not purchasing insurance.

However I have a story from this week.
I have been having a sore gum near one of my bridges which I attributed to a piece of popcorn hull being lodged in there. After a week of tenderness and no relief I decided to go see my dentist,
Sure enough she was able to dislodge 3 small pieces. Good news!
Now for the bad news. Being thorough they decided to take a few small x rays of the area and discovered a small decay in that same area.
Of course it is under the end tooth of the 3 tooth bridge and to fix it the bridge must be removed and redone.
$6310 quote!:facepalm:
So even if I paid approx $800/year in premiums it would only cover $1000 max per year for a net improvement of only $200 out of the $6310.
I may need a second opinion:(

So has the dentist already offered you a cash-price discount? I'd be curious to know if purchasing a $125 Discount Plan NOW (I don't think there are any open enrollment period restrictions) from Aetna or Cigna or the likes would discount that quote any further.
 
So has the dentist already offered you a cash-price discount? I'd be curious to know if purchasing a $125 Discount Plan NOW (I don't think there are any open enrollment period restrictions) from Aetna or Cigna or the likes would discount that quote any further.


So I just got this quote yesterday afternoon and haven't pursued any discounts or plans to do it at beginning of next year etc.
 
Hope I'm not getting to far off topic but has anybody considered going to Los Algodones Mexico for dental work. I understand the work they perform is first rate and about 25% the cost of dentists in the United States.
 
Every year when I price out the plans and benefits it doesn't seem to be worthwhile.
Typical quotes run the about 70-$90/month for 2 of us and max out at $1000 each in coverage plus some have waiting periods for any major work So even if I need significant work I am liable for everything over $1000 which is ridiculously low for dental care. We probably have broke even in the several years with very little usage compared to a few years of heavier needs by not purchasing insurance.

However I have a story from this week.
I have been having a sore gum near one of my bridges which I attributed to a piece of popcorn hull being lodged in there. After a week of tenderness and no relief I decided to go see my dentist,
Sure enough she was able to dislodge 3 small pieces. Good news!
Now for the bad news. Being thorough they decided to take a few small x rays of the area and discovered a small decay in that same area.
Of course it is under the end tooth of the 3 tooth bridge and to fix it the bridge must be removed and redone.
$6310 quote!:facepalm:
So even if I paid approx $800/year in premiums it would only cover $1000 max per year for a net improvement of only $200 out of the $6310.
I may need a second opinion:(

I think this is fairly typical with dental insurance. They just do not insure a very high value. And any savings should be calculated against the cash prices you pay when you do not have insurance.

I had a crown break and my dentist said insurance would not cover it because the crown had to be 8 years old. The regular price of the crown was $1100. But if I went ahead with no insurance, cash price was $800. Obviously a huge discount and I did not even negotiate it.

In fact, I still have the old crown as it is not bothering me. But one thing is clear: the insured prices are often inflated.
 
Since dental is break-even right now, this is just a little peace of mind and another option in the crazy confused world of medical insurance.

I'm not so sure about that "peace of mind" factor. Back in the day when we had dental insurance, the annual limit was $2k. That didn't give me much peace of mind. If a really serious, and expensive, dental issue came up, $2k wouldn't be enough to make much of a difference.

An example of "peace of mind" is Medicare Part D. As long as you have some plan, you have catastrophic coverage which could be a real retirement saver if you run into health problems causing many $k of drug expenses per year.

During the years we had dental insurance, it tended to run about break even over the long haul. In years we had only checkups and cleaning, the premiums were more than the dental work would have been. When I had a crown put on, the insurance did save us some significant money. But in the end, I can't say the dental insurance was any kind of real difference maker. And the $2k annual cap kept it from providing any real "peace of mind."
 
I purchase the group dental insurance, VADIP, offered to veterans who served (not retired from service). There are two providers, Delta Dental and MetLife. My Delta Dental high option plan is $43.58 a month with $3000 in coverage. I have been very happy with it. This is my 7th year.

I'm getting my money's worth this year as I had a tooth extracted yesterday and will be having an implant to replace it. My cost will be $2100 and insurance will pay $1377. The reimbursement rate is 50% but the bone graft ($212) and the surgical implant index ($550) are not covered. He does do free CT scans though. Very cool looking at your teeth in 3D!
 
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