Kevin Knauss: Health, History, Travel, Insurance
Posts about dental insurance for individuals, families, small groups and Medicare eligible individuals.
The Covered California plan covers no adult orthodontia unless medically necessary. The direct Delta Dental HMO plan does include adult orthodontia or braces. Neither plan covers dental implants. If you need a whiter smile, the direct Delta Dental HMO plan includes custom trays for the home bleaching process at a $125 fee.
PPO dental plans are more widely accepted than HMO plans. PPO plans will also reimburse you if you receive services from an out-of-network dentist. You will always minimize your out-of-pocket costs if you use an in-network dentist. PPO plans have higher monthly premiums because of the larger network of dentists and the out-of-network coverage provided. None of the dental plans will cover implants, tooth whitening, or adult orthodontics.
A health plan without your preferred doctors is not health insurance. Similarly, dental or vision benefits without it being accepted by your preferred dentist or optometrist is just a selling gimmick. Consequently, before favoring a Medicare Advantage plan because of the dental or vision benefits embedded in the plan, it is important to learn about the network of providers and if your preferred doctor is in the network.
Dental insurance is analogous to gambling. You sit in front of the slot machine, put in the quarters, pull the arm, and most of the time you win nothing. However, gambling is entertainment, so you had some fun. Occasionally, you hit the triple teeth and win your money back plus a little extra.
The Premium plan is fairly comprehensive covering all of the minor and major dental services that are normally encountered. In addition, it also has limited coverage for teeth whitening, mouth-guards, orthodontics, and dental implants. The major services are covered at 50 percent after the 6-month waiting period. The 6-month waiting period is better than some plans that have a 12-month waiting period, but it also adds to the cost of the Premium plan.
Under this scenario, when the member cost-sharing plus premiums are added together, the Delta Dental Gold plan was the least expensive. The plan costs were exactly the same for years 3, 4, and 5. It was the monthly premium that made the big difference. The Delta Dental Gold plan had a lower premium, and assuming all plans would inflate at the same rate, it will remain lower for the remainder of the enrollment.
If you are over 50 years old and know that you have immediate dental issues that need to be addressed, or will have in the next couple of years, the No Wait plan from Morgan White Group Dental for Everyone, underwritten by Delta Dental, may be a good option. It is also one of the few plans available to individuals and families that will provide coverage and cost-sharing for dental implants.
The value of dental insurance is questionable in the minds of many consumers. And I don’t necessarily disagree with that evaluation. However, the importance of regular dental exams, cleanings, and hygiene cannot be disputed. If dental insurance keeps a person on track with good dental hygiene and habits, they will be spared the expense of expensive dental procedures in the future.
The big question is how do all these dental tools included in the dental plan help reduce the premiums. The tooth brushes wirelessly connect to a Beam application on the member’s smart phone. Yes, your toothbrush will use Bluetooth technology – isn’t that ironic – to log your household’s brushing frequency. All the frequencies from all the members in the group are then aggregated to provide a score. If the score is high enough, any future rate increase on the renewal date of the dental plan is reduced.
There a lots of different dental plans off-exchange or outside of Covered California. The number of plans makes comparisons complicated and confusing. Delta Dental and Anthem Blue Cross offer dental plans through Covered California and a variety of different plans off-exchange. The single largest difference between the Covered California plans and the ones offered off-exchange is the 12 month waiting period for major dental work such as extractions, root canals, and crown. The six month waiting period usually applies to minor restorative work such as getting a cavity filled.
