Dental Insurance

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OpenMinded1
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Dental Insurance

Post by OpenMinded1 »

Any thoughts on dental insurance? Is it generally worth it? My wife's employer provides it for both of us at no cost. (She doesn't pay premiums.) However, she won't be able to carry it into retirement. At that point we would be able to get it thru my former employer, but at a price.

Have any of you had dental work done that you wouldn't have been able to afford without dental insurance? My wife's insurance seems to pay about half, and dental insurance I had thru a previous employer seemed to pay about half. Have those of you that have dental insurance found this to be true, that it pays about half of the bill?

I don't think it would have been worth it so far for us if we were paying for it, but maybe it will be as we get older and possibly need more expensive procedures like crowns and implants. Not sure.
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JoeRetire
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Re: Dental Insurance

Post by JoeRetire »

We don't have dental insurance.

Our teeth are good, and we can easily afford the periodic cleanings, x-rays, and exams.

If your oral health is very bad, you might consider dental insurance (at least for a while). Otherwise, it's generally not a good purchase, IMHO.
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furwut
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Re: Dental Insurance

Post by furwut »

The dental insurance I’m familiar with had a large co-pay (50%) and a low annual cap. It covered 2 cleanings a year. Many people say between paying full premium and the annual cap it was pretty much a coin toss.

Good dentistry requires skill and the good dentists aren’t going to accept some insurer’s limitations on cost. That’s why if you go thru the insurer to find a dentist who’ll does you may regret it.
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JoeRetire
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Re: Dental Insurance

Post by JoeRetire »

furwut wrote: Sun Sep 06, 2020 10:30 am Good dentistry requires skill and the good dentists aren’t going to accept some insurer’s limitations on cost.
Good dentists do that all the time. Are you trying to say that good dentists don't accept any insurance?
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furwut
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Re: Dental Insurance

Post by furwut »

There’s a difference between assigning insurance benefits to the dentist who then balance bills any remainder and a dentist who accepts the insurance amount as full payment.
sport
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Re: Dental Insurance

Post by sport »

In my experience, dental insurance has a maximum annual payment of $1500. So, when you really need it for something big, it does not help very much. I also find that our dentists are not part of the network. So, for example, if there is a procedure that costs $500, the insurance will allow $320 and then pay 50% of that, or $160. We then get to pay the other $340 on balance billing. Of course, there is also a $50 deductible per year, so then they would pay $110 and we would pay $390.
Yooper16
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Re: Dental Insurance

Post by Yooper16 »

As in the other threads of similar topic--it really comes done to services needed/used, policy $$ and what it covers etc.
We are the lucky ones with our GEHA (federal) policy. Cost is 48/moth for both and also covers some optical and hearing aid $
It also helps to go to a participation dentist. We recently moved to the Tucson area--- very big military population.
Our new dentist is a GEHA provider
We each had appointment and had the same work done.
2 comprehensive eval.---new patient
2 sets bite wings
2 panoramic radiographic imaging
2 prophylaxis

Total bill for both was $526.00

Total out of pocket was $0.00

Spouses recent Optometrist visit to a preferred provider to get an RX for his contacts(previous had expired. Covid got in the way and didn't realized the previous RX had exprired and couldn't be reused.
Appointment/exam cost to us was $46, although the type of contacts he prefers are not covered.

The good policies are out there, if you are able to get them through work, retiree benefits, use their providers etc.
It worked for us having so recently moved here (May) and we needed to establish care.

Our max benefit each per year for all covered items is 2500. They do have a policy for about $100 per month that has a 20K yearly max. I am probably off somewhat on the costs and benefits but that is pretty close.
hectorochoa
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Re: Dental Insurance

Post by hectorochoa »

My family of 5 used to pay for dental insurance until our dentist started a 'Dental Savings Plan.' For approximately the same price as our dental insurance premiums (acutally a little less and no copays or deductibles) we each get 2 free cleanings each year along with the exam, fluoride treatments, sealants, xrays, etc. If someone has a cavity and needs to get it filled, we pay a discounted rate of around $80. We pay $1,260 per year for a family of 5. Lots of dentists are offering dental savings plans now. Might be a good fit for you. Here's a link to one I found when searching for example: hwww.drminnitidental.com/dental-savings-plan/
Pdxnative
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Re: Dental Insurance

Post by Pdxnative »

It depends whether the dentist you prefer is in the insurance network. We were skeptical of dental insurance because it seemed like the annual cap wasn’t much more than our annual premiums. So we dropped it. Then we needed a few crowns and root canals in the same year, which we paid out of pocket. Through discussions with the billing person, we discovered that if we had kept our insurance, even if they hadn’t reimbursed for these procedures, we would have been charged a contracted price about 40% less. That would have paid for several years of insurance. And, there’s no cap on that ‘discount’. So we view dental insurance as a charge to access better pricing, with reimbursements a bonus that is limited by the annual cap.
startwithtruth
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Re: Dental Insurance

Post by startwithtruth »

Pdxnative wrote: Sun Sep 06, 2020 11:44 am Through discussions with the billing person, we discovered that if we had kept our insurance, even if they hadn’t reimbursed for these procedures, we would have been charged a contracted price about 40% less.

So we view dental insurance as a charge to access better pricing, with reimbursements a bonus that is limited by the annual cap.
This. My husband and I have needed extensive dental work at times, and insurance has been well worth it, partly because our dentists are required to accept payment based on the insurance company's UCR rates. As our employers changed dental plans, we were always glad to find our dentists on the "medium" list which meant we could count on the lower UCR rates. We opted not to switch to dentists on the insurance companies' most preferred list although that would've given us highest caps/lowest co-insurance; I've heard too many horror stories about bad dentists to switch to whoever is cheapest.

Once we're both retired and don't have access to the same plans, concerned that we'll be stuck paying much higher prices.
livesoft
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Re: Dental Insurance

Post by livesoft »

Companies that sell dental insurance are not in the business to lose money. So I think that in general, the cost of the insurance is going to be about what the cost of the services that the insurance would cover pays less any expenses and profits that the insurance company needs to stay in business. At least that is what we have found out over the years.

So dental insurance makes sense if you can get it subsidized through your employer and the projected services will cover your share of the payments and costs.

I also think that typically people who have dental insurance through their employer get all those suggested crowns and gum tissue transplants in their last couple of years of working before they retire. Also employed people do kinda know if they are going to need a root canal and will have higher dental expenses coming up, so in such situations they do choose to go with the dental insurance through their employer.
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mkc
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Re: Dental Insurance

Post by mkc »

Lots of good info in this recent thread viewtopic.php?f=11&t=323399
squirm
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Re: Dental Insurance

Post by squirm »

dental insurance can be good, you realize it's a use it or lose it, vs not paying into one....sorta forces to go and get checked up and cleaned etc.
Big Dog
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Re: Dental Insurance

Post by Big Dog »

In my experience, individual dental insurance (not thru employer) only works if you see a participating dentist (on their list of preferred providers) and you need work. Otherwise, you might be better off asking your dentist if they offer a cash discount, i.e., pay at time of service.
Lalamimi
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Re: Dental Insurance

Post by Lalamimi »

Get everything done before she retires. When its time for a cleaning, just look for a local dentist with a special New Patient deal. I had to have a 17 yr old bridge replaced this year - $3600, no insurance. It happens. But I got a cleaning and exam for $108.
ChrisC
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Re: Dental Insurance

Post by ChrisC »

I have pretty good dental insurance from my former employer in retirement, which was free when I was working (unless you went with a high option plan). My basic dental insurance in retirement cost around $26 per month, and covers 2 free cleanings/exams per year, and up to $3000 in annual dental expenses. It covers bridgework, root canals, crowns, and similar procedures at 80%, and implants at 60%. I've used it for 4 implants in retirement and other procedures -- it has saved me a considerable amount of money especially since the negotiated network rates when I do have to pay the co-pay is substantially lower than the normal billing rate the dentist would charge. Even if the coverage wasn't good, there is still a benefit in paying negotiated rates, rather than the normal rates charged by oral surgeons, endodontists or general dentists.

I just received a notice from my dental insurers that they will be refunding May and June premiums because of Covid-19, when most dental offices were closed in my State.
Kelrex
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Re: Dental Insurance

Post by Kelrex »

furwut wrote: Sun Sep 06, 2020 10:30 am The dental insurance I’m familiar with had a large co-pay (50%) and a low annual cap. It covered 2 cleanings a year. Many people say between paying full premium and the annual cap it was pretty much a coin toss.

Good dentistry requires skill and the good dentists aren’t going to accept some insurer’s limitations on cost. That’s why if you go thru the insurer to find a dentist who’ll does you may regret it.
There is *some* truth in this, but it's not really accurate.

Many young, extremely talented dentists in the US can't afford to not subscribe to insurance, especially if they are working in an oversaturated area where patients aren't likely to even give them a try if they don't.

In general, yes, if a dentist is able to charge full fee regardless of insurance plan, aka a fee-for-service dentist, then that's some solid evidence of that person having been quite successful, which *sometimes* correlates with skill. Often it just correlates with how likeable they are, since patients generally don't actually have the ability to assess the quality of their own dental work.

It is fair to say that pretty much every dentist *wants* to be a fee-for-service dentist, and would much rather not have their work devalued by insurance companies. That doesn't mean that the market forces allow this, or that the ones who can't pull it off aren't great dentists by default.

So if someone can find a talented dentist in their insurance network, then even though the dental plan may pay for very little compared to its cost, it *may* be a net benefit based on the discounted fees alone if that person requires expensive dental care, which many MANY people do as they age.
newyorker
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Re: Dental Insurance

Post by newyorker »

Dentist here.


Just because dentist is a part of insurance network, it doesnt mean that he/she is unskilled. This holds especially true for younger dentists in hcol area.


It is very difficult to differentiate good vs bad dentist. Just because one has great chairside manner, it doesnt translate to good dentistry.
sport
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Re: Dental Insurance

Post by sport »

Kelrex wrote: Sun Sep 06, 2020 7:19 pm
furwut wrote: Sun Sep 06, 2020 10:30 am The dental insurance I’m familiar with had a large co-pay (50%) and a low annual cap. It covered 2 cleanings a year. Many people say between paying full premium and the annual cap it was pretty much a coin toss.

Good dentistry requires skill and the good dentists aren’t going to accept some insurer’s limitations on cost. That’s why if you go thru the insurer to find a dentist who’ll does you may regret it.
There is *some* truth in this, but it's not really accurate.

Many young, extremely talented dentists in the US can't afford to not subscribe to insurance, especially if they are working in an oversaturated area where patients aren't likely to even give them a try if they don't.

In general, yes, if a dentist is able to charge full fee regardless of insurance plan, aka a fee-for-service dentist, then that's some solid evidence of that person having been quite successful, which *sometimes* correlates with skill. Often it just correlates with how likeable they are, since patients generally don't actually have the ability to assess the quality of their own dental work.

It is fair to say that pretty much every dentist *wants* to be a fee-for-service dentist, and would much rather not have their work devalued by insurance companies. That doesn't mean that the market forces allow this, or that the ones who can't pull it off aren't great dentists by default.

So if someone can find a talented dentist in their insurance network, then even though the dental plan may pay for very little compared to its cost, it *may* be a net benefit based on the discounted fees alone if that person requires expensive dental care, which many MANY people do as they age.
One time I asked my dentist why he was not in the insurance network. He said that if he were in the network, he would have more patients, but would get paid less for each one. The result would be more work for no higher income. So, he had no interest in joining the network.
sport
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Re: Dental Insurance

Post by sport »

newyorker wrote: Sun Sep 06, 2020 7:48 pm Dentist here.


Just because dentist is a part of insurance network, it doesnt mean that he/she is unskilled. This holds especially true for younger dentists in hcol area.


It is very difficult to differentiate good vs bad dentist. Just because one has great chairside manner, it doesnt translate to good dentistry.
A dentist friend once told me "When you go to a dentist for the first time, you will know within 5 minutes whether or not you like him/her. However, it will take 5 years before you know if that dentist is a good one."
GlennK
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Re: Dental Insurance

Post by GlennK »

I had a dentist that called himself a pain free dentist. Would offer nitrous oxide, put head phones on you, other amenities. Unfortunately, he charged more than what the insurance would state is allowed and would bill for the difference. I obviously learned quickly that he wasn't for me.

Our dentists since then have always accepted the fee set by the insurance companies. Of course, they do not like it. But my latest dentist told me they are NOT allowed to bill for the difference or they would no longer be in the insurer's list of providers. But he also told me that he and all the dentists in the area purposely state higher fees than necessary which forces the insurance company to eventually raise their standard price.
newyorker
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Re: Dental Insurance

Post by newyorker »

sport wrote: Sun Sep 06, 2020 8:02 pm
newyorker wrote: Sun Sep 06, 2020 7:48 pm Dentist here.


Just because dentist is a part of insurance network, it doesnt mean that he/she is unskilled. This holds especially true for younger dentists in hcol area.


It is very difficult to differentiate good vs bad dentist. Just because one has great chairside manner, it doesnt translate to good dentistry.
A dentist friend once told me "When you go to a dentist for the first time, you will know within 5 minutes whether or not you like him/her. However, it will take 5 years before you know if that dentist is a good one."

Thats a good one.

Ive seen great work from a dentist working in a clinic that accepts all insurances and Ive also seen crap works from a dentist who only takes cash patients.
Kelrex
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Re: Dental Insurance

Post by Kelrex »

sport wrote: Sun Sep 06, 2020 8:00 pm [One time I asked my dentist why he was not in the insurance network. He said that if he were in the network, he would have more patients, but would get paid less for each one. The result would be more work for no higher income. So, he had no interest in joining the network.
Yes, as per my previous post, that means your dentist is attracting enough patients to support their business without needing to join the networks.

Not every dentist in every market can afford to do that. Obviously they would all like to, but many very talented ones can't do it and still be busy enough for their practice to survive. So instead they make the trade off of getting paid less per procedure just to be able to attract enough patients to stay busy.

Again, as I said, it comes down mostly to how much competition there is.
Kelrex
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Re: Dental Insurance

Post by Kelrex »

sport wrote: Sun Sep 06, 2020 8:02 pm
newyorker wrote: Sun Sep 06, 2020 7:48 pm Dentist here.


Just because dentist is a part of insurance network, it doesnt mean that he/she is unskilled. This holds especially true for younger dentists in hcol area.


It is very difficult to differentiate good vs bad dentist. Just because one has great chairside manner, it doesnt translate to good dentistry.
A dentist friend once told me "When you go to a dentist for the first time, you will know within 5 minutes whether or not you like him/her. However, it will take 5 years before you know if that dentist is a good one."
Kiiiind of...soooort of...but not really to a meaningful degree.

It's only partially true because treatment failure often has more to do with how the patient takes care of the work than the quality of the work to begin with.

Also, all dental work has a lifespan, which varies dramatically as well and depend on a lot of factors aside from quality of work.

Sure, better work tends to last longer, but this is virtually impossible to measure meaningfully for the individual.
MDfan
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Re: Dental Insurance

Post by MDfan »

sport wrote: Sun Sep 06, 2020 10:49 am In my experience, dental insurance has a maximum annual payment of $1500. So, when you really need it for something big, it does not help very much. I also find that our dentists are not part of the network. So, for example, if there is a procedure that costs $500, the insurance will allow $320 and then pay 50% of that, or $160. We then get to pay the other $340 on balance billing. Of course, there is also a $50 deductible per year, so then they would pay $110 and we would pay $390.

Our insurance (Delta Dental) has a cap of $2,000. I know that because I just had a dental implant and am paying almost $5,000 out of pocket for everything (CT scan, implant, anesthesia, crown, and some periodontal work on top).
mnsportsgeek
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Re: Dental Insurance

Post by mnsportsgeek »

JoeRetire wrote: Sun Sep 06, 2020 10:26 am We don't have dental insurance.

Our teeth are good, and we can easily afford the periodic cleanings, x-rays, and exams.

If your oral health is very bad, you might consider dental insurance (at least for a while). Otherwise, it's generally not a good purchase, IMHO.
Our dental is cheaper than the cost of 2 cleanings, and way cheaper than the cost of 2 cleanings plus annual x rays. So we have it.
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TexasPE
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Re: Dental Insurance

Post by TexasPE »

Personally, my comfort level with my dentist is more important than whether I have dental insurance. My current dentist is in his late 50s, has an established practice, and has achieved the income level and workload he wants (closed Fridays). He accepted my employer dental insurance, but doesn't participate in the individual policy marketplace. He continues to give me the insurance discounted price for procedures (cash).

I found him by asking my previous dentist (who was retiring) who HE recommended after giving the young dentist who bought his practice a chance. The young dentist trotted out a list of recommended high-dollar procedures, including cosmetic, on my first visit-issues the retiring dentist never raised.

I assume he has a large student debt to retire. :moneybag
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JoeRetire
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Re: Dental Insurance

Post by JoeRetire »

mnsportsgeek wrote: Mon Sep 07, 2020 7:19 am
JoeRetire wrote: Sun Sep 06, 2020 10:26 am We don't have dental insurance.

Our teeth are good, and we can easily afford the periodic cleanings, x-rays, and exams.

If your oral health is very bad, you might consider dental insurance (at least for a while). Otherwise, it's generally not a good purchase, IMHO.
Our dental is cheaper than the cost of 2 cleanings, and way cheaper than the cost of 2 cleanings plus annual x rays. So we have it.
Does your dental cover 100% of the cleanings and x-rays? Or just part of it?
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JoeRetire
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Re: Dental Insurance

Post by JoeRetire »

TexasPE wrote: Mon Sep 07, 2020 9:01 am Personally, my comfort level with my dentist is more important than whether I have dental insurance.
Most dentists don't require folks to make that choice.
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mnsportsgeek
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Re: Dental Insurance

Post by mnsportsgeek »

JoeRetire wrote: Mon Sep 07, 2020 2:32 pm
mnsportsgeek wrote: Mon Sep 07, 2020 7:19 am
JoeRetire wrote: Sun Sep 06, 2020 10:26 am We don't have dental insurance.

Our teeth are good, and we can easily afford the periodic cleanings, x-rays, and exams.

If your oral health is very bad, you might consider dental insurance (at least for a while). Otherwise, it's generally not a good purchase, IMHO.
Our dental is cheaper than the cost of 2 cleanings, and way cheaper than the cost of 2 cleanings plus annual x rays. So we have it.
Does your dental cover 100% of the cleanings and x-rays? Or just part of it?
I have the 100% non-deductible plan. My company only charges me like $19 a month for my wife and I.

The only thing they ask if we want to add on is fluoride treatment or the cancer scan. The fluoride treatment isn’t much. They recommend it once a year. I usually pass on the oral cancer scan.
Last edited by mnsportsgeek on Mon Sep 07, 2020 6:13 pm, edited 1 time in total.
hicabob
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Re: Dental Insurance

Post by hicabob »

This year was the first time I ever paid for dental insurance then corona-virus hit and I still have not been able to get the anticipated work done. Bad timing. They don't want to refund me the payments (just $48/mo but some principle involved) for the months when it was/is unusable surprise, surprise.
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JoeRetire
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Re: Dental Insurance

Post by JoeRetire »

mnsportsgeek wrote: Mon Sep 07, 2020 6:06 pm
JoeRetire wrote: Mon Sep 07, 2020 2:32 pm
mnsportsgeek wrote: Mon Sep 07, 2020 7:19 am
JoeRetire wrote: Sun Sep 06, 2020 10:26 am We don't have dental insurance.

Our teeth are good, and we can easily afford the periodic cleanings, x-rays, and exams.

If your oral health is very bad, you might consider dental insurance (at least for a while). Otherwise, it's generally not a good purchase, IMHO.
Our dental is cheaper than the cost of 2 cleanings, and way cheaper than the cost of 2 cleanings plus annual x rays. So we have it.
Does your dental cover 100% of the cleanings and x-rays? Or just part of it?
I have the 100% non-deductible plan. My company only charges me like $19 a month for my wife and I.
Ah. Of course if your company is subsidizing the cost of the insurance it can be a good deal.

I think the OP was taking about private insurance.
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toofache32
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Re: Dental Insurance

Post by toofache32 »

startwithtruth wrote: Sun Sep 06, 2020 1:18 pm
Pdxnative wrote: Sun Sep 06, 2020 11:44 am Through discussions with the billing person, we discovered that if we had kept our insurance, even if they hadn’t reimbursed for these procedures, we would have been charged a contracted price about 40% less.

So we view dental insurance as a charge to access better pricing, with reimbursements a bonus that is limited by the annual cap.
This. My husband and I have needed extensive dental work at times, and insurance has been well worth it, partly because our dentists are required to accept payment based on the insurance company's UCR rates. As our employers changed dental plans, we were always glad to find our dentists on the "medium" list which meant we could count on the lower UCR rates. We opted not to switch to dentists on the insurance companies' most preferred list although that would've given us highest caps/lowest co-insurance; I've heard too many horror stories about bad dentists to switch to whoever is cheapest.

Once we're both retired and don't have access to the same plans, concerned that we'll be stuck paying much higher prices.
This is state specific. Google "non covered services laws" for your state. Also be aware that when dentists are forced to accept fees set by insurance, they will not be able to offer all services since the fees are sometimes lower than the cost. For example, my dental office does lots of full arch implant cases. One insurance company pays $2400 for the final bridge. The lab bill is around $4000 to fabricate this. So our choice was to either drop that insurance plan or to tell patients we are not able to treat them. We dropped the plan.
chw
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Re: Dental Insurance

Post by chw »

I think so. DW and I are early retirees in early 60s. We pay $100/mo for a good exchange plan that our regular dentist accepts. It covers 2 cleanings/yr, and xrays. I have periodontal maintenance done an additional 2 times yearly that are also covered at 80%.

I would rate our dental health as good, but we’ve both had fillings/crowns over the course of our lives, which need periodic maintenance to keep ahead of problems. I had 2 old fillings replaced this year, and a crown was needed to deal with another old filling that was failing. These were all covered to some extent (fillings 80%, crown 50%), and if we had no insurance, the dentist could have billed whatever he wanted, instead of being limited to the insurance companies reasonable charges.

We do have the ability to self insure, but given our ages, we feel the premiums are modest enough to pay for the peace of mind for the unexpected.
SlowMovingInvestor
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Re: Dental Insurance

Post by SlowMovingInvestor »

My experience has been that Dental HMO plans typically have a pretty skimpy provider directory. I'm guessing they don't pay enough to dentists.

Dental PPOs with the major providers have pretty good coverage. Your specific dentist may not be in the plan, but I haven't found it difficult to find good practitioners. Insurance also gives you 2-4 cleaning visits, dental x-rays periodically, and insurance billing on other services, even after the max coverage is reached.
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midareff
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Re: Dental Insurance

Post by midareff »

I've not had any success finding dental insurance that extends past a small basic amount, such as $1000, that didn't cost nearly that much. I had a discount plan for awhile.. Aetna Vital Savings I think it was called but it seemed the only places that actually took it were clinics with relative newbie practitioners and their discounted cost was nearly the same as you would find at an experienced skilled provider.
bberris
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Re: Dental Insurance

Post by bberris »

mnsportsgeek wrote: Mon Sep 07, 2020 6:06 pm
JoeRetire wrote: Mon Sep 07, 2020 2:32 pm
mnsportsgeek wrote: Mon Sep 07, 2020 7:19 am
JoeRetire wrote: Sun Sep 06, 2020 10:26 am We don't have dental insurance.

Our teeth are good, and we can easily afford the periodic cleanings, x-rays, and exams.

If your oral health is very bad, you might consider dental insurance (at least for a while). Otherwise, it's generally not a good purchase, IMHO.
Our dental is cheaper than the cost of 2 cleanings, and way cheaper than the cost of 2 cleanings plus annual x rays. So we have it.
Does your dental cover 100% of the cleanings and x-rays? Or just part of it?
I have the 100% non-deductible plan. My company only charges me like $19 a month for my wife and I.

The only thing they ask if we want to add on is fluoride treatment or the cancer scan. The fluoride treatment isn’t much. They recommend it once a year. I usually pass on the oral cancer scan.
The cancer scan scam: would your dentist really not tell you that he saw a mouth lesion if you didn't pay for a cancer scan?
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