ChrisC wrote: ↑Sat Sep 24, 2022 12:48 pm
How much help do you need? Our dental insurance, included as a retiree benefit, is around $26 per month and covers myself and wife at an annual cap of $3k per year for each of us; covers cleanings, extractions (80% of network rate) and implants and crowns (60%). My wife maxed out this year with one extraction and two implants. So despite the co-pays and the $50 deductible, all subject, as well as the dental insurance premiums, to HSA reimbursement — we think we’re getting a good deal. I’ve had around $20K in dental work since retirement and the insurance has saved me around $14k. And it covers out of network treatment, which we’ve had on several occasions.
My point is that some group dental insurance is pretty good. I remember growing up not too far from the Brooklyn piers that children of longshoremen had incredible dental insurance coverage from the union.
The point of insurance is not to get a good deal---if everyone profits, the insurance company can't survive. Insurance should cover rare but catastrophic costs. Even at $3k, dental insurance doesn't do that, and some dental insurance is capped much lower, sometimes $500.
The point of taking out insurance, from the insured's standpoint, is to pay for coverage that is worth it to you, taking into account the insured's peace of mind and transaction costs. I don't believe insurance is solely beneficial to cover "catastrophic costs," which might be your way of viewing insurance -- I'll take out travel insurance in some cases, product insurance in other cases, and some aspects of car or home owner's insurance in other cases, even though these lines of insurance to me would not involve "catastrophic costs" to me if the risk I insured against had to be borne by me entirely.
At least for me, I'm better off paying $312 a year for my dental insurance, which alone covers two cleanings at $148 per visit (at the reduced network rates) for my wife and I. So, at our ages, where we've had at least one major dental procedure per year since retirement (and sometimes 2 or 3), I believe our insurance is a good deal to us. I think I would be making an unsound decision to forego this dental insurance coverage because it doesn't cover everything under the sun or catastrophic costs. It covers what I need it to cover, for us.
ChrisC wrote: ↑Sat Sep 24, 2022 12:48 pm
How much help do you need? Our dental insurance, included as a retiree benefit, is around $26 per month and covers myself and wife at an annual cap of $3k per year for each of us; covers cleanings, extractions (80% of network rate) and implants and crowns (60%). My wife maxed out this year with one extraction and two implants. So despite the co-pays and the $50 deductible, all subject, as well as the dental insurance premiums, to HSA reimbursement — we think we’re getting a good deal. I’ve had around $20K in dental work since retirement and the insurance has saved me around $14k. And it covers out of network treatment, which we’ve had on several occasions.
My point is that some group dental insurance is pretty good. I remember growing up not too far from the Brooklyn piers that children of longshoremen had incredible dental insurance coverage from the union.
The point of insurance is not to get a good deal---if everyone profits, the insurance company can't survive. Insurance should cover rare but catastrophic costs. Even at $3k, dental insurance doesn't do that, and some dental insurance is capped much lower, sometimes $500.
Thats why it's better to get dentalinsurance with higher caps. Several of the group plans for federal employees/retirees have no annual cap in benefits, or a very large number like $35k.
There is another consideration for self employed like me. I cannot deduct dental expenses but I can deduct dental insurance. This means my after tax cost of premium is around 70% of the total cost.
OK, I'm reviving this thread for a question. Thanks to a recommendation by PaunchyPirate from about 8 months ago, I dropped my $61/month Delta Dental insurance and signed up "dental plan" (basically paying $120/year to prevent being price gouged and forcing the participating dentist to accept a "fee schedule") for this for $10/month:
Here is my question: How do I know that the dentist is charging me only the agreed to Aetna "fee schedule" fee? As an Aetna participating dentist, can I instruct that the dentist submit my claim to Aetna to generate an "Explanation of Benefits? I get it that Aetna will still pay zero, but at least they'll price out what I have to pay? What are the logistics of how does this "dental plan/fee schedule" thing works?
Leesbro63 wrote: ↑Fri Mar 17, 2023 7:14 am
How do I know that the dentist is charging me only the agreed to Aetna "fee schedule" fee? As an Aetna participating dentist, can I instruct that the dentist submit my claim to Aetna to generate an "Explanation of Benefits? I get it that Aetna will still pay zero, but at least they'll price out what I have to pay? What are the logistics of how does this "dental plan/fee schedule" thing works?
Hi there - based on the fine print on the Aetna site 'You are responsible for paying the provider but will receive a discount from those providers in our discount program network.' So it sounds like it will work a little bit differently than my dentist works with Delta Dental today. I receive a bill, pay up front and then my dentist submits the invoice to Delta. My dentist is out of network but is wonderful so I'm happy paying a little extra. Delta tends to pay me back 95-98% of my dentist's charges for cleanings, exams and bitewings but sometimes a lower percentage for other procedures. I consider my Delta premium nothing but a dental savings account that only 'pays off' when I need a filling, crown or some specialized procedure.
In your case it seems that as long as your dentist is participating in Aetna's program you'll receive the appropriate discount. Perhaps that discount is applied (and payable by you) immediately or perhaps they need to pass billing to Aetna first for reimbursement of the discount but your participating dentist should be able to answer. They should also be able to present you with their fees for common procedures so you know where you stand.
Good luck and I'm curious to hear how this goes for you!
Time is your friend; impulse is your enemy. --John C. Bogle
InvestorHowie wrote: ↑Fri Mar 17, 2023 7:24 am Perhaps that discount is applied (and payable by you) immediately or perhaps they need to pass billing to Aetna first for reimbursement of the discount but your participating dentist should be able to answer. They should also be able to present you with their fees for common procedures so you know where you stand.
Good luck and I'm curious to hear how this goes for you!
I'm almost positive that my dentist, who participates with many insurances, has no idea what the Aetna fee schedule is when I go to the front desk after work or routine dental care. And I have no way of knowing if the fee they tell me is the true Aetna fee. There has to be a more definitive way.
Thank you so much for the reply. But to be honest, all you did was just restate my question! How, exactly, does this work?
I just asked my dentist and they said that I would need to call Aetna. She thought the fee would be around $125 for cleaning and exam instead of their usual $295.
Freeadvice wrote: ↑Fri Mar 17, 2023 8:47 am
I just asked my dentist and they said that I would need to call Aetna. She thought the fee would be around $125 for cleaning and exam instead of their usual $295.
Ok, so you call Aetna and they tell you $125. And you go back to the dentist and say "I talked to Aetna, and they said you cannot charge me more than $125." And the dentist just says "Sure, you're fee is $125". No.
It can't work that way. There has to be a way that both the dentist and the patient can definitively see what is the maximum that the patient has to pay. What, specifically, is the verification method?
What I did was send an email to the dentist office with the prices to confirm. I did this because I’ve been previously blatantly lied to about dental fees for basic service twice in the past.
Freeadvice wrote: ↑Fri Mar 17, 2023 11:09 am
What I did was send an email to the dentist office with the prices to confirm. I did this because I’ve been previously blatantly lied to about dental fees for basic service twice in the past.
I did some digging and found the answer. You have to call the actual Aetna, not the re-seller known as "Aetna Dental Access". Aetna DOES have the actual Aetna Dental Access member information directly on file, even though they don't pay any claims for them. You give them the codes of the dental procedures that will be or were performed, and they will tell you the maximum dollar amount that your dentist can charge for that code(s). Then, I guess, you can fight with the dentist if there is a discrepancy or not. But at least I've now found that you have to call Aetna at 1-877-238-6200 and give them your information and they will tell you the maximum that dentist can charge based on his/her agreement with Aetna. I hope this helps someone else. Thank you all for helping me.
nerdybynauture wrote: ↑Fri Jul 29, 2022 8:59 am
Hi Bogleheads!
Happy Friday!
I have a question for you.
I currently purchase dental insurance for about $100 per month from the health care exchange. This is for our family of four (myself, wife, 2 kids).
We currently do our 6 month visits but with deductibles we pretty much pay the full price anyway. None of us have dental issues.
Do you think dental insurance is worth buying?
Thanks and have a wonderful weekend!
Would anyone buy health insurance that only pays 50% of the bill for most procedures?
Yes, it is a good deal, for the insurance companies or they would not offer it. But for the buyer? YMMV.
nerdybynauture wrote: ↑Fri Jul 29, 2022 8:59 am
Hi Bogleheads!
Happy Friday!
I have a question for you.
I currently purchase dental insurance for about $100 per month from the health care exchange. This is for our family of four (myself, wife, 2 kids).
We currently do our 6 month visits but with deductibles we pretty much pay the full price anyway. None of us have dental issues.
Do you think dental insurance is worth buying?
Thanks and have a wonderful weekend!
Would anyone buy health insurance that only pays 50% of the bill for most procedures?
Yes, it is a good deal, for the insurance companies or they would not offer it. But for the buyer? YMMV.
For the fee schedule. Which is why I dropped my "insurance" and now just bought a much cheaper fee schedule. But that's the main benefit of any dental coverage that I can see. Otherwise you have no protection from getting charged any rate. Of course you have to find a participating dentist, but that's a lot easier than needing work done and having to blindly negotiate with dentists for the best combination of quality and cost. Especially in a dental emergency.
Freeadvice wrote: ↑Fri Mar 17, 2023 8:47 am
I just asked my dentist and they said that I would need to call Aetna. She thought the fee would be around $125 for cleaning and exam instead of their usual $295.
That sounds about right. I have Delta Dental and had a regular exam / cleaning this past January. The bill was $254 for the exam, cleaning, and four bitewing x-rays. The discount (fee adjustment) was $138, amount payable to the dentist $116. I have the regular insurance, so Delta paid the $116 as they cover exams and x-rays with no deductible.
I have generally found my annual premiums to be around the cost of what two cleanings would be. As I am diligent about 2x / year cleanings + pretax advantage+ some additional coverage if needed it usually is a no brainer for me
Dentists in our area (the highly rated ones) will charge about $150 if you have no insurance for cleaning and X-Rays once a year. Some of them send flyers where they will do your teeth for $50 and not bill your insurance but only for a new patient. You can always ask for a cash price. Only you can decide if you really need dental insurance or not. Murphy's law would say you'll need it as soon as you drop it.
An alternative is to pay yourself the $100 per month into an account paying 4.5% or more per month and build up reserve to cover emergencies.
Last edited by enad on Sat Mar 18, 2023 9:28 am, edited 1 time in total.
What Goes Up Must come down -- David Clayton-Thomas (1968), BST
enad wrote: ↑Sat Mar 18, 2023 12:10 am
Dentists in our area (the highly rated ones) will charge about $150 if you have no insurance for cleaning and X-Rays once a year. Some of them send flyers where they will do your teeth for $50 and not bill your insurance but only for a new patient. You can always ask for a cash price. Only you can decide if you really need dental insurance or not. Murphy's law would say you'll need it as soon as you drop it.
An alternative is to pay yourself the $180 per month into an account paying 4.5% or more per month and build up reserve to cover emergencies.
We pay for dental "insurance" because it is subsidized through work and worth it (just barely).
My real frustration is, when did the ridiculously low caps become the norm? This isn't really "insurance". It is much closer the the scam like Aflac plans that I avoid which take advantage of people with cute duck commercials.
We don't have dental insurance but given all the dental costs over the past 5 years I wish I did have it. Every year it's something like $3k after I max our HSA between my kids and wife. Oh well. Braces are coming off soon and wife is all fixed up haha.
"Great parenting sets the foundation for a better world"
RobLyons wrote: ↑Sat Mar 18, 2023 6:38 am
We don't have dental insurance but given all the dental costs over the past 5 years I wish I did have it. Every year it's something like $3k after I max our HSA between my kids and wife. Oh well. Braces are coming off soon and wife is all fixed up haha.
Dental insurance is pretty limited. Not sure what work you've needed but braces and expensive stuff is pretty well limited, if any coverage at all. You might still be head without any dental insurance.
