Open enrollment is coming up quickly for 2020's insurance plans. We are often asked for input from people on what plans we recommend, and which insurance companies are best. So, we thought we'd aim to be helpful and address some of the most common question topics.
Choosing A Plan Level Through An Employer
For individuals who have just one dental insurance plan offered through their employer, the choice is easy. However, some employers offer two plans and we’re often asked by patients in this situation which plan they should choose. Typically, the two plans offered are provided by the same insurance company but are a "standard" plan and a "high option" plan. The "high option" plans undoubtedly provide better coverage to a patient, but many times patients struggle to decide if they really need the “high option” plan because it costs them more per month. If you already know that you have a lot of dental needs, strongly suspect you do, or have periodontal disease--the high option will always be the better choice for you. On the contrary, if you are a patient that routinely comes in for your six-month cleaning & check-ups and rarely ever needs a cavity filled, it's more cost-effective to go with the "standard" plan. If you haven't been to a dentist for several years and aren't really sure of your needs--you could look at seeing a dentist for a comprehensive exam & check-up x-ray appointment prior to your open enrollment deadline to find out what dental treatment you do need and make a more educated decision from there.
If you are a federal employee your choice is the most difficult. The federal government offers the greatest number of options to its employees. Last year, their open enrollment offered plans through Delta Dental, Aetna, Cigna, GEHA, and MetLife and there were "standard" and "high option" plans for each of those companies. Our office is contracted with each of those insurance companies. As a contracted provider, we've signed a contract with these different insurance companies agreeing to use contracted fees, rather than our normal office fees, when completing treatment for patients with in-network plans. This typically results in our office writing off a portion of our fees and the patient having a lower out-of-pocket cost.
From the insurance choices given to federal employees last year, the "high option" plan through GEHA has proven to be the best plan in terms of procedures covered, the total amount of procedures covered, and the out of pocket cost to patients. Another great benefit of the GEHA high option plan is there is no deductible, no waiting periods, no missing tooth clause, no downgrades on treatment completed on molars & pre-molars, night guards and implants are covered, and there is orthodontic coverage for adults! GEHA is also great at processing their claims in a timely manner with limited hoops to jump through.
Choosing An Individual Dental Plan
If your employer doesn’t offer a dental plan and you’re seeking dental coverage you will need to purchase an individual dental plan. There are many companies that offer individual dental plans. We strongly recommend that before signing up for an insurance plan you read all the small print and ask questions. Here are a few questions we recommend:
1). Is the provider you hope to see considered “in-network” for each of the plan(s) you are considering?
It is important to ask the insurance representative to check on the “in-network” status for each of the plans you’re considering because many insurance companies have several networks within their overall company. For example, Nelson Dentistry is contracted with Cigna. So, if you ask Cigna if we are “in-network” their answer will be yes. However, we are not “in-network” for all of Cigna’s plans. Cigna has a specific network called the Cigna DPPO Advantage network that Nelson Dentistry is not “in-network” with. So, if you selected that plan and then came to Nelson Dentistry for treatment we would be considered out-of-network.
2). Are there waiting periods for services?
It's common for there to be waiting periods on major services such as crowns, dentures, implants, and bridges of either 6 months or 12 months. It's less common for there to be waiting periods on basic services like fillings, extractions, and periodontal treatment but some plans do have a 6-month waiting period.
3). Is there a missing tooth clause?
If you're looking at dental insurance because you would like an implant, a bridge, or dentures knowing about the missing tooth clause will be very important to you. If a plan says yes, there's a missing tooth clause, most times that means they will not cover any tooth replacement options listed above for any teeth that were removed prior to you enrolling on the plan. There are some plans whose missing tooth clause is just for the first year or two, meaning that you must be covered on that plan for the first year or two and after that, the missing tooth clause is no longer a factor.
4). What are the yearly maximums & deductibles?
In the dental insurance world, the maximum refers to how much your insurance plan will pay up to each year. The deductible is usually $25-$150 and is applied to your first treatment appointment of the coverage year.
5). What are the number of preventative appointments covered?
A standard tooth cleaning is called prophylaxis. For most patients, this is recommended 1 time every 6 months and most insurance plans cover it at that interval. Some patients do have a greater need and it's recommended 1 time every 4 months. It's always nice to know if your plan covers 2,3, or 4 prophylaxis per year. Or if they only cover 2 per year but you have the option of an additional cleaning if you are pregnant or have diabetes. The other type of routine cleaning is called periodontal maintenance and is necessary for any patient who has active periodontal disease. Periodontal maintenance is recommended 1 time every 3 months or 1 time every 4 months, depending on individual needs. You'll want to know if your plan will cover this 2,3, or 4 times per year and whether it will be covered as a preventative service (100%) or basic service (80%).
6). Which dental insurance do we recommend?
To date, the best individual dental plan we've encountered has been the BlueCare Dental plans offered through BCBS of Montana. Each year, they typically offer two or three different plan levels to choose from. We're fans of the BlueCare Dental plans because BCBS of Montana is one of the companies we contract with so there are few surprises when it comes to allowed fees, they are easy to communicate with and receive answers from, they process claims efficiently, and they pay a decent amount on all dental services with minimal downgrades and exclusions. The only downside we've encountered with the BlueCare Dental plans is that they are only offered to those under 65 years old.
Is Dental Insurance Cost-Effective
The answer to whether an individual dental insurance plan is cost-effective for someone is highly variable. If you haven't had a cavity in 20 years, have zero teeth concerns, and just need your 6-month cleaning & check-ups, a dental insurance plan will most likely cost you more money than if you just paid your dentist out-of-pocket. That being said - life happens. For example, say you are leisurely enjoying a movie while munching on your popcorn with extra butter and you don't notice the unpopped kernel of corn and the worst happens - you break a tooth. If a finicky 12 month waiting period doesn't intervene, your dental insurance will likely cover half the cost of your needed crown. In this scenario, your dental plan definitely ends up being cost-effective! The risk and the choice are up to you.
Nelson Dentistry knows that choosing the appropriate individual dental plan can be very confusing. We are here to help so do not hesitate to give us a call with any questions. Additionally, if you are a retiree seeking an individual health plan your options are limited. We are excited to announce that we will be rolling out the Nelson Dentistry Savings Plan by the end of 2019 that will help you save on your dental costs.