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Question: I’m going on Medicare soon and was considering a Supplement, but they don’t have dental or vision coverage like Advantage Plans. Can I buy those separately and if so, what company do you recommend?

Answer: This is one of the biggest concerns for those who are going on Medicare or currently enrolled. I’ll tell you the same thing I tell all potential clients. Dental and vision coverage isn’t necessary at all. There are so many other more important factors to consider when making your decision on Supplement vs Advantage Plan. Let me explain.

First and foremost, remember why we have insurance. We buy it to protect our assets. You aren’t going bankrupt because you need a root canal or a new pair of glasses. Secondly, all medical conditions of the eye or mouth like Cataract, Glaucoma, infections, a scratched cornea, a broken jaw, etc., are covered as a medical benefit with both Supplements and Advantage Plans. You don’t need additional vision or dental coverage for those. 

I’ve been searching for a viable individual dental plan to sell since I opened The Health Insurance Store 11 years ago to no avail. I could make a lot of money if I ever found one. But after reviewing available plans, I always come to the same conclusion. You will never get back in benefits what you pay out in premiums over time. The only dental plans that come close to offering value are those provided by an employer. Industry standards for dental plans through an employer are as follows: Preventative services (cleanings and X-Rays) are covered 100%. Basic services (fillings and Periodontal) are covered at 80%. Major services (Crowns and Root Canals) are covered at 50%. And generally, the maximum benefit is $1,000 per year. I have never come across a plan on the individual market that was this comprehensive. Most are just discount plans that have no real defined benefits or have waiting periods of two years or longer before any “basic” or “major” services are covered. Do the math. What are you going to pay per year in premium and what would the so called “covered” services cost if you had to pay it on your own? It’s not going to come out in your favor. If it did, companies that sold dental plans would go out of business quickly.

As far as deciding on what type of plan to take, Supplement or Advantage, based on dental or vision, be careful! Most Advantage Plans that offer so called dental only cover cleanings, X-Rays, and nothing else! And as far as vision, the average benefit is one eye exam and $150 towards a pair of glasses every two years. Remember that Advantage Plan HMO’s and PPO’s expose those on them to between $3,400 to $6,700 in out of pocket medical bills annually, as opposed to Supplements which have zero or close to zero out of pocket costs.  A five day or longer hospital stay is likely to have a co-pay of over $1,000 with the majority of Advantage Plans. I’m not sure passing on a Supplement to get what I consider to be very limited dental and vision coverage is wise in the end. How free was that teeth cleaning if you had to pay $1,500 in total bills related to a knee replacement or other inpatient surgery or hospitalization?

I estimate that 10% to 15% of available Advantage Plans in Western PA do offer “comprehensive” dental that not only cover cleanings and X-Rays, but also help pay for fillings, crowns, root canals, and even dentures. The benefits closely mimic what I described as industry standard for employer plans. And a couple of them are also very competitive in what I consider to be the most important aspects of Advantage Plans; premiums, annual Maximum out of Pocket (MOOP), and lower hospital co-pays. If you prefer Advantage Plan HMO’s or PPO’s and can get a plan with a similar or lower premium to what you currently have, overall lower co-pays, and the same or less MOOP, while gaining up to $1,000 per year in preventative and comprehensive dental benefits as well as maintaining or gaining access to all Western Pennsylvania hospitals, it makes sense to do that.

But again, I still don’t recommend choosing an HMO or PPO over a Supplement for that reason alone. 2019 is the first time in ten years these comprehensive dental benefits have been offered to those who aren’t on Medical Assistance. There’s a very good chance that these companies will eliminate them as soon as 2020.

And if you weren’t already aware, Supplement companies can discriminate against those who had or currently have certain medical conditions and deny coverage. So, if you opted out of your Supplement or initially chose an Advantage Plan for dental coverage and then it goes away, there’s a chance you may never be able to get an affordable, or any, Supplement policy in the future.

If you’re going to choose an Advantage Plan over a Supplement, it’s my professional opinion that should be done for the potential to save thousands of dollars in premiums over a five to ten-year period. We never advise potential clients to put more weight into dental, vision, hearing, or a free gym membership than nationwide access to doctors and hospitals and the elimination of thousands of dollars in medical bills that Supplements offer. What I consider to be the biggest risk of choosing an Advantage plan, never being able to enroll in a Supplement again, also should be more of a factor in your decision in my opinion. 

If you have any questions, fell free to call and speak to myself or another of our licensed agents. To read previous columns visit us on Facebook or go to our website at getyourbestplan.com.

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