This week’s questions from Mark
I wonder if you represent any insurers who offer dental and vision insurance. I tried to track down articles you may have written on this topic with no success. I’ve incurred some large dental bills in recent months. Fortunately, we had good coverage through my wife’s employer. She plans to retire June 30 and we would like to plan the best way to cover future dental bills.
Answer
We Haven’t Found The Right One
It’s been a while since I wrote about this topic Mark. And unfortunately, I still don’t have an individual dental plan I’m comfortable selling to clients. Here’s what I’ve been searching for the last 14 years; A plan that costs $30 per month or less and looks like employer provided plans. Those generally cover preventative (cleanings and X-rays) services at 100%, basic or restorative (fillings and periodontal) services at 80%, and major (crowns, root canals, partials, and dentures) services at 50%. And all need to be offered without a “waiting period,” which most individual plans who cover all three categories of services employ. This means claims for basic or major services will not be paid for one to two years.
I’ve found individual plans that met my criteria, however, they rarely have nearly enough dentists in the network. More recently I discovered a company who offered what looked like a couple of excellent plans and we started selling them. Unfortunately, the company was an absolute mess internally and they didn’t provide enough customer or agent support that we expect and need. After the company failed to solve several issues, I decided to suspend sales of their products.
And that wasn’t the end of the world because even employer and some of the better constructed individual plans don’t do whole lot in the grand scheme of things. They generally only pay between $1,000 to $1,500 in claims per year. Expensive services like root canals, crowns, and dentures are only covered at 50% of the retail. This means a $1,200 crown still costs someone with insurance $600. We buy insurance to protect our assets. This is why we have homeowners, auto, and life insurance policies that can pay out tens or hundreds of thousands of dollars in claims. Not having those types of insurance can end up causing a financial catastrophe. But when it comes to dental insurance, you’re not going to be forced into bankruptcy because you didn’t have insurance to pay $60 of a $75 of an amalgam filling or $500 of a $1,000 root canal. I think most of us are used to having dental and vision through our jobs so we’ve been somewhat programmed that it’s a must have. It simply isn’t necessary. It’s more of a luxury.
You May Already be Covered
There are a ton of plans available that we could sell if all we were looking to do was make a commission. But that’s not how we operate. I won’t sell any product that isn’t a value to clients. Virtually every dental plan available on the open market will never be a “win” for the insured. If it were, there wouldn’t be any dental insurance companies in existence. I estimate that 99% of people who have individual dental insurance will pay more in premiums than they will ever get back in claims paid during any five-year period.
And vision insurance is practically useless. The industry standard benefits for vision plans are one free eye exam a year, which is a $50 value, and $150 towards a set of glasses or contacts every two years. That means someone with vision plan receives a maximum benefit of $250 every two years, or $10 and change per month. With dental plan monthly premiums in the $8 or $9 range, it’s like trading two dimes and a penny for five nickels. It’s not worth the effort.
And if you didn’t already know, your medical insurance, be that through your employer, the ACA, or Medicare, covers all medical issues of the eye or mouth such as glaucoma, cataract, macular degeneration, an eye infection, a broken jaw that needed surgery, etc. Please be advised that extractions of teeth are not considered medically necessary or covered by commercial insurance or Medicare.
Our Offerings Include Alternatives
However, Medicare Advantage Plan HMO’s and PPO’s that we recommend to our clients who choose to go this route, do offer very good comprehensive dental and vision. Select plans pay 100% of all dental services other than implants, up to $3,000 annually, and as much as $400 for a pair of glasses or contacts each year. The majority of Advantage Plans that offer comprehensive dental and vision provide coverage that’s as good or better than most employer plans.
The advice I gave to Mark was he looking into to taking COBRA for just dental, which is an option for almost everyone who leaves an employer and is losing their health and dental insurance. As long as it’s $30 or less, it will be his best and only viable option in my opinion. The question I often get from people in Mark’s position is, “What do I do after COBRA runs out.” My answer is always the same. You don’t buy dental insurance and pay for services as you go.
Thank you!
If you have any questions or concerns regarding this column topic, or would like to make an appointment for a no-cost consultation, please feel free to give us a call – we would be happy to help. I’d like to remind everyone that I do a live call-in talk show called Medicare A to Z every 1st and 3rd Monday of the month on WMBS Uniontown, 590AM and 101.1FM, from 1 to 3 PM. You can listen in on their website, wmbs590.com.
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