Advice about dental plans?

In My Humble Opinion
1

As of the date of this pos, I am choosing a HMO dental plan to coincide with my Obamacare health insurance plan. The first payment is due the first of March

I need a lot of dental work done. I have: one chipped tooth, multiple teeth with horizontal and vertical cracks, sweet sensitivity, slightly stained teeth, etc. Thus I will be using the coverage a lot.

The dental plan requires my to choose a primary dentist. This is where the problem lies.

All the dentists in the HMO dental plan have terrible Yelp.com reviews, mostly two stars and lower. The low reviews were bad enough but; what really gives me pause are specific transgressions like: the lack of communication, rudeness, high turnover of staff, consumer fraud.

All the in HMO dental plan primary dentist belong to the same company.

I thinking about forgoing this HMO dental plan and finding something else independently.

Any Advice?

2

Reported for forum change.

3

In-network doesn’t pay much to the dentist, so the good dentists don’t like being in network. If you want to get a good dentist, you may need to get a PPO plan and then get out-of-network services. Different plans have different OON reimbursements. Some will reimburse 0%, some will reimburse 80% of their standard value. For example:

Good dentist: A crown is $1200. I’m not in network for anyone.
Good insurance: We’ll reimburse 80% of our standard rate of $900 (.8*900 = 720)
You’ll end up paying: 1200-720= $480 for a crown

HMO’s are cheap because they don’t pay out very much. So you end up with the dentists which are hungry for patients even if they don’t make much money from them. But that may be your only choice depending on your finances. Good PPO insurance will cost more $$ than an HMO. You’ll have to spend more $$ for the premiums and more $$ for the out-of-pocket costs.

4

And dental PPOs are expensive. I’ve been through the same dilemma you’re having. I finally ended up with a dentist I pay out of pocket. I get good care, and it’s not more expensive than paying for PPO insurance + copays.

I am fortunate to be able to afford this and not everyone can. A lower-cost option is to see if there’s a dental school near you that will take you as a patient. Yes it’s students working on you, but under supervision, and it’s not so different from being treated by residents at a hospital.

5

Dentist here, pretty much what filmore and TSBG said. There are good plans out there but they tend to be expensive. Also most good plans will have pre existing condition clauses for missing teeth. That is they will not cover anything towards replacing missing teeth so no coverage for bridges or removable partial dentures. They also tend to have low maximums typically $1000 to $2000 per year. As for coverage that filmore mentions 80% is usually for fillings, extractions and root canals. Crown and bridge coverage is usually 50%. Cleaning and exams usually 100%. Of course there is a lot of variability but that is how the vast majority I have seen are.

6

Advice is best suited to IMHO.

Colibri
General Questions Moderator

7

Thought about this a little more. I did get decent care from one place I was eligible for on my HMO, when I had it. But I generally take good care of my teeth, or have since I had a ton of cavities as a kid. But there was constant upsell pressure from them–teeth whitening, antibiotic treatments for my gum pockets, etc. To be fair, I did have deep gum pockets, though that went away after I quit smoking–but I still got the big sell on “deep cleaning.”

I’m lucky enough to have a cousin who’s a dentist, so once every couple years I would check in with him; he agreed with the antibiotic treatments when I did have the deep pockets, but he never thought I needed the “deep cleaning.”

At a certain point I got tired of the upsell from my dentists, and tried a couple different ones. One claimed to have found five cavities that needed immediate filling. I haven’t had a cavity in 30 years…back to my cousin, who confirmed I had none. After that I dropped my HMO and started seeing my current dentist.

I don’t mean to say that all dentists are shysters, far from it. But the ones who take HMO patients most likely feel some pressure to increase the margin. Deep cleaning is one thing, though, phantom cavities are another.

Some dentists (like some doctors) will negotiate on price for cash patients, and all will give you some kind of a payment plan, especially if you’re having a lot of work done.

If the dental school isn’t an option (and they don’t take everyone, only need so many practice patients) I would suggest spending your money in this way:

Identify three good dentists through Yelp, personal referrals, whatever. Call them up and find out who charges least for X-rays. Go to that dentist first for a checkup and X-rays. Visit dentists 2 and 3 for checkups with X-rays from dentist #1. See what the assessments of your needs are, and who you feel comfortable with. Settle on a dentist and call their billing person to see if you can make a deal for the work needed and how long they will spread out payments (should be interest-free, btw).

rsat3acr, that all makes sense, right?

8

I’m retired and was recently looking around for dental insurance. The best I found cost $1200 per year and would pay out a maximum of $1500 per year. So, at best I could save $300, but it would cost me some money and planning to do it. There would be co-payments and deductibles before I reached the max payout.

I didn’t buy dental insurance. I kept up on my dental work while I was employed, so I don’t need much done now (although that could change quickly).

When I was young and poor, I had work done at a dental college. My experience was good.

My main piece of advice is to be sure to find out if there’s a maximum amount the policy will pay per year.

9

How much is the dental plan?

When I signed up for insurance on the exchange there was only 1 or 2 options for health insurance that were both incredibly expensive. The only dental plan was really cheap…so cheap it wasn’t even worth thinking about. If I never use it, the extra cost is insignificant. If it ever does cover anything, I’m ahead.

10

yes

11

Dental plans work best as an employee perk from the employer, not as private insurance you buy yourself. You are really just adding an additional bureaucracy layer that also wants a cut with private insurance. You may get (un)lucky and hit one of the higher benefit claims for private insurance every once in a while but you will most likely end up paying more anyway over time.

I have a very good dental PPO plan but my employer pays for all of it and many procedures still aren’t cheap at all even after the insurance. I have had to still shell out hundreds to over a thousand dollars myself even with that plan. Cleanings, examinations and periodic x-rays are covered but actual procedures are covered at different rates. I am glad that I have it because there is no cost to me but I wouldn’t buy it myself even if I could find a reputable company that offered it.

Besides dental insurance, there are also dental discount plans. The aren’t insurance at all but supposedly negotiate reduced rates with some dentists for a rather small monthly fee. I think most of them are a scam but there are some that have been around for a long time and have decent reviews as long as a dentist suitable to you participates in their network.

12

My bad!

13

My part of the monthly payment would have been just over nine dollars.

14

I do live near a dental school. A damn good one in my opinion. I had all four of my wisdom teeth pulled there about a decade ago for just over three hundred dollars.

When I first chipped my tooth, I did go there to see if they could repair it on the cheap, but was rejected as patient.

Funny story. Immediately after having my teeth pulled, with my mouth still numb and filled with absorbent material I went to a Wally World (Walmart) pharmacy to get a prescription filled. People were giving my nasty looks and I could not figure out why until I got home and looked in the mirror.

I was drooling long strands of viscous, bloody saliva from my mouth the while I was walking in Wally World. But I did not notice because my mouth was still numb.