Dental Insurance

I did see the other Dental Insurance thread from 3 or 4 years ago but it doesn't seem to deal with much that I'm concerned about.

I'd been going to the same dentist for many years (with good results) but he recently retired. He didn't accept any insurance, as far as I know, and once stated that dental insurance usually wasn't worth what it cost. As I understood the arrangement (some years ago now):

-- I'd be paying the "plan" a certain amount each month for the coverage.

-- The plan would give me a list of dentists I could go to but my dentist wouldn't be one of them.

-- The dentists on the list would have a deal with the plan where the plan would send them patients in exchange for the dentists charging plan members a little less (something like 80% of their standard fees, I thought).

-- The savings to me would be roughly equal to what I'd be paying the plan in premiums, and my premiums would go to keep the plan in business.

It occurred to me that dental practices that weren't attracting enough patients on their own -- in other words, not necessarily the best dentists in town -- would probably be the ones most interested in getting more business through the plan.

I also remember reading somewhere (I wish I could find it now) that dental insurance would never be a particularly good deal for patients because it was possible to predict pretty accurately what kind of treatment someone was going to need, how much it was likely to cost, and therefore what the premiums would have to be in order for the insurer to come out ahead.

Now my healthcare provider (a large nonprofit) tells me that for an additional $16 a month I can get supplemental vision, hearing, and (ta daa-a-a!) dental coverage. My new dentist (whom I haven't actually met yet) accepts the coverage. I have until the end of this month to decide. I'm thinking of trying it, at least for the rest of this year, but I also wonder how it'll work out for me -- and especially, if it'll be any better than the plan I described above.

I normally get four cleanings and one set of x-rays a year, almost never any fillings. I've had several crowns so far, several extractions, one root canal, and two rounds of gum surgery; and I could very well need more of any of the above eventually. The plan, if I signed up, would allegedly pay for three cleanings, one set of x-rays, and (with varying copays) pretty much every kind of treatment including gum surgery. What I don't understand is what the loopholes and the catch are likely to be, that might make this not such a good deal after all -- or else, what I'm overlooking that might make it a better deal than I expect.

Sounds like its worth it just for the cleanings.

It does. What I'm imagining, though, is that someone will tell me that the cleanings I've been getting for years are the fancy $150 kind but the ones covered by the plan can only be the basic, oh... $30 or something kind.

And maybe the x-rays will only be available when Superman happens to be in town....

I see. Thats true, they do like to change up the cleanings you get. Sometimes you get a thorough one by an expert, sometimes its "we dont do that anymore, its against covid rules."

The only way to win their game is to be rich. Otherwise, yep youre the fooze ball being flipped and batted around!

I like my insurance, it prevents a heart attack when i get a crown!

I've been in a place of having dental insurance and paying out of pocket at various times. Since cleaning tend to be the main cost and tends to be well covered I find dental insurance to generally be a pretty good deal. I've generally stuck to the same dentist through changes in insurance and paying out of pocket and have never noticed a difference in the type of cleanings I got as a result. Hopefully you won't run into something like that.

Sometimes you have the opportunity of going out of network to a dentist of your choice and then making up the difference between what your insurance would pay an in-network dentist versus the dentist of your choice. Like I used to get tooth colored composite fillings in a time and place where amalgam fillings were still used. My insurance would only pay for an amalgam filling at the time so they paid that amount and I paid the difference for the composite filling.

My current dentist isn't in network to my current plan but it still covers her costs 100% for cleaning and x-rays, and my last cleaning was VERY thorough! It sounds like it may be worth trying out, crunching some numbers, and maybe even shopping around. Hope it works out for you!

Thanks for the feedback, unaluna and ArmorPlate. I've printed out the application form and I'm going to send it in.

i hope they accept your form thing fooze

If I don't misunderstand this (I'm not American), I would see this "arrangement" as an outright scam....and would be highly skeptical that this would be true of normal insurance, as in, the point of insurance is everyone pays a little regularly, so that they do not have to pay a lot at one point out of pocket. But I don't know a lot about the US health insurance, just assuming that it's still a type of insurance as far as this basic concept can be applied. This doctor though, that stated all this about the "arrangement" above, he may have had self-interest in claiming that insurances got no point to them. After all, he did not accept any insurance at all.

I'm hoping I don't misunderstand it too badly either. If I remember correctly, I last asked about (and researched) the subject about 15 years ago, when I was looking at paying for a root canal that I might need before I could properly afford it. My dentist looked at the x-rays and decided he'd better send me to a specialist. Unlike my dentist, the specialist didn't extend credit.

I don't remember exactly how the numbers added up, but my co-payments for various services were going to be around 80% of what my dentist normally charged. It wouldn't have made sense for the insurer to select dentists who'd charge more than normal, so I figured they had to be settling for a bit less than normal. The insurer might make up part of the difference between what I paid and what the dentists received, but they'd have to take something for themselves or they wouldn't be able to stay in business.

I think that particular plan would have been a slightly better deal for me if I were going to get lots of crowns, root canals, gum surgery, and other expensive stuff, but I'd just have been spending 80% of a whole lot (plus the plan premiums) instead of the full whole lot.

I have reason to think that the plan I'm applying for now may be a better deal. For one thing, it's being offered as a supplement to something that's partly subsidized by federal programs.

16 bucks a month seems well worth it. The cleaning process itself stays the same whether I have insurance or not. I've also used it at dentists and specialists who don't accept it. I pay up front and the insurance company reimburses me.

The catch is that most plans only cover 1k of work a year. It's very easy to max out if you need a couple of fillings or a root canal and a crown. I try to time things, if I can, so I get the root canal in one year and the crown the next.

I've had to have a great deal of rather major dental work done in the last few years. My dental insurance has certainly covered a great deal of that work -- worth the premium for me.

Now that I have that major work finally done, I may step down to a different plan that has lower premiums since mostly I should only need routine cleanings from this point onward.

Personally, dental care needs to be part of health insurance, but that's a whole other discussion.