 Personal Finance PowerPoint Presentation Dental Insurance Shopping Prepare to get financially fit by practicing personal finance. Remember that insurance is part of our long-term risk mitigation strategy using the adage of measure twice cut once, putting a formal plan in place, looking something like setting up our goals, setting up a plan to meet those goals, putting the plan in action, reviewing the result, repeating the process periodically. We're looking at the dental insurance. Most of this information can be found at Investopedia. Dental insurance plans find the best deal for you, which you can find online. Take a look at the references, the resources. Continue your research from there. This is by Ronnie Sandroff, updated March 31, 2021. In prior presentations, we've been talking about insurance in general, then focusing on the health insurance, noting that health insurance can be more complicated due to the health insurance industry complexity, as well as the laws and regulations around health insurance industry and health insurance itself, noting that it's a little bit different than when we think about the other kinds of insurance like liability insurance and the property insurance and the life insurance, for example, where we're often safeguarding against some future event that might be not likely to happen, but if did happen, would be financially devastating, thereby making it worthwhile to buy the insurance to safeguard against an event we hope doesn't happen, but if it did, it would be financially devastating. Similar thing can be thought of for the medical insurance in that we could have a medical problem that is financially devastating, that just pops up out of nowhere, that we hope doesn't happen, but if it does, we want to be insured against it. But we also have all those other kind of things that there's pressure for the insurance to kind of cover the maintenance kind of stuff, like the day-to-day kind of things, and that's where the deductibles and the copays and so on get a little bit confusing. The dental insurance, you'll remember, is similar in many ways to the medical insurance, can be easier in some ways because the dental insurance, it's kind of easier to categorize the types of things that are going to be covered under normal wear and tear kind of dentist procedures as to the whole medical field, can be much more complex. But it's also kind of confusing that the dental insurance seems to be more focused on whether or not you can buy the insurance to mitigate the day-to-day or routine costs because when you look at the caps on the insurance, it's a little bit different structure. On the medical insurance, we've got that out-of-pocket maximum, which is the ultimate, you know, the maximum that you might want to see if you could self-insure up to in the event that there'd be a problem, have a savings account to cover it, whereas the dental insurance has a fairly low cap, which caps the amount that the insurance company will actually pay, which might not be enough to cover, you would think, even fairly modest, but significant, you know, dental bills. So it's a little bit different structure on the dental insurance we want to keep in mind. Okay, buying affordable dental insurance may not be top of mind for most people, but it probably should be. In 2016, about 74 million Americans had no dental insurance. Most health insurance plans do not cover everyday dental needs, such as checkups, fillings, and root canals. So notice these kind of normal kind of day-to-day or routine over a life kind of things can be categorized a little bit more clearly when you're thinking about simply the insurance then when you're talking about more cosmetic type of stuff, possibly, which could also be in the dental, right? So you got this kind of crossover in terms of what's going to be categorized that would be covered in the dental insurance versus possibly medical insurance, for example. And then, of course, we've got the categories we've got to think of with regards to preventative versus non-preventative and so on. So and although health insurance does not cover some extreme oral surgery, such as jaw restoration after an auto accident, once again, although health insurance does cover some extreme oral surgery, such as jaw restoration after an auto accident, routine dental work is usually not covered. So again, you got kind of like that overlap, and when you're thinking about the big catastrophic event, then you might have some overlap which you would be covered for on the medical kind of thing, which of course would be would you have reconstructive surgery or something like that as opposed to normal wear and tear or maintenance on the teeth. So dental benefits plans are designed to fill the gap, whether offered by an employer or through a private insurer. Most plans have monthly premiums deductibles of $25 to $100 co-pays and an annual maximum benefit that the median is $1,500. One good argument for buying dental coverage is that many plans focus on preventative care. So obviously this is one of the arguments that's involved in the medical field in general. They're trying to get more focus on the preventative care if you can get people that are insured. If you were insured, then you might be saying, I'm going to try to maximize the benefit I'm getting from the insurance by doing all the preventative care because that's the stuff covered by the insurance company. So if cleaning and check-ups are free under the plan, you may be more likely to make and keep an appointment. And that could be an incentive. It can feel a little manipulative to me sometimes, but if you're buying the insurance yourself and you're saying, I'm going to buy the insurance because I think that might help and motivate me to take advantage of the free things that are under the insurance, the things that the insurance covers, the preventative stuff, and maybe that'll be an incentive for me to do that, then that could be a positive incentive. But I think it should be something that you yourself are trying to self-motivate as a tool. Otherwise, you might feel that that is a little bit coercive or something like that. So this can save you money and your teeth over the long run. So what are your dental insurance needs? Here are some things to consider when estimating your family's dental insurance needs for the next few years and what they might cost. Do you have a dentist or a hygienist you like? So clearly you might start by saying, okay, am I going to someone I like? Similar with a doctor. If you go into a doctor you like, if you go into a dentist you like, then you might try to tailor your policy around the dentist. If you're not going to a dentist, then you might look for a dentist and then tailor the policy around the dentist, or you might look for a policy and then find a dentist within the network of the policy. Do you have a dentist or hygienist you like? If so, the best place to start looking for a dental benefits plan may be a conversation with your dentist or their staff. So you can start talking to the dentist about what kind of plans they might be a participant in. So find out which plans, if any, the practice accepts and whether it is part of any networks. Also inquire if the dentist participates in any discount programs or has an in-office plan. Are you willing to choose a dentist from a network list? So the other way you might look at it is if you've got the list set up for the network, then you have the plan set up, then pick the dentist that's within the network. You may be able to save money by choosing a dentist from a network list of a dental insurer. However, the least expensive plans offered by private insurers may have small networks. So check that there are dentists in your area who take any plan you are considering. So when you're looking at the actual plan first and you're just going to say, I'm just going to pick a dentist from the network whatever, you want to realize that the network might not be the most expansive network. So you might want to make sure that you do your research in terms of having a dentist that you think is appropriate within the network if you're going to start from that point. What type of care do you need? Most plans generally cover preventative care such as cleanings and checkups to estimate what the cost for the dental care in your zip code will be without insurance. Visit Fair Health or Healthcare Blue Book. So you can go to those websites and get an idea of the healthcare costs, which can help you to measure the pros and cons and the breakeven point possibly of the health insurance. So if you've been getting regular care, your dentist can help you anticipate what you might need in the next few years so they might be able to project forward. Well, this is the standard for people in your situation. Expensive dental care such as braces for a child or an adult can cost from $3,000 all the way up to $10,000 for complex cases. Dentures can cost thousands of dollars and implants even more. If you expect these kinds of expenses, it's worthwhile to investigate what kind of dental benefits can help the most. Can you wait 6 to 12 months for full coverage to kick in? Plans often have waiting periods up to 12 months before you are eligible for some expensive benefits such as the braces or dentures. So remember that that in my opinion is their way to try to handle the preventative situation for pre-existing conditions. So in other words, if you bring up the term pre-existing conditions, insurance companies go, no, we're not going to because it's a big political kind of thing. But obviously from an insurance standpoint, if someone has a pre-existing condition for dental condition, then buying insurance one day and then maxing out the policy the next day would not be beneficial to the policyholder. So they're going to try to screen for that by having that waiting period in place so that you can't basically do that strategy. But you got to know that, got to take that into consideration if you're putting together a realistic plan for risk management for the dentistry. So if you can wait, this kind of policy could save you money. If you can't wait, more expensive plans are available in which benefits start immediately. So you might be able to look at a plan and say, is there a plan I could get that doesn't have kind of that waiting period? But again, you would think the plan would be skeptical to do that because obviously you'd be buying the insurance to cover some pre-existing. But anyway, do you want cosmetic procedures? Cosmetic dentistry includes teeth whitening, veneers, gum lifts, and restrictive fillings or crowns. So most that's restorative fillings or crowns. Most dental insurance plans do not cover cosmetic procedures and plans that do may have a limited network and pay only a small percentage such as 20% of the cost. Dental discount cards which provide discounted services from a network of dental providers may be used for cosmetic procedures. You can see more below under dental servings plans in that case. Dental benefit options. Your location and where you get your health insurance often determine the dental plans available to you. Monthly premiums for individual coverage range from $20 to $80 on average. Both private and employer sponsored plans also have annual deductibles and annual maximum benefits of $1,000 to $2,000. So again, those are fairly low kind of maximum benefits because we just talked about the fact that the big procedures that could come into play could clear the $2,000 by a significant margin, you would think. And again, you might be able to self-insure up to a reasonable range around $2,000, although, you know, the plans will differ and those might roll over from year to year two. So if the plan's maximum benefit is not enough to cover your expenses, look for a plan with a higher maximum. So keep in mind that pre-existing conditions are not generally covered by dental benefits. If you had a tooth missing before the effective date of your coverage, for example, you may not be entitled to benefits. Here are the main sources for dental benefits plans. So one, employer-based dental plans. Most Americans, 77 percent in 2016, get dental insurance through their employer. So similar to the health insurance, you might have those plans or the group plans and so on through the employer. This is often the most economical choice because the employer pays for part of the premiums. So you might be able to get a benefit that would have tax implications and incentives like with the health insurance, which can make it beneficial to get the insurance through the employer. So it's important to check the policy before you enroll so you're not surprised by out-of-pocket costs. If a flexible spending account is available, consider using it for your share of the expense. Two, flexible spending accounts. Those are the FSAs. Any dental visit or procedure that treats or prevents a disease is eligible for FSA coverage, sometimes offered by employers along with insurance. Cleaning, x-rays, crowns, tooth extractions, dentures, gum treatment and more are included. However, cosmetic procedures such as teeth whitening, veneers or cosmetic orthodontia are not. Your dental office should be willing to help make sure services are covered under your FSA plan. So we've got number three, we've got the Medicare Advantage plans. Most people on traditional Medicare do not have dental coverage. Almost half of them have not been to the dentist in the past year and nearly 20% spent more than $1,000 out-of-pocket on dental care. Traditional Medicare does not cover dental bills except those associated with severe conditions that require hospitalization. Most Medicare Advantage plans, however, offer at least some dental coverage. Some plans pay only for preventative care while others have more extensive coverage. Some Medicare Advantage plans charge an additional premium for dental coverage. Several on AARP's best Medicare Advantage plans include dental coverage. Number four, we've got healthcare.gov and Medicaid under the Affordable Care Act. Dental coverage for people under 18 years of age considered as essential benefit and must be available for your child. But dental coverage is not considered an essential benefit for adults. So in that kind of makes sense, obviously, when your teeth are changing, it might be more of a requirement at that point. Some participants' plans for adults include dental benefits. In some cases, the insurer offers separate standalone plans for a separate additional premium for children covered by the Medicaid or the Children's Health Insurance Program, that's the CHIP, CHIP. Dental benefits are provided by the state. Some states also provide dental benefits to adults covered by Medicaid. Privately purchased dental insurance then insurance companies sell a variety of individual and family dental benefit policies online. You can choose a plan that covers only preventative care or a more comprehensive plan that also pays a percentage of costly procedures such as root canals, bridges and implements. In choosing a plan, check whether there are dental practices in your area that are part of the network. Number five, we've got the dental savings plans, often called discount savings or referred plans. This is a membership club for reducing dental bills. The discount company contracts with dentists who agree to reduce their fees to members. The discount usually applies to all services including cosmetic procedures, which is nice. To join a savings plan, you pay an annual fee that entitles you to discounted rates from network dentists with no annual maximum. So that's interesting. Some dental offices offer their own in-house discount plan with lower prices on services for patients who use that practice. People who require little dental work say just cleaning an occasional x-rays may save money using a discount plan rather than paying for dental insurance. People who have medical conditions that affect their teeth and gums or need extensive work may save more with insurance if they can stay under the plan's annual limit. The best way to decide is to compare the cost of a discount plan versus a dental insurance policy for your individual situation. What's the bottom line you might ask? That's a horizontal mark that goes under the last point of a discussion or math calculation, often time. We call it the bottom line because it's at the bottom. Any case, make sure you don't leave money on the table. If you enroll in dental insurance or use an FSA, it's a good idea to keep tabs on key dates for using your benefits. Only two to six percent of those covered by dental benefit plans reach their annual maximums according to the National Association of Dental Plans to get the most out of your policy plan and schedule dental appointments in advance throughout the year to help ensure the work is done before the benefit runs out.