 Personal Finance PowerPoint Presentation, dental insurance and crowns. Prepare to get financially fit by practicing personal finance. Insurance is part of our long-term risk mitigation strategy where we follow the adage of measure twice cut once putting a formal plan in place, something like setting up the goal, putting a plan together to reach those goals, putting the plan in action, reviewing the results and repeating the process periodically. Most of this information can be found at Investopedia. Does dental insurance cover crowns? Which you can find online. Take a look at the references, resources, continue your research from there by Rosemary Terpalali, updated August 28th, 2020. Does dental insurance cover crowns? Are crowns covered by dental insurance? In prior presentations, we've been talking about insurance in general. And then we went into the medical insurance, which can be a little bit more complex because of the complexity of the medical field, as well as the laws and regulations that surround it and its insurance. Also noting that we kind of are expanding the insurance from not just covering the big event that's hopefully not likely to happen, but if did happen would be financially devastating to also covering or hoping to cover at least part of the preventative or kind of maintenance kind of procedures. Dental insurance kind of follows that policy a little bit easier than the medical insurance to understand because there's certain things that we can fairly well define in terms of what the normal kind of procedures would be on the dental side of things, making the categorization a little bit easier, but it's still a bit different and possibly even more different than what we would think about from standard insurance when we're trying to safeguard against a big event that possibly is less likely but would be financially devastating and the dental insurance tends often to be a type of thing that's gonna help us with the preventative and maintenance kind of things, although we can use it and possibly some self insurance to help us to safeguard against kind of higher costs depending on our circumstances. So now we're looking at the crowns which can be a significant kind of dental procedure. So are crowns covered by dental insurance? The short answer is yes, but not in all cases. So the most important determinist is the reason for the procedure. So obviously if you just want a gold crown because it looks cool when you're smiling on the YouTube or something like that and you don't really need it, then that might be different than other types of crowns that are required. If done for health reasons, coverage is possible. If done only for cosmetic reasons, chances are the crown is not covered. So what does dental insurance typically cover? The typical annual maximum coverage cap on dental insurance amounts to a median of $1,500. It covers procedures strictly related to health and wellness and has a three tier structure known as 18050. So we talked about this idea that the insurance is gonna typically going to be helping with the more procedural types of things that they're gonna categorize in different categories to determine what the coverage will look like. We've got the deductibles and the copays that are gonna be in place, but also the difference between the medical that I just wanna make sure that we continually point out is the medical side often has that out-of-pocket max, which is a good number to know because then in a really bad situation on the medical side, if you had a big sickness or gotten an accident or something like that, it's interesting to know what that big cap would be because after that point in time, the insurance might kick in. On the dental, you've got a fairly low cap which is different. That's the cap that the insurance will max out at and then you'll pay the rest after that point in time, making it again, a little bit different in how you might think of it to other kinds of insurance. You just wanna keep that in mind as you're trying to co-insure and think how you're gonna put your insurance in there as well as thinking about what kind of procedures are under the dental insurance versus the things that are medical insurance. If you got in a car accident and you had to reconstruct your jaw or something like that, that would clearly be quite expensive but it's not the typical thing you think about with the dental insurance, which is more usually wear tear maintenance on the teeth, which is more kind of predictable kind of stuff generally. That's my interpretation generally. Preventative care such as annual cleaning, x-rays and sealants is covered 100%. So typically you got the insurance, it's gonna cover that basic stuff. Now, if that's all you need is the basic stuff, then it might cost more for the insurance than to do that kind of basic stuff, but it might still be worth it because one, the insurance might be helping you to kind of incentivize you to take advantage of what you already paid for in the form of insurance, which can be good, although you wanna make sure that you consciously put that plan in process so that it's your choice to put that kind of pressure on otherwise you can feel kind of like it's a coercer type of thing or I could have paid it for it without the insurance, but also that it might cover to some degree if there's some kind of risk factor that goes over and above that that's more expensive, although again, you've got kind of like that cap and how much the annual insurance will pay out, which is fairly low. Then we've got the basic procedures such as fillings, extractions, periodontal treatment for gum disease are covered to 80%. So those are the stuff with the insurance, you'll have to pay part of it, they're not preventative at that point. And then we've got the major procedures, the crowns, the bridges, the inlays and the dentures are covered 50% oftentimes. So depending on your plan, root canals can fall into either the basic or major category, most plans focus on preventative and basic care and not all procedures are covered. Now notice the types of things that we're talking about are pretty kind of set types of things, right? These are the things that we kind of expect to happen or quite possible to happen just from normal wear and tear and whatnot and the normal progression of a person's life, not including reconstructing their jaw or something like that with a big kind of accident type of thing. That's the kind of thing that we're typically and those kind of things, notice, you could be a little bit more basic or you know exactly what's gonna happen with some more certainty possibly than with other things in the medical area where you might be saying, I don't know exactly what the problem is. There's a ton of things that could be the problem. I know there is a problem and so those are harder to kind of categorize. So with the categorization of the standard kind of things that makes the dental insurance easier to some degree to understand. So most insurance companies have a waiting period for new patients though there are some that don't. So note this in my opinion is a way for people on the insurance companies to deal with the preexisting conditions. That's a catchy thing. It's a term that people don't like the preexisting condition situation but obviously if you buy the insurance because you know you need a crown and then the next day you get a crown and you max out the amount that the insurance company has to pay that is not really the design of insurance. Insurance is there so that it does the preventative stuff and then it would kick in in the event that you have the need that's gonna be more kind of an expensive kind of need. So one way they can kind of get around that is they could basically say, we're gonna have a waiting period before we pay for that more expensive stuff and which kind of makes sense. Otherwise you would think that they would have to actually give you a checkup and say, oh, do you have any preexisting conditions and then tailor the insurance coverage to that which one would make people upset and two would require an extra kind of step in the process. So to me, this is a way that they might be mitigating that but one that you have to be well aware of when you're buying the insurance and know why you're buying the insurance. This waiting period usually applies to non-emergency procedures such as crowns and typically ranges anyone where from a few to 12 months though it can be as long as two years for some companies, annual coverage limits which can be as low as $1,000 despite the median mentioned above meaning this is the amount that the insurance company will kind of cap out before you have to pay the rest over and above that which I think the median was 1,500 that could be as low as $1,000 which is fairly low limit. That's much different than the medical insurance where we think about the term of the out-of-pocket maximum where the insurance company pays for the amount over the maximum. Here we've got a fairly low amount that the insurance company maxes out at before you have to pay and that's the yearly amount so it'll reset I believe in the following year that's my interpretation. So it can result in situations where a loss, feeling or cavity earlier in the year has already eaten up a large portion of that year's dental allowance. In other words, if you have some stuff that's not preventative because the preventative oftentimes might be 100% covered not kicking in or eating in to the limit which was 1,000 or 1,500 on the median then but if you have some other things like some cavities that do kick in or start eating into that $1,000 the insurance company will pay out for you that could add up quite quickly with just a few kind of things that would come up like one cavity okay but if you got a couple cavities and then you got something that's gonna be a bigger item here such as a crown then that could end up in a problem. So this would likely result in a crown being covered at less than 50% so you have to be strategic about when you plan for certain procedures. So you would like to be able to maximize the amount that the insurance company is gonna cover given the fact that there's that limit and how much they're gonna pay out. How much does a dental crown cost with insurance? Most dental plans cover the cost of dental crowns in cases where a patient has a weak or cracked tooth. However, crowns are generally not covered if they're requested purely for cosmetic reasons. So if you want that gold crown not only do you gotta pay for the gold I would suppose but then if it's totally cosmetic then the whole thing probably nothing. So that's because dental insurance usually doesn't cover cosmetic procedures which exists for the main purpose of improving the appearance of a patient's teeth and smile rather than for health reasons. I'm not sure the gold tooth or a crown or whatever actually improves the appearance but whatever it's all about taste I guess. Other cosmetic procedures include whitening treatment, veneer bonding and straightening procedures such as Invisalign which is kind of like embraces type of thing which is trying to straighten your teeth type of thing. The patient has to pay the entire cost of these treatments. Although the cost of crowns depends on whether the material used is porcelain or metal the price tag can range from $807 to $2015 per crown. Now note that's quite expensive because you'll remember the max that they're gonna max out at possibly per year was that 1000 to the medium 1500 and then how much you have to pay just in terms of the copay and so on so it can get quite expensive of course. And remember the cost is generally only covered at 50%. So now you're typically thinking this is the type of procedure where even if the insurance company doesn't hit the max it's only covered at the 50% and they might hit that max which is relatively low depending on what other procedures you've had throughout the year. So the patient must pay the remainder. Dentists can provide preliminary estimates and many offer payment plans. So you might be able to put it on the payment plan so that's that. So furthermore credit plans such as care credit offer low interest financing methods and some dental schools offer low cost dental procedures. Employer sponsored plans generally require low insurance premiums due to group coverage.