Author Topic: I need a crown. Buy a dental plan for 2021 that includes major dental work?  (Read 1366 times)

FIREin2018

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Obamacare has this dental plan:

Delta Dental Major ($31.75/month):
$50 deductible
includes preventative (cleanings 2x/yr)
50% co-insurance for fillings- 6-month waiting period if no prior dental coverage
50% co-insurance for major dental care- 12-month waiting period if no prior dental coverage

the dentist i've been going to for over a decade said i need a crown soon on one of my molars. (no pain, yet.)
a crown is like $1000.
i currently have Delta Dental Basic (just cleanings and 50% co-insurance for fillings. no major dental) so the 12 month waiting period shouldnt apply.

sounds like a no brainer to get the $31.75/month plan?

edit:
With the deductible, it's $381 + $50 = $431/yr.
so i'll be ahead with the 2 cleanings

edit2:
i called and if i switch to their major dental plan, the 12month waiting period doesnt apply because i already had a policy with them for a year.
yeah, im probably getting this
« Last Edit: November 18, 2020, 07:24:54 AM by FIREin2018 »

Cranky

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If the crown is $1000 and insurance pays 50% less $50, you just about break even. Do you need multiple crowns? Have you asked the dentist about a cash price?

FIREin2018

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If the crown is $1000 and insurance pays 50% less $50, you just about break even. Do you need multiple crowns? Have you asked the dentist about a cash price?
well, i'll be a little ahead of breakeven.
that $431 also includes 2 cleanings.
(will edit my OP)

FIREin2018

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i called and if i switch to their major dental plan, the 12month waiting period doesnt apply because i already had a policy with them for a year.
yeah, im probably getting this

nirodha

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What is the annual maximum for benefits? I see this page for Delta in VA, for example:

https://www.deltadental.com/us/en/dental-insurance/virginia-dental-plans.html

What's the dentist's cash price for a crown, vs. what you'll be paying 50% of through Delta? There's a good chance they don't match.


Not to say you cannot find an opportunity to come ahead, but insurance companies aren't in the business of losing money.

FIREin2018

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What is the annual maximum for benefits? I see this page for Delta in VA, for example:

https://www.deltadental.com/us/en/dental-insurance/virginia-dental-plans.html

What's the dentist's cash price for a crown, vs. what you'll be paying 50% of through Delta? There's a good chance they don't match.

Not to say you cannot find an opportunity to come ahead, but insurance companies aren't in the business of losing money.
$1000 max benefit

the dentist i've been seeing for the past decade doesnt have a cash price.
insurance or no insurance its the same price.

dresden

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We use an Aetna dental savings plan instead of buying insurance.  This ensures we have the same discounts as regular Aetna insurance and we can pay for preventive and any costs out of our HSA.

This works out best for us.


MissPeach

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Are you getting the plan through a group? I used to administer a workplace dental plan years ago and while this might have changed, I remember a lot of dental PPOs (especially ones not in a group plan) wouldn't cover major work for a period of time. Basically it was to protect themselves on people who need a bunch of work, get the plan for a little bit, and then end the coverage. I would double check for that before signing up.

Blue Skies

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Before you get all excited about what the dental plan will pay - I would confirm it with them.  My dental plan covers 50% of crowns, BUT it only covers 50% of the cost they THINK you should have to pay. 
For me, my dentist charged about $1200 (and I called around, this is what it cost at ALL the dentists around here) but for some reason the dental insurance was sure it would only cost me $400.  So, yes, they covered 50% of the imaginary $400.  I paid the other $1000 out of pocket.

JoJo

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Are you anywhere near mexico?  I've heard there are great dentists on the MX side of the US border.  Runs about 25% cost of same services in the USA. 

FIRE Artist

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Re: I need a crown. Buy a dental plan for 2021 that includes major dental work?
« Reply #10 on: November 23, 2020, 04:59:50 PM »
Before you get all excited about what the dental plan will pay - I would confirm it with them.  My dental plan covers 50% of crowns, BUT it only covers 50% of the cost they THINK you should have to pay. 
For me, my dentist charged about $1200 (and I called around, this is what it cost at ALL the dentists around here) but for some reason the dental insurance was sure it would only cost me $400.  So, yes, they covered 50% of the imaginary $400.  I paid the other $1000 out of pocket.

This, there should be a dental fee guide referenced with the insurance that states the limits of what they think things should cost. 

Malcat

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Re: I need a crown. Buy a dental plan for 2021 that includes major dental work?
« Reply #11 on: November 23, 2020, 05:10:27 PM »
Before you get all excited about what the dental plan will pay - I would confirm it with them.  My dental plan covers 50% of crowns, BUT it only covers 50% of the cost they THINK you should have to pay. 
For me, my dentist charged about $1200 (and I called around, this is what it cost at ALL the dentists around here) but for some reason the dental insurance was sure it would only cost me $400.  So, yes, they covered 50% of the imaginary $400.  I paid the other $1000 out of pocket.

Lol, what decade is your insurance company working in? It can cost the dentist almost $400 in fees just to have the crown made at the lab. Unreal.

MissPeach

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Re: I need a crown. Buy a dental plan for 2021 that includes major dental work?
« Reply #12 on: November 30, 2020, 12:24:04 PM »
Before you get all excited about what the dental plan will pay - I would confirm it with them.  My dental plan covers 50% of crowns, BUT it only covers 50% of the cost they THINK you should have to pay. 
For me, my dentist charged about $1200 (and I called around, this is what it cost at ALL the dentists around here) but for some reason the dental insurance was sure it would only cost me $400.  So, yes, they covered 50% of the imaginary $400.  I paid the other $1000 out of pocket.

The term insurance companies use for this is "usual and customary".