Dental & Vision Insurance after 65 - best options?

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TexasPE
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Re: Dental & Vision Insurance after 65 - best options?

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UALflyer
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Re: Dental & Vision Insurance after 65 - best options?

Post by UALflyer »

toofache32 wrote: Thu Oct 07, 2021 9:30 pm
PowderDay9 wrote: Thu Oct 07, 2021 9:10 pm The value of a dental plan is that they have contracted rates with participating providers that are typically 20-50% lower than the charges you would normally pay. Over 65 year olds are by far the highest utilizers of dental services.
But this is only for the (on average) $1200 of dental benefits per year.
As you know, depending on the service provided, dental insurance has different percentage copays. So, preventive services, for instance, may be covered at 100%, while major services may be covered at 50%. The point is that even if the insurance benefit maximum happens to only be $1,200/person/year, because of the percentage copays, maxing out the annual benefit means that you've incurred a couple thousand dollars in dental claims. In the meantime, because of the in-network discounts, you're saving money on all those services.

The benefit maximums then reset the following year, and a lot of dental services can and often have to be spread out over more than one year, meaning that you get to take advantage of more than one annual benefit maximum. In other words, a dental insurance policy buys you a lot more than just $1,200 in coverage.

You then obviously need to see the coverage network to determine whether the providers that you're interested in seeing are in-network. Where I live, it's actually not that easy to find a dental provider who is out of network with the major dental policies, but obviously YMMV.
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Re: Dental & Vision Insurance after 65 - best options?

Post by UALflyer »

David Jay wrote: Thu Oct 07, 2021 3:14 pm
557880yvi wrote: Thu Oct 07, 2021 2:56 pmMy recollection from reading many posts over the years here is that one is better off paying out-of-pocket and looking for discounts than paying for insurance - but want to be sure I have not missed something.
You are correct.

Insurance is for things where the cost of dealing with the problem would cause financial hardship. I have a paid-off home, but I carry home insurance because a loss of our house would cause financial hardship. In contrast, I do not buy extended warrantees on low cost appliances.
People repeat this on this forum on the time, but the reality is actually more complicated. If I can pay $100 for an insurance policy that in my situation is virtually certain to pay out $200 without causing me any headaches in the process, it'd be kind of silly of me not to do it. Losing out on his benefit won't cause me any financial hardship, but why forego free money?

People tend to respond to the above by saying that insurance companies are in the business of making money, so their payouts have to be lower than the premiums paid. That's true on average, but has nothing to do with your individual decision. Lots of people, for instance, pay for dental insurance that covers 2 preventive dental services per year at 100%, but fail to use them both, which is one of the ways that an insurance company makes money. It's kind of like the value of cashback credit cards: their issuers make money on average, but lose money on those of us who collect the cashback and pay off the charges every month. Likewise, the value of dental insurance isn't just in the payouts that it makes, but often in the negotiated pricing. If you are comfortable with its network, meaning that you'd get to see the same providers that you'd see anyway, the negotiated insurance pricing can actually represent a fairly significant benefit.

Hence, if insurance can save you money and make your life a little bit easier by eliminating the need to price check various providers, it can make sense to purchase it even if the benefits have nothing to do with foregoing financial hardship. Not all dental insurance plans fit the above criteria, but my point is that I don't think that your approach to insurance is appropriate for quite a few people out there.
bberris wrote: Sat Oct 16, 2021 7:26 pmThis is true, but you don't need insurance to get the preferred rate. You can join what amounts to a savings club such as Preferred Network Access from Cigna to get the reduced rates. There are many others, and they all have a network of dentists that agree to the allowed charges for each procedure. Some dental practices have their own club. I like it better than insurance because it's cheaper, there are no claims, and no rejections.
I am not familiar with the Cigna dental savings club, but in general, lots of dental plans don't work well. For instance, a number of dental plans only provide percentage discounts (something like 40% off certain fees), which are meaningless, as the providers simply inflate their fees and then apply all these percentage discounts to them.

Likewise, the fact that there are no dental claims means that the dental provider is the one that gets to interpret the terms, which creates various opportunities for the dental provider to play games. For instance, they can charge you separately for various things that an insurance company reviewing a claim wouldn't allow them to charge you for, etc... Hence, from a patient's perspective, there are a lot of concerns with dental plans that don't exist with dental insurance.
bberris
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Re: Dental & Vision Insurance after 65 - best options?

Post by bberris »

The dollar rate is contracted with in-network dentists under Cigna. The rate depends on your location.
soitgoes2
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Re: Dental & Vision Insurance after 65 - best options?

Post by soitgoes2 »

Vision and dental insurance often is more of a way to spread payments over a year and take advantage of negated rates. I know my dentist offers his own savings plan where you pay for two exams and cleanings at a slight discount and he offers a discount for other work you need. Unfortunately even many insurance don't cover the biggest dental expenses such as implants.
toofache32
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Re: Dental & Vision Insurance after 65 - best options?

Post by toofache32 »

soitgoes2 wrote: Mon Oct 18, 2021 7:54 am Vision and dental insurance often is more of a way to spread payments over a year and take advantage of negated rates. I know my dentist offers his own savings plan where you pay for two exams and cleanings at a slight discount and he offers a discount for other work you need. Unfortunately even many insurance don't cover the biggest dental expenses such as implants.
Which is why it's not really insurance.
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jeffyscott
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Re: Dental & Vision Insurance after 65 - best options?

Post by jeffyscott »

toofache32 wrote: Mon Oct 18, 2021 10:54 am
soitgoes2 wrote: Mon Oct 18, 2021 7:54 am Vision and dental insurance often is more of a way to spread payments over a year and take advantage of negated rates. I know my dentist offers his own savings plan where you pay for two exams and cleanings at a slight discount and he offers a discount for other work you need. Unfortunately even many insurance don't cover the biggest dental expenses such as implants.
Which is why it's not really insurance.
In general, I think it's more "not really insurance" because nearly all policies have low caps.

Implants are an expensive option, if insurance does cover the replacement of teeth, it is still not going to pay for implants. Instead it would pay based on what a cheaper alternative would cost. Similarly, insurance may pay for fillings only based on what the cost for metal would be and, if you want composite, you pay the difference yourself.

At one time we had pretty comprehensive coverage, but it was still limited to $3000 per per person per year (this was about 15 years ago). If we had needed an implant at that time, I think the plan would have paid for part of that, but only based on cost of a cheaper alternative such as a partial denture or a bridge. So if you needed all your teeth replaced and wanted mouth full of implants, the insurance would only have paid up to what a full set of dentures would cost at the insurance discounted price, but also still subject to the $3000 annual limit.
Big Dog
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Re: Dental & Vision Insurance after 65 - best options?

Post by Big Dog »

doobiedoo wrote: Sat Oct 16, 2021 9:00 pm
557880yvi wrote: Thu Oct 07, 2021 2:56 pm After spending far too much time looking at all the Dental & Vision plans offered in my state (MA) by the companies that offer Medicare Supplement plans (will be eligible in 2022), the benefits seem hardly worth the premiums. Dental plans are expensive and have very limited annual benefits. Vision plans are a bit more complicated to price out as they typically cover some or all of an eye exam but the remaining "benefits" are basically discounts on glasses/contacts - highly dependent on what, how often and how many you buy.
...
Are there better plans than what might be offered by the major insurers (i.e. UNH, BCBS, Humana, etc.) or is it most cost efficient to self-insure if one can afford to? Searches turn up a dizzying and confusing array of choices! Tried sources like Consumer Reports but nothing about insurance plans after 65. Although some Medicare Advantage Plans offer Dental and Vision, we are going with a traditional Medex Supplemental plan.
I use Kaiser Medicare Advantage Plus which costs $16/month [in southern CA]. I found a good dentist on the eligibility list in my area, He is way cheaper than my previous dentist and maybe even does better work.

I still use my old optometrist [~$200 per year for exam], but I may switch to Kaiser's optometry services at some point.
I have found the $350 allocation for hearing aids to be useful too.

Unfortunately for the OP, I don't think Kaiser is available in MA.
$200 for an optometrist exam seems pricey, unless you are in NYC. My SoCal ophthalmologists only charges $125.
UALflyer
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Re: Dental & Vision Insurance after 65 - best options?

Post by UALflyer »

jeffyscott wrote: Mon Oct 18, 2021 11:16 am
toofache32 wrote: Mon Oct 18, 2021 10:54 am
soitgoes2 wrote: Mon Oct 18, 2021 7:54 am Vision and dental insurance often is more of a way to spread payments over a year and take advantage of negated rates. I know my dentist offers his own savings plan where you pay for two exams and cleanings at a slight discount and he offers a discount for other work you need. Unfortunately even many insurance don't cover the biggest dental expenses such as implants.
Which is why it's not really insurance.
In general, I think it's more "not really insurance" because nearly all policies have low caps.
I think that's toothache's point, which is that while dental insurance may save you hundreds or thousands of dollars per year, it won't save you tens or hundreds of thousands of dollars, so it's not the type of insurance that'll prevent a financial catastrophe. That's obviously true, but this doesn't mean that all dental insurance policies are useless or won't save their users money and headaches.

To toothache's point, you shouldn't just focus on the financial side, however, and should make sure that the in-network providers are the ones that you'd want to see anyway.
Implants are an expensive option, if insurance does cover the replacement of teeth, it is still not going to pay for implants. Instead it would pay based on what a cheaper alternative would cost.
Are you talking about the policies that you've looked at or all dental policies in general? There are a ton of dental policies out there than do pay for implants and do not contain the "least expensive alternative benefit clause," which is what you're describing.
Similarly, insurance may pay for fillings only based on what the cost for metal would be and, if you want composite, you pay the difference yourself.
You're describing what is called the "least expensive alternative benefit clause." There are a lot of dental policies without this clause.
musicmom
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Re: Dental & Vision Insurance after 65 - best options?

Post by musicmom »

I hope not to need implants.

My Delta dental policy dies pay for crowns.
I have a $2000 per year max limit.
I am proactively replacing very old fillings and crowns Age 65.

I can get two full cleanings and x-rays covered 100% each yr and still have 2 crowns done at 50% coverage in that year.
My out of pocket for cleanings is zero.
Each crown at my very good dentist office in network is $548 out of pocket

The numbers work for me.
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Re: Dental & Vision Insurance after 65 - best options?

Post by UALflyer »

I totally get the reason that toothache and other dental providers (I don't just say "dentists," as the same is true for all dental specialists out there as well) out there hate dental insurance. The policies are all different, have different coverage requirements, effectively dictate how much providers can charge for every procedure, force the provider to pay a billing coordinator/assistant to submit and track all the claims, etc... The providers also say that with dental insurance, there's no financial incentive for them to focus on quality work, as insurance pays exactly the same regardless.

The above is all true, but it's virtually impossible for consumers to assess their providers' clinical skills, so people's assessments and reviews tend to focus on things like the provider's bedside manner, how nice the office is, etc.., which doesn't have anything to do with the person's skill and quality. Likewise, whether a dental provider takes insurance or not tends to have very little correlation with the provider's competence and quality.

Hence, the reason that as I mentioned above, if the dental policy that you're considering has the same in-network providers that you'd want to see anyway, and it looks like the policy will save you money (because of both the actual coverage, but also the in-network pricing), such a policy can be quite worthwhile.
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