Supplemental dental insurance is purchased to fill the gaps in a policy holder’s dental or medical coverage. Gaps in coverage can occur when the primary policy’s annual spending limit is reached, or when a policy doesn’t provide coverage for necessary or desired dental treatments.
And, since many health plans do not include dental coverage, dental insurance itself is often acquired as a “supplementary” policy.
This article outlines the most typical scenarios that result in a need for supplemental dental insurance such as limited or no dental insurance, or running out of dental benefits due to a need for expensive treatments such as braces, root canals, crowns and dental implants.
The article provides guidance on choosing Medicare Advantage, supplemental insurance plans, and dental savings plans and how to coordinate dental insurance benefits when using a supplemental or savings plan.
Medicare does not cover dental care or treatments such as cleanings, fillings, tooth extractions, dentures, bridges, root canals or crowns. There are a few extremely limited exceptions to this rule – for example, if you need to be hospitalized to receive complicated or emergency dental treatment, Medicare Part A (Hospital Insurance) may cover inpatient costs but not the fees associated with the actual dental treatments.
Consequently, Medicare policy holders tend to look for broader health coverage through a Medicare Advantage program – a Medicare-sanctioned, regulated program offered by private health insurance providers. These plans are widely considered to be supplemental coverage, even though they are technically providing an alternative to the basic Medicare offering.
Some Medicare Advantage plans do include dental benefits, others do not. Check the plan’s documentation to determine if dental is included. Then look at how many providers are in the plan’s network, and whether your dentist accepts the plan. And check to see if the plan offers any additional benefits that matter to you as well, some Medicare Advantage plans provide vision and prescription coverage/savings along with dental.
If dental services are covered, check to see if you’ll need to pay an extra monthly premium for dental coverage, whether there is a deductible and an annual spending cap, and what your co-payment for services will be. And check to see if the plan has a waiting period before coverage is available, and whether any pre-existing dental problems you may have will be eligible for treatment under the plan.
Other options for Medicare policy owners include buying a standalone dental policy from a private insurance company, or a dental savings plan.
Insurance can be a great choice for covering basic, preventative care as coverage often includes free checkups, cleanings and x-rays annually for policy holders. Need more extensive dental care? Dental savings plans, unlike dental insurance, don’t have a low annual spending limit making these plans an excellent option for those who need restorative treatments such as root canals, crowns, dentures and other costly services. Not familiar with dental savings plans? Continue reading or cut to the chase and click here to learn more about how these plans work.
Dental insurance typically limits a plan’s annual coverage – the amount the plan will pay for each year – to $1000-$1500. T
his presents no problem if you just need preventative care and perhaps a small cavity filled. But with the average cost of a single root canal on a front tooth ranging from a low of $700 to $1,300 (depending on where you live, and what a particular dentist charges), and another $500-$1000 for a crown that’s often necessary following a root canal, it’s all too easy to exhaust your dental allowance in a single visit or two. Another dental budget-buster are braces, which cost from $3,000-$7000 or more over the course of the treatment.
Supplemental insurance would seem to be the answer if you have exceeded your dental insurance plan's annual maximum or if your plan does not cover a needed procedure. But before you pay more for yet another insurance policy, consider potential problems and your options.
A new-to-you dental insurance plan may not cover work in progress or preexisting conditions. Plus there will almost always be months-long waiting period before you can get reimbursed for major procedures such as crowns or root canals. Remember too that dental insurance often will not pay to restore teeth that were missing before you purchased the policy, or work that was underway prior to the policy going into effect.
And it can be difficult to coordinate benefits from two dental insurance plans. Make a mistake, and your insurance claim can be denied, leaving you liable for the cost of care. That said, your dentist may be able to schedule treatments in a way that maximizes your available insurance coverage.
Your best bet when trying to figure out how to pay for expensive dental care is to talk with your dentist and see what he or she suggests. The dental practice may offer payment plans that make it easier to afford costly care, or your dentist may be aware of a supplemental policy that fits your needs perfectly, or it may just require postponing part of a treatment until after your insurance plan renews. And talk to your company’s human resources staff if the plan is employer-provided to see if they have any suggestions.
Dental savings plans offer an exceptionally easy way to get affordable dental treatment quickly with no worries about annual spending limits, pre-existing conditions or waiting periods.
Some people find that their needs are best met by having both traditional dental insurance and a dental savings plan. Families with young children may want insurance to cover preventative care for the little ones, and a savings plan to make adult care more affordable. Or you might want to get a dental savings plans to bridge the gap between insurance-mandated waiting times for some procedures, or buy a dental savings plan when their dentist informs them that the care they need will cost more than their dental insurance policy’s maximum annual allowance.
In addition, some dental savings plans offer discounts on some dental specialties that are rarely covered by dental insurance, including cosmetic dentistry services like veneers, teeth whitening and more. Those who need or want these treatments often buy a dental savings plan membership to get a discounted rate on the services.
Whether you’re using supplemental insurance, a second dental insurance policy, or a dental savings plan you should be aware of how (or if) your primary plan has any policies about coordinating benefits. This information can usually be found in your plan’s policy documents. If you can’t locate the information, speak with your dentist or the member’s service team at your insurance provider’s member service team.
Rules about benefits coordination can vary, so it is critical to get the specific details about your plan from your healthcare provider or insurance company – frankly, you may want to get the information from both. If you’re on Medicare, you can just call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627.
Basically, coordination of benefits comes down to deciding which insurance plan is the “primary payer” – which plan pays first. Just to make things more complicated, the payer who pays first isn’t the first one to pay – it’s the insurance company that is responsible for paying the bill up to the limits of your coverage. Anything remaining goes to the second payer, and perhaps even a third.
If you and your spouse both have dental insurance plans which cover your children, the plan belonging to the spouse whose birthday falls earlier in the year will be the primary payer. In other words, if you’re born in January and your spouse’s birthday is June, your plan is the primary payer. This can change if you’re divorced, or due to other legal issues, but it is often the typical way of deciding whose plan is primary.
Even if your family is covered by two dental insurance plans, the second plan is considered supplementary. You won’t get double of everything – 4 free cleanings as opposed to 2, for example. The secondary plan fills in the gaps left by the first plan, but do check each’s plans "non-duplication of benefits" provisions before you assume that you’re covered for services that the primary plan covers.
It’s an unfortunate fact of life that dental insurance – any kind of insurance, really – is often not easy to understand or use. The infamous “small print,” the exclusions, inclusions, requirements and exclusions can come as a surprise when you’re already going through a difficult time.
In general, dental savings plans are easier to understand and use than dental insurance. Dental savings plans offer discounts of 10%-60% on average dental care costs. Since they are not dental insurance, dental savings plans do not have co-payments, deductibles, paperwork hassles or annual spending limits. You simply go to a dentist who is part of your plan’s network – that is, a dentist who has agreed to provide discounted dental services to plan members - and pay the reduced rate directly to the dentist. No fuss, no worries, and no confusion.For dental insurance plans, the best thing you can do is ask plenty of questions before purchasing, and don’t hesitate to get your dentist’s opinion on which insurance plan meets your dental care needs. If you don’t have a choice about what plan you purchase, rest assured you can fill in any gaps in your dental coverage with a supplemental insurance policy or a dental savings plan.
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