Dental Insurance for Implants

[Blueback]

NCD does

 

[ehall2]

I constantly receive solicitations from Physicians Mutual and it is the worst plan I have ever seen. I can't believe the Georgia Insurance Department approved such a terrible plan. The plan would pay $29. for an extraction and the plan only cost $1.00 per day. The last time I was at the dentist and asked the person that handles insurance if they had anyone come in that had PM. She said yes we have quite a few. I asked, are they happy with the coverage and said she hasn't one yet that was happy with the coverage. I realized then that people don't look at the coverage, only the price.

 

[somarco]

I realized then that people don't look at the coverage, only the price.

That is true for so many things in life . . . especially insurance.

One of my favorite questions to ask, when someone says "All my friends have X insurance and only pay $Y, why is your plan so much more?".

Have your friends actually USED their plan for anything other than routine care?

A boat in dry dock can look better than all the others, but when you put it in the water is the real test.

 

[RobinMontrose]

Caveat, not an agent.

I understand asking about Dental Insurance. I have had to try to learn some things about it myself in the last few months because of dental problems I am experiencing.

The thing that it appeared to me that you were asking is if one could purchase dental insurance and have it cover dental services provided prior to the effective date of the policy. I have seen that discussion in threads here over a variety of types of insurance. From reading those threads, I would expect any insurance agent to know the answer to that question regardless of the type of insurance for which the question is posed.

On the other hand, if you were asking if a dental patient had a crown placed when they were covered by a dental insurance policy, but the provider did not file a claim at that time, can a claim be submitted at a later date for that service, the answer to that question should be yes, IF the claim is submitted withing the carrier's time frame for submitting claims for a service.

A very specific example. I have an outstanding bill of over $1300 at a dental provider for a crown placed in May. I just this week checked with my dental insurance carrier to see if a claim has been filed. They told me no, but not to worry because the provider has 1 year and 90 days from the date of service to file the claim. So my account could show a balance for awhile.

What I have see is Defined Benefit Dental Plans generally place their services in 3 layers; Preventive, Basic and Major.

They will usually have deductibles ranging from $50-$100. Usually those are per person per year. Sometimes there will be no deductible, sometimes there will be a lifetime deductible, sometimes the deductible will not apply to preventive services.

There will most often be annual caps on the dollar amount of benefits paid for. Somewhere in a range of $1,000 to $3,000 is the most common I've seen. There are plans with caps above and below those amounts. Orthodontics will usually have lifetime caps of $1,000 to $2,000.

You can commonly find plans that have no waiting periods for preventive services. (DO NOT assume that the preventive services provided by all plans are the same. I have seen xrays that some plans treat as preventive placed in basic services in other plans. I have seen some plans that only cover 1 cleaning per year instead of 2, and so on.)

A few plans will also give you no waiting for Basic services, or sometimes a reduced waiting period of 4 or 6 months for the basic category (others will stick with a full 12 month waiting period for this category).

Major services usually have a waiting period of 12 months.

IF you have had other dental coverage including Major Services (say coming off an employer plan) and follow the carrier's documentation steps, some carriers will waive their waiting periods (for example I currently have 3 dental plans. I was able to have waiting periods waived for the secondary and tertiary plans because of the primary coverage I have.)

Plans that will cover implants and orthodontics will probably cost $70 +/- per month. It is quite likely that most of your prospects that want those services will NOT have or NOT have had recent coverage that will waive waiting periods so they will have to pay 12 months of premiums and then can get treatment just up to the annual cap of the plan. Crowns and root canals have a similar problem, but they cost less so if one has a plan with a $2,000 - $3,000 annual cap with a good provider network, getting a root canal and crown covered is possible.

You would have to ask your dentist, but I think it may be possible that the CROWN PORTION of a dental implant MIGHT be covered under a dental plan that includes coverage for crowns.

Some carriers are also going to have different plans and premium levels for under 65 and 65 and over.

If you are wanting to have dental insurance products to offer, my personal (non agent) suggestions would be to look at UHC, the Manhattan Plans @rousemark talks about and the afeusa Delta Dental plan that @Travis Price offers. (you would have to ask him, but that afeusa plan may also cover implants.)

I'm a consumer. I keep hearing on TV of a new law that HMO's have to pay for dental. Are there any Obamacare HMO plans that would cover "major" services or is this type of advertising pie in the sky? It seems dentists in general are clueless of this.

 

[rousemark]

Manhattan's Dental Select covers Implants with no waiting period.

 

[RobinMontrose]

I mean dental plans inclded with the HMO. It's supposed to be a new law. It affected hearing aids as well.

 

[goillini52]

I mean dental plans inclded with the HMO. It's supposed to be a new law. It affected hearing aids as well.

I don't do O'bummercare, but I hadn't heard that. As far as the hearing aids go, in the Inflation Increasing Act, they made it to where you can buy hearing aids over the counter.

Why not call a couple of the HMO's you're interested in and ask them?

 

[Joel T]

Im in florida. Have had 4 implants using a dental discount plan which gave me a 30% discount on implant and abutement. No waiting period.

 

[Trickytone]

Finding dental insurance that covers implants can be tricky, especially with waiting periods. You might want to check out different insurance providers in Pennsylvania and compare their coverage options.

 

[jadynshay]

Finding dental insurance that covers implants can be tricky, especially with waiting periods. You might want to check out different insurance providers in Pennsylvania and compare their coverage options.
As for recommendations, it really depends on your individual needs and budget. It might be worth reaching out to insurance agents or doing some online research to find the best fit for you.
Also, if you're interested in kids' dental care, especially pediatric orthodontics, there are resources available that offer insights and advice specific to that area.