Dental insurance plan question

baseball347

New Member
2
Hey all. I am new to the forums and I have a question about dental plans.

I have a lot of work that needs to be done such as fillings. My primary insurance is Capital Blue Cross (a Medicare Advantage Plan) and Medicaid is secondary. My dentist is in network with my primary insurance. However, they are not in network with Medicaid or any HMO plans. My plan with Capital Blue Cross is a PPO plan which is fine. My Capital Blue covers 50% of work with a $2,000 maximum. I am going to need a good amount of appointments with copayments for each appointment. I am not going to have that kind of money because it's going to add up. I was thinking if I get a standalone dental plan as secondary, would I need to pay anything out of pocket? I talked with Medicaid earlier in the day and asked if I can submit claims to them for reimbursement. They said I cannot. Only one of their providers can submit claims.

Thanks!
 
I see a couple of problems with your idea.
1)Medicaid could decide that if you can afford a stand alone carrier you no longer qualify for Medicaid
2)If you purchase a stand alone you will most likely be subject to a 6-12 month exception for routine repairs
3) you have a $2000 max per year of covered dental work. You MIGHT be able to get 2000 in repairs in November 22 and 2000 in repairs in January 23 but then NO repairs until 2024
 
I feel your pain. This is what we call falling in the gap.

The stand alone with medicaid could be dangerous. Money paid to you, or for you, may be (not sure your state) counted as income.

Another option might be a credit card, but the interest needs to be evaluated.
 
Caveat, not an agent.

I did not respond to this because I know nothing about Medicaid or Medicare Advantage.

not sure of exact amount-I spend $90-$95 per month on two dental policies. Not an agent on the board will tell you that is a wise purchase.

If you can't afford copays/coinsurance on treatment, how would you expect to pay for a second dental plan and then pay some copay/coinsurance in addition to that?

You could start by looking at individual purchase options for BCBS for your state. Checking on:

What the premium is.
Checking on if they waive waiting period for major services with proof of other dental coverage with major service coverage.
What their maximum per year is.

That would give you some idea of cost and benefit of second coverage in relation to your specific situation.

If you need something like 3-4 root canals and crowns and a half a dozen or more fillings, not sure you will be able to get that all done with insurance coverage, even in two years.

Edit,
just reread your original post and see my suggestion probably wont work because you already have BCBS coverage. In Ks, the individual Delta coverage is not quite as good as the indivdual BCBS coverage, but you could try my suggestion with Delta coverage and see where that gets you.
End edit
 
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3) you have a $2000 max per year of covered dental work. You MIGHT be able to get 2000 in repairs in November 22 and 2000 in repairs in January 23 but then NO repairs until 2024

I did the equivalent of this with two stand alone dental plans in 2020 and 2021. My primary insurance allowed me to get a secondary plan that waived waiting periods. However, it is important to note two things with that statement: The cost of two plans is probably more than op could afford, and I did not get the services without also spending some out of pocket money.
 
There is also a company that some dentists use to finance dental work for their patients. I can't remember what its name is.

You could talk with the appropriate person in your dentist's office and see what kind of options they can provide you for financing the treatment necessary under your care plan.
 
I just read all of the replies now.

I can afford a standalone dental plan because it will be paid monthly. I wasn't going to use the standalone plan to replace Medicaid.

My dentist is saying there are a total of 10 cavities and some of them are broken teeth. I have a hard time keeping my mouth open for a very long time so he is going to do one or two at a time which is where the cost comes into place. I only receive income once a month and that's a lot of appointments. I was thinking it would be cheaper to pay a monthly bill which I can definitely afford.

Unfortunately, I cannot get a credit card due to poor credit.

Delta Dental I believe has waiting periods.

And my dentist mentioned to me about my teeth being stained so I am guessing he might be whitening my teeth once the fillings are complete.
 
Delta Dental I believe has waiting periods.

Caveat, not an agent.

This is why I made the comments I did about some companies waiving waiting periods with proof of other coverage which includes major services.

I have been through this recently. At one point I had 3 dental plans-partly to cover expected services and partly because of misinformation from a dentist office insurance person. That same dentist's office fired me as a patient, in part because I had 3 dental plans.

Different states are going to be different in policy characteristics, all I can do is suggest based on my personal experience in KS.

In Kansas, the BCBS dental plans available for purchase cover fillings without any waiting period. That is why I led with suggesting BCBS as a possibility before I went back and reread your post carefully. In 2020 I had BCBS KS dental for one month and used $1,400 of a $1,500 annual benefit on fillings and root canal services. I had some out of pocket costs but I also got the benefit of both network pricing reductions and insurance payments-at I think 80% of allowed amounts.

In Kansas Delta Dental allowed waiver of waiting periods if I could provide them proof of Dental Coverage in the last 60 days that included coverage for Major Services. If your Medicare Advantage plan covers Major Services, it might meet that criterion. If you are desperate for dental services, don't make assumptions, talk to insurance company customer service people and get a definite answer to your questions so you are making your decisions based on facts, not assumptions.

I think Delta's coverage for fillings was a lower percent than BCBS but don't remember for sure. I only used it for a cleaning and some xrays and then dropped it after I'd paid enough premium to reimburse them for the payments they made for me. With Delta you are probably going to be looking at something like 50% of the in network price being paid, which would leave you with 50% of the filling cost plus premiums as your cost. But again check the specifics for your state.

I don't know if you will be able to get 10 fillings done in one year, having insurance coverage for all.
 
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