- 30,529
Hahaha, I'll be laughing at that the rest of the night.
Breast or penile...hmmmmm, in this day and age could be both. There's some weird people out there.
Denture/Dental coverage & MA plans
- Thread starter Greenie
- Start date
Breast or penile...hmmmmm, in this day and age could be both. There's some weird people out there.
- 30,529
Yes, I saw that, but overall I like the other plan and I'm sticking with it. Glad you can still sell it. Doesn't the new one put a limit on vision? I like the fact that you can get spares on your glasses on the old one.
Also, $1,500 lifetime max isn't a big deal on the implants. I was looking into them and by the time you're done, you're looking at $5K an implant x 4 = $20K.!!! I can buy a lot of Fixodent for $20K.
Perhaps it is as you say.
Not calling you a liar, but there are quite a few agents that don't know or understand the inner workings of a dental plan. It doesn't matter if it is stand alone or baked into an MA plan. It is still dental insurance which is not the same as medical insurance.
The only real difference in MAPD with dental vs stand alone dental is, MOST folks won't enroll in a MAPD for the purpose of getting dental coverage. Still, there is an element of adverse selection that must be considered by the carrier.
MAPD plans can be changed yearly without barriers. The medical part of MAPD does not have coverage for run-in claims, only those incurred since the start of the plan or calendar year
Dental plans without networks have other ways to protect against losses and that can be found in the way they reimburse claims. If the plan pays 50% on major claims you can bet it won't be 50% of what the dentist charges. They will pay 50% of what the carrier says is a "usual" charge for the procedure.
Plans with networks typically have a disclaimer such as . . . " If your dentist is part of your Medicare plan's network or has agreed to the terms and conditions of payment, you may use your Medicare plan for dental care at that location."
In other words, a dental provider must opt-in and sign a contract agreeing not only to treat patients that have that plan, but also agrees to the fee schedule proffered by the carrier.
It is not unusual for a dentist to agree to treat a patient with a PPO dental plan, and some will even agree to submit a claim to your carrier, but unless the dentist agrees to the terms of the reimbursement schedule the patient will still be responsible for the difference in what the dentist bills and what the carrier pays.
This is no different from a medical claim submitted by a non-par provider.
Dental plans are a profit center for carriers but they generate profits for that line of coverage by designing ways to deny claims as spelled out in the policy. Brochures will have loosely worded caveats but no one ever reads those, much less the actual policy language. Only when the claim is denied or pays less than the patient expected, does anyone bother to read the "fine print"
Ancillary lines of coverage, including any and all dental plans have a lot of weasel language. I guarantee it.
If you think the plan you sell doesn't have traps you have not really read the policy. It's there, you just never saw it.
- 30,529
Hahaha, don't misunderstand me...I'm still a Med Supp guy. My wife and I would've both MOOPed out last year and she would've again this year. Med Supps don't have the bells and whistles like MA does, they just get the job done.
But the fact is though that these MAPD plans are getting better each year. As I mentioned. I attended an Aetna MA webinar today. Their dental has no network , they can go to any dentist in the U.S. and since the benefit is reimbursable, they even cover dentists that have opted out starting in 2022.
On the DVH I have with Manhattan, after a $100 deductible it pays 80% of actual charges. After I took mine they changed it on new policies issued to pay based on Usual, Customary and Reasonable fees.
I agree that dental insurance is probably the worst value of any type of insurance as far as maximum coverage to premium ratio. But that's probably because you're likely to use it every year, similar to why most of the time Plan F cost more than $203 more than Plan G, because you're likely to use it.
OK, my intent was not to morph this thread into a MAPD vs Medigap. There are a few thousand of those threads already.
Regarding a reimbursement dental plan, I doubt it is Carte Blanche where almost everything will be reimbursed.
Think of the early cancer plans. You send your bill to the carrier, they pay what they want and leave the rest to you. Some claims can be denied while others are partially reimbursed.
There is always a catch when the carrier is involved after the claim was incurred.
Who is Aetna reimbursing? Policyholder or the dentist. My guess is, the policyholder, especially where the provider did not opt in to the plan.
They are still in control of the purse strings.
Carriers and agents have a way of selling the positives and ignoring the negatives.
I have been on both sides of the insurance game for too long to know if it sounds to good to be true someone is going to be disappointed.
Carriers do some incredibly stupid things but those are quickly discovered and the plan is usually yanked.
Will some folks pay $1,000 in dental premiums and get back every penny and more? Sure, but not everyone on the plan will break even or profit.
You can cherry pick any plan to justify your position. The truth is, those situations are not the norm.
Big print gives, small print takes away. Games are rigged so the house wins. Casinos are built on the bets of losers.
That is the way life, and especially insurance, works.
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Looks like someone read the "fine print" . . .
I've had clients use the Aetna MAPD dental for 2 years now and they all said they got completely reimbursed up to the limit. Just this Monday another client told he he got refunded within a couple of weeks.
I'm not sure how it is next year, but in 2021 they reimburse for everything except Fluoride. Odd.
It's not a %, it's not based on customary rates and no deductible. There's no network because the client gets reimbursed.
That said, I still don't do a ton of that plan.
- 30,529
They said yesterday that the only thing they won't reimburse for in 2022 is teeth whitening, because they don't feel it's medically necessary.
Starting in 2022 Aetna will have a network of dentists for their MAPD's. You don't have to go to a network dentist but if you do they will submit the claim and you will get the lower contracted amount so their $1000 or whatever their particular plan has for a maximum will go further. They are doing away with not reimbursing for opt out dentists which a couple people have discussed already. They said even dentists that are not in network can submit the claim for reimbursement. The clients haven't needed a claim form to send in the claim for a couple years. They just write their member ID# on the receipt and mail to the address on the back of their card. Best dental plan I have ever seen due to just a straight reimbursement of all claims up to the maximum.
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