Welcome Guest! To enable all features please Login or Register.

Notification

Icon
Error

Options
Go to last post Go to first unread
VAer1  
#1 Posted : Saturday, April 2, 2022 7:43:55 PM(UTC)
VAer1

Rank: Advisor

Groups: Registered
Joined: 1/27/2020(UTC)
Posts: 130
United States
Location: Washington DC

Thanks: 4 times
Was thanked: 1 time(s) in 1 post(s)
For example, Annual Maximum Benefit is $1500 and Dental Benefit Intermediate 45% coinsurance.

What does Annual Maximum Benefit mean?

Does $1500 mean that Insurance company will pay maximum of $1500 toward to my dental benefit, if my annual premium is $500, then the maximum amount Insurance Company can lose is $1000, correct?

Assuming (numbers may sound ridiculous, but just making up example) that my total dental bill is $10,000 during the year, then insurance pays $1500, and I pay $8500, correct? In this case, 45% coinsurance means nothing, correct? As soon as it exceeds $1500, then technically I will pay 100% coinsurance.

By the way, does Federal Dental Plan(High, some does not have Annual Maximum, technically Insurance Company will pay unlimited amount of money toward dental care) cover Dental Implants? To be clear, let us make up an example: a few Dental Implants costs $20,000 and there is NONE Annual Maximum. If coinsurance is 45%, does it mean that patient pays $9000 and insurance company pays $11,000 ? If that is the case, insurance company will lose a lot of money, which does not make sense for insurance company.

Thanks.
GSBS  
#2 Posted : Monday, April 4, 2022 2:58:10 PM(UTC)
GSBS

Rank: Senior Member

Groups: Registered
Joined: 10/9/2011(UTC)
Posts: 3,032

Thanks: 373 times
Was thanked: 375 time(s) in 326 post(s)
Originally Posted by: VAer1 Go to Quoted Post
For example, Annual Maximum Benefit is $1500 and Dental Benefit Intermediate 45% coinsurance.

What does Annual Maximum Benefit mean?

Does $1500 mean that Insurance company will pay maximum of $1500 toward to my dental benefit, if my annual premium is $500, then the maximum amount Insurance Company can lose is $1000, correct?

Assuming (numbers may sound ridiculous, but just making up example) that my total dental bill is $10,000 during the year, then insurance pays $1500, and I pay $8500, correct? In this case, 45% coinsurance means nothing, correct? As soon as it exceeds $1500, then technically I will pay 100% coinsurance.

By the way, does Federal Dental Plan(High, some does not have Annual Maximum, technically Insurance Company will pay unlimited amount of money toward dental care) cover Dental Implants? To be clear, let us make up an example: a few Dental Implants costs $20,000 and there is NONE Annual Maximum. If coinsurance is 45%, does it mean that patient pays $9000 and insurance company pays $11,000 ? If that is the case, insurance company will lose a lot of money, which does not make sense for insurance company.

Thanks.
Wouldn't it mean after you satisfy your Deductible and any applicable co-pay, the insurance company will pay out a maximum yearly benefit of $1500? Dental coverage maximums are less than they were 30-40 years ago, I got $2000 when I worked with Dick Clark, he always had nice teeth!

VAer1  
#3 Posted : Monday, April 4, 2022 5:44:08 PM(UTC)
VAer1

Rank: Advisor

Groups: Registered
Joined: 1/27/2020(UTC)
Posts: 130
United States
Location: Washington DC

Thanks: 4 times
Was thanked: 1 time(s) in 1 post(s)
Originally Posted by: GSBS Go to Quoted Post
Wouldn't it mean after you satisfy your Deductible and any applicable co-pay, the insurance company will pay out a maximum yearly benefit of $1500? Dental coverage maximums are less than they were 30-40 years ago, I got $2000 when I worked with Dick Clark, he always had nice teeth!



I don't know. I did not buy dental insurance before, that is why I am asking questions.

Edited by user Monday, April 4, 2022 5:44:50 PM(UTC)  | Reason: Not specified

GSBS  
#4 Posted : Thursday, April 7, 2022 11:59:13 AM(UTC)
GSBS

Rank: Senior Member

Groups: Registered
Joined: 10/9/2011(UTC)
Posts: 3,032

Thanks: 373 times
Was thanked: 375 time(s) in 326 post(s)
Originally Posted by: VAer1 Go to Quoted Post


I don't know. I did not buy dental insurance before, that is why I am asking questions.


My BCBS has a Dental benefit which pays about $12 a visit, major work not covered. I have had a Careington Dental plan for years, it's about $100 and offers a discount fee schedule on major work, it is not insurance. Your Dental office might have their own similar discount plan, why not ask them?

OUtside  
#5 Posted : Thursday, April 7, 2022 1:53:16 PM(UTC)

Rank: Senior Member

Groups: Registered
Joined: 8/19/2008(UTC)
Posts: 1,003

Was thanked: 55 time(s) in 52 post(s)
Checkbook Open Season Guide has a pretty good discussion of the FEDVIP dental and vision plans (easy browser search to find it). If you have one of the dental plans, usually you get gratis or low copay preventive care and then a percentage copay of other dental work, fillings, crowns, etc. Be sure to read the plan brochures to learn the details. Note that the dental work will usually be done at a preferred price where the dentist has a contract with the plan which gives you a nice discount; so you save money in two ways, you get a discount off the top, then you pay a percentage of the discounted price, and the plan pays the balance.

Note there is usually a missing tooth clause, which means the plan won't provide a replacement tooth for a tooth missing when you sign up for the plan.

Offhand I don't recall the source of a good suggestion I came across some time ago in a discussion like this: it can be very helpful to ask your dentist if he/she thinks it would be beneficial for you to enroll in a such a dental plan; since they know your dental situation in detail, they would have pretty good idea what dental work you might need down the road.












teeeeej  
#6 Posted : Monday, April 11, 2022 1:50:35 PM(UTC)
teeeeej

Rank: Senior Member

Groups: Registered
Joined: 2/22/2013(UTC)
Posts: 558

Was thanked: 75 time(s) in 67 post(s)
GEHA is the Stnadard FEDVIP plan that offers the most benefit.

If you want a high benefit, you need to have a high plan, which understandably costs more.


Dental insurance in general doesn't cover a lot. The private sector doesn't typically have plans like the FEDVIP "High"
GWPDA  
#7 Posted : Monday, April 11, 2022 2:25:58 PM(UTC)
GWPDA

Rank: Senior Member

Groups: Registered
Joined: 2/26/2011(UTC)
Posts: 2,787

Thanks: 292 times
Was thanked: 605 time(s) in 495 post(s)
$50/month for Delta Dental, which covers the most expenses for dental issues of any insurance there is. I've had Delta Dental for more than 20 years, first as part of my American Express health insurance, later as a stand alone policy, now as part of FEDVIP. It is not attached to any federal health insurance - it's by itself. Check it out. I find that it, combined with GEHA standard covers everything that anyone could need. Not braces - I'm pretty much past braces. Root canals? Yep. Crowns? Yep. Implants? Yep. Fillings? Yep.

Edited by user Monday, April 11, 2022 2:28:56 PM(UTC)  | Reason: Not specified

FatHappyCat  
#8 Posted : Monday, April 11, 2022 3:33:51 PM(UTC)
FatHappyCat

Rank: Senior Member

Groups: Registered
Joined: 1/9/2011(UTC)
Posts: 953

Thanks: 3 times
Was thanked: 147 time(s) in 129 post(s)
Originally Posted by: VAer1 Go to Quoted Post
For example, Annual Maximum Benefit is $1500 and Dental Benefit Intermediate 45% coinsurance.

What does Annual Maximum Benefit mean?

Does $1500 mean that Insurance company will pay maximum of $1500 toward to my dental benefit, if my annual premium is $500, then the maximum amount Insurance Company can lose is $1000, correct?

Assuming (numbers may sound ridiculous, but just making up example) that my total dental bill is $10,000 during the year, then insurance pays $1500, and I pay $8500, correct? In this case, 45% coinsurance means nothing, correct? As soon as it exceeds $1500, then technically I will pay 100% coinsurance.

By the way, does Federal Dental Plan(High, some does not have Annual Maximum, technically Insurance Company will pay unlimited amount of money toward dental care) cover Dental Implants? To be clear, let us make up an example: a few Dental Implants costs $20,000 and there is NONE Annual Maximum. If coinsurance is 45%, does it mean that patient pays $9000 and insurance company pays $11,000 ? If that is the case, insurance company will lose a lot of money, which does not make sense for insurance company.

Thanks.


Correct - that means that your plan won't pay more than $1500 for the year. It doesn't sound like a lot, but it's really more than most people needs; here's why:

First - most federal medical plan covers major dental procedures. I had a root canal done where dental insurance paid 1/2 but my medical paid the other half. This is probably the co-insurance...

Second - your primary benefit for carrying dental insurance is not the co-pay, but the negotiated rate that they have with their in-network providers. So let's say your dental implant dentist charges 20k. This is most likely their market rate. Their negotiated rate with the insurance provider is generally significantly lower, maybe 90% + of lower because of the volume of business the insurance will bring to the dentist. Then as an in-network provider, you would be on the hook for whatever percentage that whatever they don't pay. If the procedure was discounted to say $2k - you would owe $500.

This is why insurance company always asks you to get preapproval before the procedure so you don't get a surprise bill. Different companies have negotiated different rates so the dentist can't tell you how much you'll be billed for their service w/o knowing who your insurance company is and what the payout is for the plan.

Edited by user Monday, April 11, 2022 3:36:13 PM(UTC)  | Reason: Not specified

VAer1  
#9 Posted : Monday, April 11, 2022 3:46:00 PM(UTC)
VAer1

Rank: Advisor

Groups: Registered
Joined: 1/27/2020(UTC)
Posts: 130
United States
Location: Washington DC

Thanks: 4 times
Was thanked: 1 time(s) in 1 post(s)
Originally Posted by: FatHappyCat Go to Quoted Post


First - most federal medical plan covers major dental procedures. .


What??? I have FEHB health insurance (very cheap plan, basic plan, around $50 per pay check. I don't know what it covers, and never use it before, but it is unlikely for a cheap medical plan to cover dental. I thought FEHB medical plan is completely separate from dental plan, this is the first time hearing that there is overlap.

Thanks.

Edited by user Monday, April 11, 2022 3:59:52 PM(UTC)  | Reason: Not specified

GSBS  
#10 Posted : Monday, April 11, 2022 9:36:06 PM(UTC)
GSBS

Rank: Senior Member

Groups: Registered
Joined: 10/9/2011(UTC)
Posts: 3,032

Thanks: 373 times
Was thanked: 375 time(s) in 326 post(s)
Originally Posted by: VAer1 Go to Quoted Post
Originally Posted by: FatHappyCat Go to Quoted Post


First - most federal medical plan covers major dental procedures. .


What??? I have FEHB health insurance (very cheap plan, basic plan, around $50 per pay check. I don't know what it covers, and never use it before, but it is unlikely for a cheap medical plan to cover dental. I thought FEHB medical plan is completely separate from dental plan, this is the first time hearing that there is overlap
Thanks.
I have a very expensive FEHB plan, Dental wasn't offered when I left service, and this is my sum total dental benefit
https://www.arkansasblue...rd.pdf?sfvrsn=87fb72fd_0

Aside from emergency Dental work performed in conjunction with an emergency medical procedure, I wouldn't count on FEHB Medical for anything dental?
https://www.arkansasblue...rd.pdf?sfvrsn=87fb72fd_0



GWPDA  
#11 Posted : Tuesday, April 12, 2022 6:15:23 AM(UTC)
GWPDA

Rank: Senior Member

Groups: Registered
Joined: 2/26/2011(UTC)
Posts: 2,787

Thanks: 292 times
Was thanked: 605 time(s) in 495 post(s)
As always, consult benefeds.com for plan comparisons. For example, Blue Cross, Aetna and GEHA all offer dental coverage as part of their medical plans - not subordinate, but as a component. Each has different pricing and different costs. FatHappyCat is correct in the way most of the pricing goes - my retirement Delta Dental cost to me for a filling is around 10% of the retail price and it's that 10% that's faded off the "annual payment". As far as I've been able to tell one primary difference between the various dental plans is not the upfront monthly fee or even the annual allowance, but the network of dentists who accept the insurance. Thus, a dentist who accepts the attached GEHA dental insurance this year may not next year. For me, that's where Delta steps up - just about every dentist in the US accepts Delta and offers very good payment on some extremely expensive dental work. YMMV.
Navy Bubblehead  
#12 Posted : Wednesday, June 15, 2022 4:53:09 AM(UTC)
Navy Bubblehead

Rank: Senior Member

Groups: Registered
Joined: 1/19/2012(UTC)
Posts: 1,356

Thanks: 29 times
Was thanked: 122 time(s) in 100 post(s)
Originally Posted by: GWPDA Go to Quoted Post
As always, consult benefeds.com for plan comparisons. For example, Blue Cross, Aetna and GEHA all offer dental coverage as part of their medical plans - not subordinate, but as a component. Each has different pricing and different costs. FatHappyCat is correct in the way most of the pricing goes - my retirement Delta Dental cost to me for a filling is around 10% of the retail price and it's that 10% that's faded off the "annual payment". As far as I've been able to tell one primary difference between the various dental plans is not the upfront monthly fee or even the annual allowance, but the network of dentists who accept the insurance. Thus, a dentist who accepts the attached GEHA dental insurance this year may not next year. For me, that's where Delta steps up - just about every dentist in the US accepts Delta and offers very good payment on some extremely expensive dental work. YMMV.


The Blue Cross dental benefit is minimal. On basic care (cleanings, etc) it pays nothing. On major work (root canals, implants,etc) it pays about $9.

What I want to know is what kind of dental implant costs $20k? Is that for a full set of teeth? Or just one tooth? Ive had a dental implant put in just a couple years ago. The total cost was about $5k. At $20k I would just do extractions and get dentures.
Rss Feed  Atom Feed
Users browsing this topic
Guest
Forum Jump  
You cannot post new topics in this forum.
You cannot reply to topics in this forum.
You cannot delete your posts in this forum.
You cannot edit your posts in this forum.
You cannot create polls in this forum.
You cannot vote in polls in this forum.

Powered by YAF 2.1.1 | YAF © 2003-2022, Yet Another Forum.NET
This page was generated in 0.165 seconds.