Monday, November 13, 2023

Dental Insurance?

Is dental insurance worthwhile buying?

It is "open season" for ACA or as some know it, Obamacare.  Every year, the cost seems to go up.  And right now, we are looking at $380 a month to continue with our current plan, so it pays to look at other plans in the ACA universe.

Which leads us to our first problem - one that might mystify Canadians or Brits. Why are there different plans with different levels of coverage?  Why not one plan for everyone?  Are we supposed to figure out how sick we will be, in advance, for 2024 and then pick a plan based on this?  Doesn't this defeat the whole point of "insurance"?  I mean, it makes about as much sense as buying health insurance only when you get sick.

The second problem, as I noted before, is that when you sign up, you have to predict, with some accuracy, what your income will be for the next year.  If you have a salary job, this is not hard to do.  If you work part-time or get overtime, well, it can be next to impossible.  If you are retired and living off your 401(k) money, well, how much you spend is what your "income" is - and with inflation last year, the amount we spent was about 20% more than the year before and 20% more than we predicted.  We will have a hefty tax bill in April, which means we have to take more money out of the 401(k) which means we lose more Obamacare subsidy, which means a higher tax bill for 2025 which means.....wash. rinse. repeat.

It is kind of a mess.

But speaking of subsidy, based on my "projected" income for 2024, the subsidy comes to over $18,000.  Read that again, dear taxpayer. And thank you for your contribution!  The "premiums" on most ACA plans start at about $1500 a month and go up from there.  ACA plans thus run (at my projected income level) from $0 a month to $500 a month or more.  So you pick a plan based on how much you want to pay per month, and they come in different levels - gold, silver, bronze, zinc, and lead.  We're on the lead plan.  It covers burial expenses.  In a pine box.

You can review the plans online, and this year there is more than one provider, including CVS Caremark. CVS has made big noise about getting into health care and away from being a Dollar General that has a pharmacy. The pharmacy business is cut-throat, with every grocery store - particularly Walmart - in on the game, not to mention online pharmacies.  On the other hand, $1500-a-month checks from ACA sound awfully enticing, provided you can keep costs down.  No wonder they are moving in that direction.

In reviewing the plans, I noticed that nearly all of them are "HMO" plans that only cover a portion of expenses, and then only for "in-network".  So you may pay only $100 for an emergency room visit, but if a doctor who is "out of network" is brought in (as a temp) he may bill you directly for his entire fee.  You might have insurance, but you might not be covered.  And when you are bleeding to death, you don't have time to ask for an in-network doctor.  Great system!

Other plans covered "in-network" services only, but only after you have reached your $18,000 deductible.  For many people, this is a half-year's income.  You get sick, go to the emergency room and end up socked with an $18,000 medical bill.  Of course, if you are astute, you try to negotiate this down, and then arrange an interest-free payment plan over a number of months or years.  Still, it is a lot of money - enough to buy a new car, or at least a lightly used one.

So the whole situation is kind of scary and I realize we have been lucky to be in relatively good health, to have "in-network" providers locally and at the local hospital.  But it can all go horribly wrong in a heartbeat.

But what about dental insurance?  We never opted for this, although some plans offer it. I have pretty robust teeth, but Mark has had some bridgework done, and over time, it needs to be re-done. He predicts that it will need to be reworked in 2024.  Maybe we should find a plan that covers dental?  Oddly enough, our "silver" plan doesn't cover dental, but some lower-priced "bronze" plans do.  But there is a caveat - or several.  First, it only covers in-network providers.  Second, it only covers 50% of costs.  Third, there are only three in-network providers locally, out of the dozens of dentists in the area.  So you give up choice of dentist, to save only part of the cost.  It might be a better bargain to just get a cheaper plan and pay cash for dentistry.

Yes, they are not giving out free money samples at the bank this week - nor are the insurance companies handing out free dental care. The idea that you can get something-for-nothing never pans out in real life.  So maybe we will give up on buying a plan with dental care - it just doesn't seem worthwhile - if you want your choice of Dentist, that is.

Of course, I am going by the search feature on the site for participating physicians.  Often, this data is outdated and obsolete.  So I will call around tomorrow to see if other Dentists accept the insurance - they might.  Our current Dentist is retiring and his son - fresh from medical school - is taking over the practice.  Apparently, he got perfect grades in "billing practices" in Dental School, as he is suggesting a lot of high-priced procedures.  After two visits, Mark noped out of that and refuses to go back.

So like Diogenes, I will keep searching for the last honest Dentist!  And maybe a dental plan, but I doubt it.

UPDATE:  I decided to go with a "Bronze" plan that had no dental coverage.  However, you can buy a separate dental plan for $25 a month or so.  I checked them out and none are from Ambetter - but Blue Cross has a plan.  Caveat?  12 month waitng period for major dental, 6 month waiting period for routine dental.  So you have to pay premiums for a year before the benefits kick in.

Also, like the health plans that include dental, few dentists take the insurance, including our current Dentist!  Our new Dentist takes no insurance but will process "out of network" claims - that only pay 50% of costs.  After a year, of course.

So you either have to get dental insurance and keep it a long time, or forgetaboutit!