Dental insurance premiums can be more expensive than simply paying out of your own pocket for routine checkups and cleanings. So if you're one of the millions of Americans with no dental coverage, is a policy for your pearly whites worth the cost? The answer may depend
on whether you expect to face aching bills for your teeth.
Most dental insurance policies emphasize prevention and diagnostics, typically covering two annual exams and cleanings, plus X-rays and, for children and older adults, fluoride treatments, says Evelyn Ireland, executive director of the National Association of Dental Plans, or NADP.
But the real benefit is being covered for bigger-ticket procedures, such as fillings, root canals and crowns, says Carrie McLean, a consumer specialist with eHealthInsurance.com.
"It's like health insurance -- you're really buying peace of mind," McLean says.
Fewer than 6 out of every 10 Americans had dental benefits in 2010, according to a report released in late 2011 by the NADP and Delta Dental Plans Association.
People with dental insurance commonly have what's described as "100-80-50" coverage, meaning it pays 100 percent of the cost of routine preventive and diagnostic care, such as checkups and cleanings; covers 80 percent for fillings, root canals and other basic procedures; and 50 percent for crowns, bridges and major procedures, Ireland says.
The vast majority of coverage is provided through employee and group policies, plans that charged annual premiums of between $234 and $432 per person in 2011, according to NADP estimates.
The cost for you to buy an individual policy averages about $360 a year, McLean says.
Meanwhile, paying out of your own pocket for two exams and cleanings and a set of X-rays in 2011 would have cost about $370, on average, according to the American Dental Association.
For care that goes beyond the routine stuff, most plans cap coverage at $1,500 a year, although higher annual limits can be arranged by paying a higher premium.
Unlike health insurance, dental plans don't bar coverage for pre-existing conditions, though some policies may restrict coverage for people with missing teeth.
Cosmetic dental procedures are rarely if ever covered by insurance, according to Ireland and McLean.
Dental insurance comes in three varieties: HMO, PPO and indemnity plans.
The HMO, or health maintenance organization, option restricts coverage to dental professionals within a limited network.
More popular are the PPO, or preferred provider organization, policies, which are similar to HMOs but allow patients to see dentists outside the "preferred" network. However, patients are typically charged reduced rates if they see an in-network dentist. Some 70 percent of dental policies are through PPOs, according to Ireland.
A third option, called an indemnity plan, allows a patient to see any dentist and typically picks up a percentage of the costs.
The advantage of PPOs over indemnity plans is that dentists within the PPO network typically agree to accept lower fees for procedures, according to Ireland. So, a crown that results in $500 in patient costs under an indemnity plan might mean $400 in out-of-pocket costs under a PPO plan.
"That's the advantage of any plan with a network -- there's a negotiated discount," Ireland says. "You're paying based on the discounted rate. The doctor can't bill you for the difference."
This article is courtesy of Bankrate.com
We all know that health insurance is something you shouldn't live without - but what about vision care insurance? Your ability to see is surely almost as important as your health. Vision care insurance can be purchased as a group benefit through your employer or as an
individual policy. But how does the cost compare to the coverage you'll receive?(Getting your own policy isn't easy or cheap but in some cases it's well worth the effort)
Overview of the System
Here's how vision care insurane works. You send the vision insurer a check for your premium (for individual plans) or have the premium deducted from your paycheck (for employer-sponsored plans). In exchange, you'll receive benefits such as discounted vision exams, glasses and contacts. Some plans also pay out if you are diagnosed with an eye disorder or if your vision becomes permanently impaired.
Some vision care plans require that you see a provider in the plan's network. Other vision care plans simply require you to be treated by an optometrist or an ophthalmologist - in other words, a vision care professional who has graduated from an accredited college of optometry and is licensed by the state or who has gone to medical school and is certified by the American Board of Ophthalmology. If you already have an eye doctor that you want to keep seeing, make sure their services will be covered by the plan you're thinking about purchasing.
Whether you purchase your own insurance or get it through an employer, expect to pay somewhere between $5 and $15 a month in premiums for an individual. To add coverage for a spouse, domestic partner or child, you may pay slightly less per person than the plan's individual rate. If your employer offers vision care insurance, you may only have one opportunity per year to sign up during the annual open enrollment period. Be aware that some individual plans charge a one-time enrollment fee in addition to a monthly premium.
Regardless of whether you obtain your coverage individually or through work, make sure to consider the policy's total annual cost and compare that cost to your anticipated annual vision care expenses. You don't want to pay out more than you expect to receive.
Covered Expenses
Each plan covers a different set of expenses. Before signing up for any plan, check to see if it covers everything you expect to need. Bare-bones plans usually cover only eye exams, contacts and glasses and may function more like discount plans than insurance. More comprehensive plans don't stop at exams and vision correction; they also help with the costs of eye surgery, eye diseases (e.g., diabetic retinopathy, retinal detachment, retinitis pigmentosa, cataracts, glaucoma, macular degeneration) and permanent vision impairment. Most plans also provide discounts on laser eye-correction surgery.
The amount of an eye-related expense that a vision care plan will cover differs significantly from plan to plan. One plan might charge you a $10 co-payment for an eye exam and cover the difference. Another plan might pay for $35 of your exam and expect you to pay the rest. Also, if a plan does offer coverage for eye surgery or permanent vision loss, it may not be anything like the coverage you're used to getting from health insurance. For example, if you need eye surgery for glaucoma (an optic nerve disease that gradually causes blindness), you won't pay an annual deductible of $200 for the procedure and have the remainder covered by vision insurance. Instead, your insurance might simply give you a flat payment of $1,000 for the surgery, and leave the rest up to you. This system might sound stingy, but it has a bright side - by placing greater responsibility on patients to cover their vision care costs and shop around for the best value, insurance companies can charge their customers lower premiums.