#Medicare Advantage Insurance Plan in Arizona | Explore Tumblr posts and blogs

ctinsurance-agency · 1 year ago

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CT Insurance Agency

Medicare-eligible Medicare Advantage offers Connecticut people who are interested in a lower monthly premium and greater provider choice an option to traditional Medicare ct medicare advantage plans You need to have approved private health insurance before you can enroll in Medicare. The high expense of healthcare and medications is something they can help with.

In comparison to traditional Medicare, the monthly premiums for some Medicare Advantage plans can be quite pricey. Deductibles and coinsurance are two examples of potential extra expenses. There are many different budgetary requirements. The Medicare and Medicaid programs must comply with CMS regulations.

Arizona is home to several first-rate medical centers that accept Medicare patients.

Medicare Advantage plans in Connecticut are equivalent to original Medicare in terms of coverage. The insurance company might pay for all or most of the insured person's medical expenses. These plans provide much more extensive benefits than Original Medicare or Medicare Parts A and B. Those in need of financial aid to cover the cost of their prescription can choose from several different programs. This loan and its accompanying costs will have a lengthy repayment period. Cash, checks, credit cards, and electronic money transfers are all acceptable forms of payment.

Some Medicare Advantage plans have annual deductibles that subscribers must meet before the plan begins paying any benefits. Nonetheless, this is a fact for a few strategies. The new Medicare plan is expected to include higher premiums, deductibles, and copayments than the old one. This is due to the fact that the plan only covers services rendered by "in-network" providers. Funding will be available to cover Medicare's costs in full. Hospitalization maximum out-of-pocket payments are not the same for all health insurance plans. In many healthcare systems, patients cannot see specialists without a referral from their primary care physicians. Your doctor has the final say on whether or not you need to consult a specialist. Medicare Advantage plans often cover preventive care services including cancer screenings, annual physicals, and immunizations.

Is the quality of treatment you expect to receive under your Medicare Advantage plan a cause for alarm? The current position can be shown on the Content Management System page. When choosing a Medicare Advantage provider, policyholders should take the total star rating into account. This is just one consideration among many. If companies in this industry care about their clients, they'll figure out how to improve their offerings without raising pricing. The satisfaction of members with their coverage and their ability to obtain care for chronic conditions would be just two of many factors considered. These are only two examples of the various variables at play here.

In order to sign up for Medicare Advantage, you must first be enrolled in both Parts A and B of Original Medicare. One must first enroll in Original Medicare before being eligible to enroll in Medicare Advantage. To join a Medicare Advantage program, you must first be enrolled in Original Medicare. You do not need to enroll in Medicare Part D if you have coverage for the cost of your prescription medicines through another plan medicare advantage plans connecticut You can still enroll in the plan the following year during the Annual Enrollment Period (AEP), even if you missed the Initial Enrollment Period (IEP). New members can only join the plan during the allotted time frame for enrollment, called as the Initial Enrollment Period (IEP).

Medicare Supplement Plans in Connecticut

Depending on their needs, subscribers can choose between Original Medicare and Medicare Advantage. Now, all Medicare-eligible medical treatments are available to members. Prescription drug coverage is frequently included in the monthly premiums of Medicare Advantage PPOs and HMOs. Maybe if you keep clarifying it, someone will finally understand. Your existing medical coverage will continue as usual while you are a member of our plan. Medicare Part D is available to anyone with either Original Medicare or a Medicare Advantage Plan. There's a lot of guesswork involved, so take your time.

Here you may view and compare all Connecticut Medicare Advantage plans. Finding insurance that meets your needs at an affordable price isn't always easy. The premiums, deductibles, and co-pays associated with various insurance plans might vary widely.

The Centers for Medicare & Medicaid Services (CMS) must provide its blessing before a plan can begin providing Medicare Advantage services. Justice is rarely appreciated, despite the fact that it is what makes freedom and security possible. Nonetheless, if you employ them, you just might arrive at your destination. Medicare Advantage and Medicare Supplement plans are available to residents of the Constitution State to help them afford medical care that isn't covered by Original Medicare. The area was given its name because of the Constitution, the document upon which the federal government of the United States was established. Medicare Supplement enrollment in Connecticut is straightforward. You can enroll in Medicare Part B during certain times for a lower regular payment.

More than 44 different Medicare Advantage plans are accessible to residents of the Constitution State. There are typically two types of Medicare Advantage SNPs (also known as Medicare Advantage Special Needs Plans). There is a higher availability of low-cost, adaptable health care solutions for people with lower incomes and prior medical conditions. Dentists, optometrists, and otolaryngologists are just a few examples of professionals whose services are not covered by these SNPs.

#ct medicare advantage plans #medicare advantage plans connecticut

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termlifeguy · 2 years ago

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Making the Right Choice | A Guide to Choosing Between Medicare Advantage and Medicare Supplements

Boise Idaho Medicare Supplement Brokers

In addition to Original Medicare, you may also be eligible for Medicare Supplement plan . Unlike the original plan, these offer similar benefits and services but with lower costs or more inclusions. Many Advantage plans include vision and dental coverage.

Additionally, you can opt for coverage that covers routine procedures like an eye exam. If you are unsure about which plan to choose, read this article to learn more about it and find a plan that will best meet your needs.

There are 59 health insurance companies in the United States that offer Advantages plans. These plans are designed to cover services that Original Medicare doesn't cover. They offer lower premiums and an extensive network of providers. Some plans even cover the cost of out-of-network care, which is particularly valuable for people with pre-existing conditions. Aside from this, these policies also give you access to a wide network of providers.

Choosing Between Medicare Advantage VS. Medicare Supplements

As you approach the age of 65, you may begin to consider your healthcare options. If you're eligible for Medicare, you have a choice between Original Medicare (Parts A and B) and Medicare Advantage plans. You may also choose to supplement your Original Medicare benefits with a Medicare Supplement plan. Deciding between these options can be daunting, but with some research, you can make an informed choice that fits your needs and budget.

Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans must cover all the benefits of Original Medicare, but they may also offer additional benefits, such as vision, dental, and hearing coverage, as well as prescription drug coverage. Most Medicare Advantage plans also have a network of healthcare providers that you must use in order to receive coverage, although some plans may allow you to go out-of-network for a higher cost.

On the other hand, Medicare Supplements, also known as Medigap plans, are also offered by private insurance companies. These plans are designed to cover some or all of the out-of-pocket costs associated with Original Medicare, such as deductibles, coinsurance, and copayments. There are ten standardized Medigap plans, each labeled with a letter (A, B, C, D, F, G, K, L, M, N), and each plan offers different levels of coverage.

Tips When Choosing Between The Two Options

When deciding between a Medicare Supplement plan and Original health insurance, it is important to choose one that meets your needs. Both plans have their own advantages and disadvantages. Understand how they work and which one will be best for you. If you don't know what to choose, start by comparing the premiums of the two plans or you can contact Boise Idaho Medicare Supplement Brokers. You may find that one is more affordable than the other. The best choice is to decide based on your health and budget.

Flexibility. For a person who loves to travel from state to state, a flexible health plan is perfect to choose no matter where you are. The majority of Advantage plans required the member to use an approved network provider, while Medigap allows the member to be treated outside the providers as long as it accepts Medicare. Moreover, they can see any doctor they wish, no matter where they live. For example, an Arizona resident can fly to Minnesota to visit the Mayo Clinic .

Predictability. Many people choose the Medicare supplement plan or Medigap because it makes out-of-pocket costs more predictable, and makes it easier to budget accordingly. The cost-sharing aspect of these plans is also appealing to many people. The best part about them is that they don't have to worry about high out-of-pocket costs when they need medical care.

Extra benefits. If you are looking for added benefits such as vision or hearing care, Medicare Advantage is the right one for you. Additionally, most Advantage plan includes prescription drug coverage.

Understanding Medicare Advantage Plan

Why consider a Medicare Advantage Plan? While Advantage plans often require you to use their network, you may find that your current doctor does not participate. You will still need a referral from your primary care physician. Additionally, they are required to have a copay and coinsurance. After that, you'll pay 100 percent of covered expenses unless you choose to pay for extra services or prescription drugs. The downside of an Advantage plan is that you can only use a network of providers. Additionally, specialized care is usually required, and most plans require preauthorization.

In a ddition to premium rates, you will also need to consider the maximum amount of out-of-pocket costs each plan will cover. The out-of-pocket maximums for Medigap plans vary by plan, sex, and location. While the maximum limit for Medicare Advantage plans is generally lower than that of the Original Medicare program, most plan premiums will still require some type of out-of-pocket expense. If you have an existing medical plan, it may be best to choose a plan that includes Part D coverage. Boise Idaho Medicare Supplement Broker Chris Antrim , can help you out with your choices, he can provide a plan that will fit right perfectly to your healthcare needs.

Originally published here: https://www.goidahoinsurance.com/guide-to-choosing-between-advantage-and-medigap

#Chris Antrim | Idaho Medicare & Health Insurance Broker

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themedicarepro · 3 years ago

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The Medicare Pro

My vision is to be the unmatched leader in improving quality and reducing the cost of Medicare for people in the communities that I serve.

#Open Enrollment Medicare Options Arizona #Licensed Medicare Insurance Plan Scottsdale #Best Medicare Insurance Plans Phoenix #Medicare Advantage Plans Glendale AZ

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melandezraya · 3 years ago

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Health Net Drops Coverage for Unwell Insureds

(Health Net removed insureds from insurance when they fall sick)

Health Net misled 4,865 Medicare clients by claiming that their plan did not charge more for the first five days of a hospital stay, while the project increased the patient's financial burden by $25 per day. The insurer allegedly misled 9,098 clients by claiming that their network contained pharmacies with lower cost-sharing terms, although the plan did not include such "preferred cost-sharing" pharmacies.

During open enrollment in 2014, the private health insurance business Health Net submitted fraudulent information to approximately 14,000 Medicare consumers in Arizona. The federal government fined the health insurer about $350,000 as a result of the blunder.

According to the federal government, this is the second time Health Net has given Medicare consumers incorrect information concerning benefits and prescription drug programs. With the Centers for Medicare and Medicaid Services, Health Net did not correct the erroneous information until more than a month after enrollment began that year.

Seniors can alter their private Medicare plans during the open enrollment, which runs from October 15 to December 7. As a result, they must assess their private plans' prescription medication plans and medical coverage provisions to determine whether they need to switch based on their particular health or financial needs. Health Net claimed to have discovered the error and mailed the correct information to the beneficiaries on November 24, or nearly five weeks after enrollment.

Gerald J. Mulcahy, who oversees Medicare's enforcement of such plans, wrote in a notice disclosing the fine, "This was over a month after the open enrollment period had started. Thus, affected the time in which enrollees could use the information to make a fully informed decision about their Medicare health care and prescription drug options for the 2015 plan benefit year."

In a statement, Health Net added, "We apologize for any confusion or irritation our errors caused." "We identified the inaccuracies shortly after the materials were delivered last year and immediately alerted CMS," says the company. And we started delivering revised information to affected beneficiaries right away."

The insurance company deceives insured patients.

Health Net was one of six private Medicare health insurance companies investigated and punished for providing customers with inaccurate benefits information. A similar issue resulted in a punishment of $86,530 for Health Net in 2013.

According to a CMS official, Medicare users who choose a plan based on inaccurate information provided by a health insurer are eligible for a particular enrollment period that allows them to swap strategies.

Following a contract audit in February 2015, Medicare authorities fined Mercy Care's Medicare Advantage prescription medication plan a total of $202,200. Mercy Care did not fulfill Medicare's requirements for prescription formulary and coverage, according to the audit. According to the report, there were also issues with the insurer's coverage determinations, appeals, and grievances.

Mercy Care's "failures in these areas were pervasive," according to CMS enforcement officers, "resulting in enrollees suffering unjustified delays or rejections in getting covered benefits and increased out-of-pocket costs."

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medicareinsuranceaz · 10 months ago

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Medicare Supplement Insurance – Medigap

Medicare is a powerful resource, and with some education, you can take advantage of the many benefits offered. This program mainly exists to support individuals who traditionally have had a challenging time finding appropriate and affordable health care coverage. That being said, enrolling and staying up to date with your own plan is stressful. Medicare is a federal program funded by income taxes, premiums paid by those receiving coverage, as well as the federal budget. Depending on the benefits you sign up for, that will determine your costs and care facilities.

Types of Medicare

There are two fundamental levels to Medicare that are important to understand: original Medicare and supplemental insurance, or Medigap. Medigap is additional coverage that fills in the gaps left by Original Medicare. Although Medicare pays most costs of the health care services and supplies covered, there are some copayments, coinsurance, or deductible expenses remaining. The right Medigap policy can help ease the burden of some of these health care bills and assist with care even when traveling outside the U.S.

Medicare itself is divided into parts A, B, C and D. Part A covers inpatient care and other hospital costs. This includes medical care in nursing homes, hospice care, and home health services. Part B focuses on two priorities: preventive and outpatient services. Necessary services would be any medical care required prior to diagnosis and treatment of a medical condition. Preventive care is received to prevent illness, like getting a physical or some kind of medical screening.

Part C is also known as Medicare Advantage Plans, which cover all of the same things as part A and B, but these medicare-approved insurance plans can be less expensive. They are offered by private insurance companies and come in the form of HMO and PPO plans. They also offer extra benefits like dental, vision, hearing and gym memberships. Supplemental policies protect your health and give you more control over the kind of provider you get coverage from. Part D covers the cost of prescription drugs.

How to Enroll

First, you should call the Social Security Administration or visit their site online to get some answers to your initial questions. Initially, you will want to enroll in Medicare part A as well as B. Some individuals automatically qualify for other parts of Medicare coverage if they already get other benefits like Social Security, etc.

Next, after confirming your eligibility for part A and B, you will want to determine if you need a Supplement Plan or an Advantage Plan. It is very important to maintain coverage through an employer or private insurance agency when retiring to avoid late enrollment penalties after your 65th birthday. This is a lot to take in and consider; and it can be very confusing to try to determine which path is best to take. Call Insurance Professionals of Arizona today for answers to your questions on Medicare.

Medicare Carrier Advantages

A Medicare Administrative Contractor (AKA MAC) works with Medicare carriers to process claims and provide other Medicare services. The Centers for Medicare and Medicaid Services tap into this network of carriers as their main source of communication between Medicare and participating health care providers. Medicare consists of private insurers handling the bulk of administrative duties like processing appeals and claims or contracting health care providers.

Our expert insurance professionals will provide you assistance to better understand your Medicare enrollment and benefits. We walk you through the process, beginning with the basics, and show you ways to expand your coverage without breaking the bank. Insurance Professionals of Arizona is here to give you access to the necessary information you need to select the best Medicare plan that works for your medical needs, not against them.

Essential Medicare Details

Fundamentally, Medicare is a federal program for people with specific cases of disability, those who are sick with end-stage renal disease, and anyone 65 and older. There are various sectors to Medicare in order to provide coverage for a substantial amount of services and health areas.

However, you can find specific supplemental health care coverage options to help fill in the gaps that Medicare does not. With this supplemental coverage, you will be able to receive care from any doctor, hospital, or provider enrolled in Medicare. Prescription drug costs are usually unpredictable and too expensive. Take a look at Medicare’s part C and D plans that may help cover you with these and more additional healthcare expenses.

Medicare carriers are here to help you sort through your top healthcare provider options. Contact Insurance Professionals of Arizona here to help you successfully pick the best Medicare options for your medical needs. We are confident that our experienced team will find you the best solution for your situation.

What a Medicare Carrier Can Do For You

Medicare carriers provide services and process claims under strict government regulation. They are charged with reviewing any claims filed and determine which of these will qualify for some type of compensation. A carrier also enforces payment policies for the regions in its area. Once these policies are established, Medicare claims are evaluated one by one to ensure the necessary medical services were offered within reason.

Setting up your personal Medicare coverage is difficult and confusing without an insurance professional to guide you through your options. The fact that there are so many choices is good for you and means you can design a plan that is just right for you. But do not settle for less than you deserve if you are stressed out, lost, or because you feel overwhelmed with the process.

Insurance Professionals of Arizona looks forward to hearing from you and helping you find the right Medicare solution for your needs. Call us today and learn how Medigap can cover your healthcare gaps. With over 47 years of combined industry experience, our team of insurance professionals is committed to providing superior service and instruction.https://www.medicareinsuranceaz.com/wp-content/uploads/2017/11/POV31_717_STD_Select.pdf

#medicare insurance az #Medicare Supplement Insurance #arizona medicare

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affordablehealth · 9 months ago

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Choose the Best Medicare Advantage Plan to Meet Your Needs

Are you looking for the best quality, affordable health care in Arizona? Affordable Health Insurance is committed to making health care affordable, less of a hassle and transparent. With the Personal Option, a doctor-supported plan that puts you in control can truly bring you the quality care that you deserve.

Please visit : https://sites.google.com/view/affordablehealthins/

#health insurance

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ncpssm · 6 years ago

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In April, Trudy Schuett will have a procedure to save a tooth, which she estimates a dentist would charge $3,000 to $5,000 to do.

But Schuett, who lacks dental insurance, will pay about $1,000, because the procedure will be performed by dental students at Midwestern University Clinics in Glendale, Arizona. Her cleanings at the school are affordable too.

Regular clinic visits have saved “buckets of money,” she said.

She is one of those resourceful retirees who always finds a way. But two out of three people over 65 do not have dental insurance, according to the Henry J. Kaiser Foundation, often because they lose the coverage when they leave their employer. Medicare does not pay for routine dental expenses, though it sometimes covers care for medical procedures considered integral to a retiree’s health, such as jaw reconstruction or heart surgery; some Medicare Advantage plans offer dental insurance.

via Center for Retirement Research.

Related Reading:

This is why we support and endorse Rep. Roybal Allard’s “Seniors Have Eyes, Ears and Teeth Act.”

The “Seniors Have Eyes, Ears and Teeth Act” would help millions of Medicare beneficiaries who need vision, hearing and dental care, which is not covered by Medicare.

You can read more from our endorsement letter by clicking here.

#dental #medicare #politics #healthcare #health care #seniors #retirement #retirees #retirement crisis #elderly #older americans #entitlements #entitlement reform #retirement security #earned benefits #congress

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sammieboniwell-blog · 5 years ago

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Some Regarding Medicare Supplemental Insurance

Currently while congress is battling over how invest for Obama's health care plan may cost $634 billion for that ten year plan: but without coming into where the cuts are coming from, who advantage and who gets quick end of this stick, this isn't that uncommon people for you to know is will it work? By using a third among the population in Arizona influenced by emergency room service on their health care needs, this particular plan put in place will Arizonan's be protected? One thing marketers for sure is, very popular the statistics the current plan isn't working!

The $6.5 billion bill would prevent a 21 percent cut to doctors who receive reimbursements from what is medicare insurance and increase their payouts by 2.2 for each. A previous short-term extension expired June 1, and the Obama administration has prevented the cut from taking effect up to now. The American dream included as well a nice vacation in fact starts year. I should have remember being a child taking these vacations with mom and dad and anticipating to that. If you cannot feed your loved ones how a person going to consider a getaway? The American dream vacation will be putting up a plastic pool on back yard for children. This could be the situation we now with wellness. Over time, and perhaps with belly of intentions (or perhaps not once we will see), the government has bought out the most of health care expenditures it's worked in consultation with certain special interests to stamp out competition. As well as the true associated with the care we receive is generally hidden from us. It's not a recipe for disaster, and disaster is where we are headed. Health spending in this particular country now exceeds 17 % of Gdp. S&P has given a highly regarded rated credit rating to You.S. government debt since 1941, through world wars, smaller wars, recessions, and various other political antics in the White House and The legislature. But the current set of politicians the able attain what some other politicians before them wouldn't be able to do: get U.S. debt downgraded. You often save lots of cash on your narcotic deaths costs ready shopping from store to hold. You might save additional by buying your prescriptions online or by mobile handset. It is an easy fact that all of the chain drugstores sell you shouldn't products. Productive in fees are caused because when much profit they try to make. You assist to save money on prescriptions by avoiding the expensive once deals offered as a drug promoting and advertising. The incredible deal you get now won't help you when really want to refill your shop for. You will actually end up paying more for likely to drug.

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rockymountain01-blog1 · 5 years ago

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Medicare advantage plans in salt lake city

Rocky Mountain Insurance was founded in 2017 by veteran experienced independent agents and brokers servicing the states of Washington, Oregon, California, Idaho, Utah, Nevada, Colorado, Wyoming, Arizona,etc

You can also viisit our website: https://falconlistings.com/medicare-advantage-plans-in-salt-lake-city/ #medicareadvantageplansinsaltlakecity

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themedicarepro · 3 years ago

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The Medicare Pro

My vision is to be the unmatched leader in improving quality and reducing the cost of Medicare for people in the communities that I serve.

#Open Enrollment Medicare Options Arizona #Medicare Advantage Plans Glendale AZ #Licensed Medicare Insurance Plan Scottsdale #Medicare Advantage Plans Mesa

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dentalinfotoday · 5 years ago

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On the search for a good dentist, it’s important to consider your dental insurance. Is s/he in your network? What will be covered? How much will you owe?

I worked for two dental offices as the office manager and was responsible for insurance billing and patient communication. And let me be the first to tell you—dental insurance (and all insurance, for that matter) is complicated.

That’s why I’m here to unravel all the myths, misconceptions, terminology, and coverage for you.

Whether you’re looking for a way to understand your current dental insurance plan, deciding which one to choose, or anything in between…I’ve got you covered.

(See what I did there?)

But first, let’s talk about what dental insurance really is—and what it’s not.

The True Cost of Dental Insurance [+ Common Myths]

The word “insurance” implies an understanding that you’ll be financially protected if the worst case scenario arises. However, you may not be aware that dental insurance is vastly different than most other insurance programs in place.

Unlike medical, life insurance, and home-owners insurance, dental coverage maximums are not hundreds of thousands of dollars. So, when (not if) you end up needing care, your dental benefits will only get you so far.

Most dental insurance plans have a $1500 annual maximum. This means if you get two teeth cleanings per year and a filling or two, you’ve maxed out your dental benefits until your plan renews.

Healthcare is considered (by some schmuck who developed the system) to be a completely separate entity from dental care.

This would only make sense if your mouth was not intimately intertwined with the rest of your body.

Thank God we don’t have to buy car insurance and a separate plan for the steering wheel, right?

Assuming you have a PPO (more on that below), most plans follow a standard 100/80/50 rule.

Preventive procedures are covered at 100%

Basic care, such as fillings and root canals, are covered by the plan at 80%

Major services like crowns are covered at a 50% rate.

The majority of dental health plans also require you meet a $50 deductible before they contribute to basic or major services.

The cost of procedures is also not standardized. If you live in Arizona, your crown may cost hundreds of dollars less than a person getting the same type of crown in Boston.

If you go in for your bi-yearly cleaning and find out you need a root canal and crown, your benefits will certainly be maxed out for the rest of the year. You would be left with hundreds of dollars of out of pocket costs.

That’s the opposite of medical insurance, which typically requires you pay only a small portion of costs after your deductible has been met.

For this reason, I think of dental insurance as more of a discount plan, rather than an insurance.

Finally, many dental insurance plans have waiting periods before certain work will be approved. Need orthodontic work? Your dental plan options may stipulate you be on their plan for six months before a dime can be paid out.

How Different Types of Dental Insurance Work

While they look very similar on the surface, the type of dental insurance you get will drastically impact how much you pay out of pocket. Some of them offer very little benefit to anyone other than the insurance company. Before you pick a plan, make sure you understand your options.

Medicare/Medicaid

Medicare and Medicaid are US taxpayer-funded health plans that require specific stipulations to be met in order to qualify. Instead of being run by a private insurance company, they’re controlled and regulated by a governmental agency called The Department of Health and Human Services.

Medicaid provides medical health coverage for some with low-income, families and children, pregnant women, the elderly, and people with disabilities.

Sadly, dental services are limited and primarily covered only for those under the age of 21.

Since each state is able to set their own coverage limits for those over 21, about half of states offer ONLY emergency dental visits and no preventive care, such as routine cleanings.

As a dentist, this greatly concerns me. Once you’re feeling pain, you’ve likely missed your window to prevent costly treatment—that’s why prevention is vital.

For children, Medicaid is quite comprehensive. However, this is where you have to use your best judgment when consenting to an overzealous dentist’s treatment requests.

I’ve come across a number of instances where parents agreed to treatment since it didn’t cost them anything out of pocket, only to find out later that it was unnecessary, or worse—not performed at all. I encourage my patients and readers to listen to their intuition when consenting to treatment and ask for a second opinion if they feel unsure.

You should be completely aware of what’s caused you or your child’s dental concerns and have multiple options for how to fix it.

Take your time looking over treatment plans and as many questions you need to feel confident in your decision.

A general rule of thumb is this: If you feel rushed into agreeing to a lot of treatment on the spot, seek a second opinion or wait until you’re able to ask all the questions you need to feel more comfortable.

Since it’s very uncommon for Medicaid procedures to be denied, having an understanding of your child’s needs is paramount. You should feel empowered to ask all the questions you need to understand their needs and how to improve their oral health in the future.

Medicare, on the other hand, is intended for those over 65 years old and are citizens or legal residents of the US, or people under 65 years old with a legally recognized disability.

This benefit primarily covers medical procedures and leaves a lot to be desired when it comes to your dental health. According to Medicare.gov, “You pay 100% for non-covered services, including most dental care.”

Unfortunately, the connection between your mouth and the rest of your body seems to be lost in this system of care.

Medicare and Medicaid are not dental insurance plans in the commonly understood form. Your dentist MUST be in-network, so for adults, you could be in for quite the search.

Think of these more as bare minimum entitlements that can come in handy, but with some kinks to work out. If you’re on Medicare, you may want to consider a supplemental plan to help prevent a dental emergency in addition to your regular coverage.

HMOs (Health Maintenance Organizations)

HMO’s look great on their face!

If you’ve ever started a new job and the HR Coordinator sat you down to show you your dental insurance options, you’ve probably been tempted to check the HMO box.

After all, HMOs are so much more affordable…Right?

Satisfaction with an HMO is, sadly, very uncommon. People who speak positively of their HMO experience typically didn’t use their insurance plan.

The way a dental HMO plans like Deltacare USA work is through a “capitation” system.

To receive care, you have to choose an in-network dentist. This means the dentist has agreed to sign a contract with your insurance company in exchange for being assigned a list of patients who can only use them for dental care.

Each month, that network dentist will be sent a check for a few bucks for each name on that list, regardless if they walk through the door or not.

In the case that you do make an appointment for preventive services (hopefully at least twice per year), your out of pocket cost will be pretty low. However, the dentist is also very poorly compensated for this type of appointment, only making a few dollars for a cleaning, exam, and x-rays.

This type of reimbursement would not even cover the cost of materials used. Dentists may then resort to charting more extensive treatment for issues that may be addressed in a more conservative manner. (If you think this sounds sketchy, you would be correct.)

For example, say you plan to only take advantage of routine cleanings to prevent decay and plaque build up. During this visit, your dentist or hygienist may find areas of concern that the typical dentist may think needs a filling.

Since s/he needs to make money to keep the doors open, you may find yourself with a root canal on your treatment plan instead of a filling. And since you need a root canal, a crown is also necessary to regain your tooth structure.

While this would be bad enough without the dishonesty factor, an HMO plan would pay VERY little of your procedure.

This may leave you with hundreds of dollars of expenses out of your own pocket.

The HMO system is great if you don’t need it, or if you follow my nutritional recommendations to keep stop decay before it starts. The monthly costs are minimal, and as long as you don’t need any additional treatment, you will probably be quite happy.

PPO (Preferred Provider Organization)

The other option you may see from your HR Coordinator is likely a PPO plan. This plan is a more expensive option that’s often overlooked, but once you dig a little deeper and see the complete details, you’ll find PPOs generally cost less in the long run.

Similar to an HMO, a network of dentists is available for your dental care where coverage is least expensive. A PPO plan costs more per month, but if you end up needing dental treatment, you’ll see the savings are well worth the monthly cost when compared to an HMO plan.

For example, if you end up needing a crown, your PPO plan will likely cover 50% of your crown as opposed to about 10% or less on an HMO plan.

If you add up all the money you’ve saved on the monthly premium and added it to your out of pocket costs, you’re very unlikely to come out on the good side of the equation if you had chosen an HMO.

This option is much preferred if you may need more extensive treatment than just preventative cleanings. And, although it’s a sad way to think about it, you’ll be somewhat less likely to get ripped off at the dentist because your dentist is also being paid more fairly.

Delta Dental PPO is one of the largest PPO networks available to employers in the US. If this is an option for you, it means you’ve got the largest network of dentists from which to choose.

Marketplace (Obamacare)

The Marketplace is a month-to-month dental insurance plan that has more stipulations than a traditional public insurance plan. In my experience, unless you are eligible for a tax credit based on income, they are not necessarily less expensive, however.

In order to use your Obamacare coverage, you must use a dentist that is part of their preferred provider network, and there is no coverage for out of network providers.

I’ve found that how many providers you’ll have to choose from depends on where you’re located. If you’re in New York, for example, your ability to find a provider may be easier than in a rural community with only a few dentists to choose from.

On a positive note, there are plenty of plans to choose from that are managed by common insurance companies that you would recognize, including Cigna, Guardian, and Humana.

While they are big names in the medical insurance system, their dental insurance networks are on the smaller side. Before picking a plan, it’s best to ask to see the full details, including in network dentists and exclusions.

Supplemental Dental

If your spouse is also offered dental coverage through their employer, you can join each other’s plans as a secondary insurance.

Supplemental plans are even more intricate than primary ones, but some can end up saving you most (if not all) of your out of pocket expenses.

However, since they’re notoriously difficult to estimate ahead of time, I’d recommend budgeting as if the 2nd plan will pay nothing. That way, you’ll have a pleasant surprise when they cover more than you expected!

4 Hacks for Affordable Dental Insurance

1. Ask your dental office if they accept bento dental.

If they don’t, encourage them to sign up! I’ve been using it for my own employees and have been quite impressed with the financial savings and ease to use.

Bento Dental is a modern alternative to traditional dental insurance. Their network of 90,000+ dentists can join at no cost.

As a private user of Bento Dental, you pay a 7% fee for services through the Bento app. However, the benefits include:

Flags for procedures that don’t match up with your records: This kind of oversight from insurance companies is one way to avoid getting ripped off or overcharged.

Guaranteed pricing: Dentists in the Bento network commit to pricing that matches many major employer dental insurance plans. This is important, because if you’re going to a dentist out of your normal dental network, there’s no guarantee whatsoever that you’ll pay a fair price.

See your cost before your visit: The Bento app shows you the cost for any scheduled procedures before you go in the office so you don’t get taken off guard by a massive bill.

Your employer can also purchase Bento Dental for you and your co-workers at only $5/person per month, which saves you the 7% cost fee you’d otherwise pay. Plus, employers can individually customize Bento plans to match whatever coverage they choose.

Bento is a great alternative for people with no dental insurance, too, since they offer many of the benefits of an insurance plan that will help you save money.

2. Customize your plan to remove coverages that you don’t need.

It may save you some dough—often, plans include extra coverages you may never use. Removing these can save you on monthly premiums.

3. Look into joining your spouse’s plan as a secondary insurance.

It’s very difficult to estimate benefits ahead of time when using two insurance plans, but they’re generally very helpful if you end up needing treatment. I’ve even seen some patients pay nothing out of pocket for extensive treatment using supplementary insurance this way!

4. Talk with your HR Coordinator to find out if your company offers HSA or FSA accounts.

These are accounts that you and/or your employer can contribute to for unforeseen health care expenses. The money will be put into an account monthly before taxes are withheld, making your tax burden less. Plus your out of pocket contributions go further.

For example, if you choose to contribute $100/month into your HSA ($1200/year), you’ll have $1200 available to you on the first day and your contribution will be taken out of your paycheck.

It’s somewhat like getting a negative interest loan (costs less than you borrow) that you don’t have to qualify for and you can use on health care expenses. It’s not limited to dental care, but might be a great alternative when you need extensive treatment not otherwise covered by traditional dental insurance.

The Best Dental Insurance Plans [2019]

The best dental insurance plans actually depends on how much dental intervention you’ll end up needing.

My best recommendation is always to avoid cavities by working on your nutrition. Since cavities turn into the need for fillings, crowns, root canals and extractions, prevention is the best chance of oral and overall health.

If you end up needing dental treatment, and do not have savings to cover the costs, choose a plan that works best for your dental needs and budget.

PPOs are more comprehensive but also cost more upfront, while HMOs cost very little monthly and provide very little coverage as well.

Medicare/Medicaid and Marketplace plans are incredibly limited in scope and coverage, so these kinds of dental insurance should be used only if no other option is available.

A supplemental dental plan can help cover costs if you and your spouse both have accessibility to dental insurance.

Delta Dental is the largest dental insurance provider in the US. Their network contains more than 190,000 dentists, which allows them to keep prices low—theirs is the lowest fee schedule.

As a general rule, the larger the insurance company, the less you’ll have to pay for your treatment. Large companies like UnitedHealthOne, Humana, Cigna, and Ameritas all offer reasonable in-network pricing for PPO plans.

The most important thing to know about dental insurance, no matter the company, is that all plans have a very small maximum payout (usually between $750-2000 per year).

If you need major work (orthodontics, bridges, root canal and crown, etc.), expect to be left with a significant cost after insurance has paid out. In these cases, an HSA or FSA is probably a good alternative to save that money if you can.

Look into Bento Dental. They offer employer plans as well as individual plans that cost nothing unless you end up needing dental services. I’ve been using it for my employees and it’s a great way to save us both some money on group plans.

Bento works similar to the big insurance companies, except you don’t pay monthly premiums but you still get access to the discounts that dentist’s give their “in network” patients. In many cases, this comes out to the same you might pay with a huge company like Delta. This saves an average of 30% for most procedures.

One thing I like about it is their mobile app. It’s simple to understand, and if you sign up as an individual, you only pay if you end up using their service. Think of it like the Uber of dental insurance.

Dental Insurance for Seniors

Dental insurance for seniors is an important topic that has been put on the backburner in our healthcare system for some time.

As we age, gum disease becomes more prevalent and in turn our health suffers. Since gum disease is linked to Alzheimers, diabetes, heart disease, and more, it’s important to keep up with your oral health into your golden years.

Its best to consider a supplemental plan, margarita fund, or Bento Dental since you’ll need to keep up with your preventive services and it’s likely you’ll need dental treatment at some point. But as always- prevention is your best defense against painful and expensive dental work.

Should I get dental insurance?

Having some form of dental coverage is the best decision for most. If you’re self paid at any doctors office, including a dental practice, there’s no guarantee you’ll be charged fair prices.

“In network” patients save an average of 30% over patients with no coverage.

For this reason alone, it’s a great idea to have coverage if it’s available to you. However, if you’re good at saving your money and don’t want to pay monthly premiums, there are alternatives out there that get you the network rates without being tied down to yet another monthly bill.

Remember, dental “insurance” is truly more of a discount plan to keep up with preventative care. All conventional dental insurance plans cover just a small portion of what you might pay for extensive work.

People who benefit most from the savings from dental insurance include:

Employees with very low-cost insurance options (preferably for PPO plans)

Children who qualify for Medicare and need regular preventative care

Those with access to an HMO plan who are able to keep additional funds in a savings account, FSA, or HSA for dental care (since the HMO will cover very little)

People who need a great deal of dental work in the next 1-2 years and want to save some of the up front cost

If, on the other hand, you fit in one of the categories below, joining Bento Dental and foregoing normal dental insurance might be the best route:

Employees who can afford to save money in a savings account, FSA, or HSA for dental care

Self-employed individuals

Those who follow proper nutrition and habits to prevent cavities and gum disease

Anyone looking to save on a dental insurance premium who only needs bi-yearly cleanings and no major work

Employees not offered dental benefits

FAQs on Dental Insurance

Which is the best dental insurance to choose?

A: The best pan to choose really depends on your particular situation. What you eat, your current dental health, and your financial situation all play a role into which option is best for you.

Do I need dental insurance?

A: Do you follow a strict oral health supporting diet like the Paleo diet, make sure you get the proper nutrition, and implement a savings plan for unforeseen dental procedures?

In that case, you will likely have no problem skipping a traditional “dental insurance” plan and opting for something like Bento Dental instead.

If I end up needing treatment, will I know how much my out of pocket costs will be ahead of time?

A: With some plans, it’s possible to submit a “pre-authorization” before you get any treatment done. In my experience, this is not without its risks.

I’ve seen numerous times where an “approved” treatment was completed, only to find out that the insurance policies “changed,” which raised the patients out of pocket contribution.

Additionally, waiting for pre-authorization to be completed by an insurance company can take weeks, which can cause unnecessary pain and risk to the patient.

It’s best to read your policy thoroughly and consult with your dental office’s insurance coordinator for their expertise. S/he works with insurance companies day in and day out and knows how to decipher your plan to offer valuable insight into your options.

Key Takeaways: Dental Insurance

Dental insurance, like health insurance, is a broken system that many times negates the pursuit of health altogether. However, it’s beneficial in the unfortunate case you need costly treatment.

Your best option is to become intimately informed about your plan’s limitations and take advantage of every prevention measure available to you, including reversing and preventing cavities naturally.

Got more questions on dental insurance? Send me an email at [email protected]!

Read Next: No dental insurance? Here’s what to do.

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