If my dental insurance has 100% coinsurance on preventative and basic care, 70% coinsurance on major care, a deductible of $50, and a maximum payout of $2000, does that mean I can only spend the insurance $ on major services and pay out of pocket for everything else?
Here, dental insurance isn’t really “insurance” like health insurance. Everyone needs dental work and preventative. Dental insurance is better thought of as a “discount plan”.
The cost of preventative is factored in. You have to go to their dentists with whom they have a relationship with and have negotiated a rate. And then they barely pay anything on major stuff.
If an employer is paying for it, great, it’s a little bonus–but I don’t think it is usually in your best interest to sign up out of pocket, unless you know you need something major done and the premium is less than the maximum payout. BUT–usually these plans (when signed up individually) have a waiting period on major items. This means you have to factor in 2 years of premiums to see if it is worth it.
On a side note, if you do need some major work done, there are a lot of different countries you can go to and get it done for a lot less and also get a vacation in at the same time.
I work in a healthcare adjacent field but even half my coworkers would probably still have difficulty answering these questions so take what I say as a hopeful truth.
Yes you would be correct. And your major care the insurance will only pay 30% of, up to $2000. To hit that max coverage amount you’d have to have a total cost of $6,666.66 and you’d owe out of pocket $4,666.66. (I actually just realized I forgot the $50 deductible but numbers are close enough).
Also for major care, many dental plans (less obvious when through an employer but still possible) there may be a waiting period to use those benefits such as 6-18 months. This is to prevent someone from getting insurance, using it immediately for the benefit, and then cancelling (or even if not cancelling, they just don’t want someone who knows they have a large procedure coming up to sign up just to save $).
To be honest that plan doesn’t sounds great and I’m shocked preventive isn’t fully covered or at least covered with a deductible. If it’s an option i’d do the math to see if it’s worth just saving the premiums and paying outright. Additionally many dental practices will negotiate discounts for cash payments.
Edit: Also thanks for the inspiration to write my first Lemmy comment. I don’t usually feel I have something unique to offer but this excited me!
@compg318 I’m honored, thank you for taking the time!! They pay 95% of the premium but geeze its awful coverage. The coinsurance thing was really confusing me! I don’t get why preventive wouldn’t be included, I’ll have to talk to my employer:(
Of course! Hopefully they can look into a different future plan. I do know a lot of people who just don’t bother with dental insurance due to the poor coverage overall.
It’s a shame most of the world doesn’t treat dental as medical considering the health risks of not treating those conditions.
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