Dental and Health Insurance--Is this a good price?

[kwynn]

Self-employed here. Just going over my budget again and checking everything.

Do you think $34/month is a good price for dental? And $159.50/month for health insurance ($7500 deductible, $35/office visit copay)?

I felt pretty good about these prices and have purchased this stuff already, but not sure if I should still look or do you think I can check these things off as "done"?

[kaylie]

Are you very cavity prone? If you only get the occasional cavity, I would bank the $34/month and have it there in case you need it. Dental care isn't that expensive and the most expensive cavity I've ever had was $300 ($120 for the cheapest). I would only think that price was worth it if I was going to need a root canal or something major.

[Deleted]

What is the annual max on the dental? $1000 or $1500? Is it a discount plan, or is it 100% for preventative (cleanings), 80% for minor (fillings, etc), 50% for major (extractions, root canals, crowns, etc) or something similar (I have seen plans that are 80%/60%/50%).

If it is a discount plan, that's probably a bit expensive. If it is a dental PPO, that's a decent enough price.

For the health insurance, do you have to satisfy the deductible before the insurance covers anything besides preventative care (which should be at a $0 copay, btw), or do you just have to pay the copay at the doctor? Do you have to satisfy the deductible before things like X-rays or labs are covered? Do you have to satisfy the deductible before emergency room is covered, or is it a copay for the emergency room ($50, $100)? What is the coinsurance and maximum out of pocket?

FWIW, in my area, there aren't plans with a $7500 deductible ($2500 is most common), and most plans don't even have a $7500 individual max, it is usually $5000 for in-network. However, the cost for the plans is like 3x what you were quoted.

[SusanBAnthony]

I would worry about the dental. We have dental insurance, and it basically just pays for cleanings. The advantage is that if we do have a major expense, we get the negotiated insurance rate for that procedure.

Insurance sounds good.

[kwynn]

Feb 15, 2013 7:10:02 GMT -5 kaylie said:

Are you very cavity prone? If you only get the occasional cavity, I would bank the $34/month and have it there in case you need it. Dental care isn't that expensive and the most expensive cavity I've ever had was $300 ($120 for the cheapest). I would only think that price was worth it if I was going to need a root canal or something major.

I'm not really cavity prone...I have two crowns which cost $1200 each and that scared me (that was about 5 years ago).

The OOP no insurance cost for a cleaning is $70 and I get them cleaned twice a year, then the cavity costs without insurance are composite only and usually around $300

[kwynn]

Feb 15, 2013 7:11:22 GMT -5 @mrsspunky said:

What is the annual max on the dental? $1000 or $1500? Is it a discount plan, or is it 100% for preventative (cleanings), 80% for minor (fillings, etc), 50% for major (extractions, root canals, crowns, etc) or something similar (I have seen plans that are 80%/60%/50%).

If it is a discount plan, that's probably a bit expensive. If it is a dental PPO, that's a decent enough price.

For the health insurance, do you have to satisfy the deductible before the insurance covers anything besides preventative care (which should be at a $0 copay, btw), or do you just have to pay the copay at the doctor? Do you have to satisfy the deductible before things like X-rays or labs are covered? Do you have to satisfy the deductible before emergency room is covered, or is it a copay for the emergency room ($50, $100)? What is the coinsurance and maximum out of pocket?

FWIW, in my area, there aren't plans with a $7500 deductible ($2500 is most common), and most plans don't even have a $7500 individual max, it is usually $5000 for in-network. However, the cost for the plans is like 3x what you were quoted.

It's a PPO. I don't have any idea what the annual max is as I have never hit it, so it must be a lot. It's 100% on preventative and 100% on minor if you do amalgam, and only the dollar value if you choose composite.

For the health insurance, you only have the copays at the doctor (one wellness visit covered per year), but then any other procedures will cost you out of pocket, such as labs, Xrays, etc...I could choose $2500, $5000, $7500, or $10k deductible, so I chose $7500 to lower my monthly payments. If you went to the emergency room, you'd have to pay $250 as a copay.

After you hit $7500, you pay 20%, they pay 80%, and no OOP maximum---I know that's risky, but I didn't see any plans that did have OOP maximums that were available to me.

[rebekistan]

Feb 15, 2013 10:27:48 GMT -5 kwynn said:

Feb 15, 2013 7:10:02 GMT -5 kaylie said:

Are you very cavity prone? If you only get the occasional cavity, I would bank the $34/month and have it there in case you need it. Dental care isn't that expensive and the most expensive cavity I've ever had was $300 ($120 for the cheapest). I would only think that price was worth it if I was going to need a root canal or something major.

I'm not really cavity prone...I have two crowns which cost $1200 each and that scared me (that was about 5 years ago).

The OOP no insurance cost for a cleaning is $70 and I get them cleaned twice a year, then the cavity costs without insurance are composite only and usually around $300

In that case, I would drop the dental coverage. It's $140/year for cleanings, versus $408 for a years-worth of premiums. The only way that makes sense if is they cover cavities 100% (which they might not, if they're like my insurance and only cover silver fillings) and you need one filled. I would opt for paying OOP for regular cleanings and being on top of things if a problem pops up. Then look into picking up coverage to cover the problems down the road. Or, you could put the premiums into a savings account so you have the $$ if something comes up. 

[Deleted]

Feb 15, 2013 10:32:10 GMT -5 kwynn said:

It's a PPO. I don't have any idea what the annual max is as I have never hit it, so it must be a lot. It's 100% on preventative and 100% on minor if you do amalgam, and only the dollar value if you choose composite.

For the health insurance, you only have the copays at the doctor (one wellness visit covered per year), but then any other procedures will cost you out of pocket, such as labs, Xrays, etc...I could choose $2500, $5000, $7500, or $10k deductible, so I chose $7500 to lower my monthly payments. If you went to the emergency room, you'd have to pay $250 as a copay.

After you hit $7500, you pay 20%, they pay 80%, and no OOP maximum---I know that's risky, but I didn't see any plans that did have OOP maximums that were available to me.

The highest max I have ever seen on a dental plan was either $2000 or $2500. Most are $1k, and very few are $1500.

What is the cost for the plan with the $5000 deductible?

There HAS to be an OOP maximum. Is this plan on ehealthinsurance.com? If so, click "show all plan details" and it is in there.

To figure out what is going to be the least expensive plan overall, this is the formula I use:

(Premium * 12) + maximum out of pocket (God forbid something bad happens) + any prescription copays you have for maintenance medication (b/c with some plans even if you meet the MOOP, you still have Rx costs). 

When comparing costs for the health insurance my husband and I have, it was only like $200 more/year to stay with our low deductible plan vs. going to a higher deductible plan, so we stayed with our current plan.