This post is part of a series on choosing benefits. Today I will look at the ins and outs of our choices for Dental Care. To me this was an easy choice.
Large Conglomerate offers three different Dental Plans through CIGNA: The Dental Health Maintenance Organization (DHMO), the Preferred Provider Organization (PPO) Core Plan and the PPO Core Plan with Buy Up (PPOBU). Each plan has it’s good news and bad news.
The Dental Health Maintenance Organization (DHMO) – We must use a dentist in their network and select a provider that can be changed no more than monthly.
The Good News
- The least expensive monthly premium, at $28.75 per month for our family.
- No charge for exams, x-rays and routine cleanings.
- No deductibles.
- No annual or lifetime dollar maximums.
- Reduced prices on covered procedures when there is a charge.
- Specialist care, but only with a referral.
- Orthodontics covered for children and adults with a maximum lifetime benefit of 24 months.
Pitfalls and PITAs
- You need that referral if you’re going to a specialist
- Coverage limitations abound, and only specific services covered (though they are likely the most common).
Total Annual Premiums: $345
NOTE: Last year I paid $75 out of pocket for a filling. l can’t even estimate what our annual costs for any of these plans is going to be without lots more research. Which I’m not doing. It will depend on what needs doing, and since I’ve had both PPO and DHMO care in the past I can tell you I didn’t notice much of a difference between my portion under an HMO and a PPO.
ESTIMATED ANNUAL COST IF NO MAJOR WORK NEEDED:$345
Preferred Provider Organization (PPO) Core Plan – gives the freedom to choose any dentist. We’d have to meet a deductible for most services and pay a percentage of covered dental costs.
- You can use in-network or out of network dentists.
- A broader range of services are covered.
- Orthodontics covered for a $1500 lifetime maximum, reimbursed at 50% after the deductible has been met.
Pitfalls and PITAs
- Monthly premium for the family of $61.62.
- Preventative services are reimbursed at 100% and there is no deductible requirement for them.
- $50 deductible per person, $100 for the family for other services.
- Basic Services reimbursed at 80% after the deductible has been met.
- Major services are reimbursed at 50% after the deductible has been met.
- $1500 individual annual maximum.
Total outlay before coinsurance: $839.44
But wait! There’s a $1500 maximum per person per year. So that means we’d be paying $839.44 for a maximum of $4500 coverage. And that doesn’t include the 50% of other services we’d have to pay.
If I had a $4500 ring I would not pay $840 a year to insure it. So why would I pay $840 a year for $4500 of dental coverage?
Okay, it’s not an exactly accurate analogy because part of that money goes to pay preventative services for which there is no maximum. But still, you pay more for potentially less coverage than the DHMO.
Always figure out the cash outlay differences between the different options, and evaluate whether or not the extras you’re getting is worth the difference to you.
PPO Core Plan with Buy Up (PPOBU) – The same as the PPO, with the following changes:
- Monthly premium for the family of $69.25.
- $3000 individual annual maximum in-network.
Whoop de doo.
Total outlay before coinsurance: $931.00
Again, l can’t even estimate the annual cost without lots more research. Which I’m not doing. If you think you’re going to need a lot of complex dental work it may be worth it to take a policy with better benefits. For us I think we’re good (please, let that be true!). Just like anything else, you take on the risk you’re comfortable with.
This one is a no-brainer for us. The PPO is $395 more per year in premiums, whether one of us needs major dental work or not. And if we do, there’s $395 towards the work. So, we’re doing the DHMO, thankyouverymuch.
Up next? The vision plan!
~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
Read the rest of the series!