October is usually the time of year when companies ask their employees to decide between their current medical and dental insurance plans and a new plan. So, someone from HR gives you a booklet or sends a long email with the many options that you have to choose from and gives no other explanation after that. The employee does one of three things: 1) Doesn’t open the email, 2) Opens it but is confused by the insurance lingo, or 3) spends hours researching only to miss the deadline.
Do not fret, you are not alone! That doesn’t make the task any less annoying. Who has time to look through multiple options and ask their colleagues which one they have and to call around all over the city to see who takes what. Whew! I’m exhausted just writing about it! But, it’s important to remember that insurance companies are not a “non-profit” which means that they are not transparent and they don’t have to be. It’s like they want to be confusing so that they can take more of your money and cover less without you knowing about it. Therefore, it is the patient’s responsibility to know their plan.
“But didn’t you just say you don’t have time?” Yes I did! But let me see if I can help with information regarding the different types of coverage:
- HMO – you cannot pick your provider, one is assigned to you. If you are unhappy, too bad. However, the family’s monthly insurance premium is lower each month which makes it a desirable plan to choose.
- PPO – this is the most widely accepted plan you will find. Your monthly premium is more each month but if you need an office that has evening hours, you can actually find one. Coverage is usually $1,000-$1,500 per year.
- Premier – the crème de la crème of insurance plans! Typically, provides the family with $2,000-$3,000 in benefits each year and covers services at a higher percentage. (In Sacramento we have a lot of state workers who are provided a “Premier” option.)
Other things you should keep in mind: Dental Insurance coverage is not 100%. Unlike medical insurance, dental insurance only covers a certain percentage of each service and they include your yearly deductible. The best plans will cover what we call 100/80/50 and have a $50 deductible.
- 100% – Exams, X-Rays, Cleanings (deductible may or may not apply)
- 80% – Root Canals, Fillings, Gum Problems, Oral Surgery (ded. applies)
- 50% – Crowns, Bridges, Dentures (ded. applies)
- For example: If you need a root canal and that costs $500 your insurance will subtract the $50 deductible and pay 80% of what’s left ((500-50) * .8 = $360 and you are responsible for the difference. See how confusing they make it??
Not all plans are the same and typically you get what you pay for. Our dental office in Sacramento works with most insurances. Call for details (916) 649-0249.