Dental Problems

Rajaah said:

Any dental insurances out there that cover implants? Even if so, I'm guessing they won't do it for a pre-existing condition. I've got a couple of molars that need to be replaced eventually so I might as well get on a better insurance regardless. What I have now covers root canals and crowns which is nice, but doesn't help when a tooth is straight-up missing.

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Many dental plans do, but:
(a) it's usually considered major restorative, so expect 60% plan pay/40% out of pocket when in network at best, and
(b) if you get an individual dental plan, there is typically a one year elimination period where coverage on major restorative is reduced or nonexistent, and
(c) you may need to contend with a preexisting condition clause as you stated (not all plans exclude, but some do), and
(d) unlike post-Obamacare health insurance, dental insurance has annual benefit maximums, so the plan "shuts off" after paying a certain amount per year, typically $1000-$1500. Implants are expensive, so there's a pretty good chance you may hit the benefit maximum.

Check out Aetna; you get free CVS Carepass along with it, which gives you $10/mo at CVS, so it helps defray the cost a bit. Their vision plan is also very good if you need it, and you can bundle to save a bit. Humana has a good rep too, but they tend to be pretty pricey. Dental Dental traditionally has had a wide network, but a lot of dentists have been dropping off their network due to allegedly anticompetitive practices, especially DD of California (like Blue Cross, Delta is a consortium of individual state companies that sell products under the Delta name, not one company.)

I'm always happy to help you evaluate insurance if you decide to go that route.

If you don't want insurance, your best bet (if you can't find a cheap dental school) is finding a small, independently owned dentist office (not a Monarch Dental or SmileGeneration), and telling them up front that you'll be cash pay. Many of them will be willing to cut you a discount because they don't want (from their perspective) the headache of dealing with insurance claims.

Lanx said:

i have aetna, are we talking like free yearly eye exams? (actually i think i pay 15$ upfront, actually i should have it scheduled this month) or like if i get old man cataracts i'll be good?

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Every company sells multiple insurance products, so it's very difficult for me to tell how good your specific coverage is without seeing your summary of benefits or contract (devil is always in the details with insurance), but as a whole, Aetna has a pretty wide network, and they have good customer service ratings (at least as far as insurance companies go.)

This is the product Aetna directly sells to individuals in Texas. Employer sponsored coverage pretty much always has better costs and allowances than individuals because companies negotiate as a group of people instead of just one person. But for individuals, this is pretty good.



Routine eye exam for zero copay is good; I've seen copays of $10 or $15 before. I wouldn't say outstanding, because a lot of plans offer zero copay exams, but it's on the better side. Bear in mind a lot of optometrists want you to do retinal scanning, which usually adds a $39 copay to the base cost. You can refuse and probably should unless you have a history of diabetes, glaucoma, retinopathy, etc. in your family.

Frame allowance of $130 is a little low (I usually see around $150), but not awful. Doable at Costco.

Lens copay of $25 is about average.

Cataracts usually fall under medical insurance instead of vision insurance because they need to be addressed by an ophthalmologist (not an optometrist) and surgically corrected.