Health Insurance HQ: An Update on the Health Care Landscape

Dear Friends,

We get a lot of questions about how to afford dental care. So this month, we’re going to give you a brief overview of dental coverage, along with some tips on how to afford it.

Welcome to Dental 101!

Dental coverage is generally separate from your medical coverage. It does not have a mandated open enrollment period, unlike medical coverage, and can be purchased throughout the year. (Note: If you get dental coverage from an employer, you may be subject to an annual open enrollment period).

It’s important to understand the two most basic types of plans, so you know what you’re getting into.

• Dental HMOs require you to see dentists within the insurer’s network of providers or your costs will not be covered. Dental HMOs generally have flat fees, known as co-pays, for specific services. You may or may not have a deductible to meet before services are provided. Most Dental HMOs do not have a maximum pay cap. There are likely numerous limitations and exclusions on procedures. For example, a common exclusion for a dental HMO plan is cosmetic or orthodontic treatment.

• Dental PPOs are usually more limited in coverage, but offer you the flexibility to choose dentists in or outside your network. This means you can access more providers. Dental PPOs generally have co-insurance (instead of co-pays) for specific services. For example, with a filling, the insurance may cover 80% of the cost, while you would cover 20%. There is generally a deductible that must be met before services are rendered, and this may or may not include preventive services. Dental PPOs often have a maximum pay cap, which is the maximum amount the insurance company will cover on your behalf in a calendar or plan year. Many plans have maximum caps of between $1,000-$1,500 per person per year.

What types of services are there?

Many of the materials we see don’t do a good job of explaining what types of services are covered. Below are examples of services covered under general categories:

Preventive and Diagnostic services

• Cleanings
• Oral Exams
• X-rays

Basic services

• Fillings
• Extractions

Major dental services

• Crowns
• Dentures

If you’re insured through Medicare or Medicaid, you may have limited dental coverage. States are required by law to provide dental coverage for children on Medicaid, although coverage for adults is an optional service, and therefore not provided by all states. Emergency dental care is normally available, but overall, Medicaid dental coverage for adults is not comprehensive. If you’re unsure about your dental coverage under Medicaid, call the number on the back of your Medicaid Managed Care card.

Most dental procedures and coverage for routine dental care, such as exams, fillings, cleanings and tooth extractions, are not covered by “original” Medicare (Parts A & B, with or without a Medigap plan). If you have a Medicare Advantage plan, you may be able to receive routine dental care as part of your coverage. Contact your plan to find out more.

If you don’t currently have any dental coverage, the following are ways to lower your dental expenses:

Dental Schools and Programs
Universities with dental programs and dental schools offer an alternative way to receive dental care. Dental schools provide training for future dentists, dental specialists, hygienists and assistants using the latest dental techniques. To find a dental school in your area, visit: https://www.asdanet.org/index/get-into-dental-school/before-you-apply/u-s-dental-schools. You can sort by dental hygiene programs at this site.

Cash
You can also negotiate your own discounts. Many offices offer lower rates when the patient pays in cash up front. Cash rates can be substantially lower than the contracted rates negotiated with insurance carriers. Why? Because the cost of billing and collecting from patients can be up to 30% of the provider’s revenue.  If it means more money in your pocket, there’s no harm in asking for a cash rate.

Discount Dental Plans
Dental savings plans (also known as discount dental plans) are an alternative to insurance. Members pay an annual fee and gain access to certain discounted rates at select dentists. There’s no payout from the discount plan company to your dental provider. This is different than dental insurance, where you pay a premium, and after any deductibles or copays, insurance pays for covered dental expenses either in full, or partially up to an annual maximum cap.

The best way to find a dental discount plan is to ask a dentist you (or your friends/family) know and trust, ask if they participate in one, then review their literature carefully. Dental discount plans can also be found on www.dentalinsurance.com.

Financing
Check with your dental office to see if they have a financing program that will allow you to receive services now and pay the balance over a period of time. Financing plans can end up costing you more if you don’t read the fine print. Always ask what the interest rate is (if any) and how quickly you must pay off the balance.

In short, you DO have options, with or without having dental insurance. Explore your options before making your final decision.

Yours in good health,

Do you work in performing arts and entertainment and have questions about health insurance? The Actors Fund provides assistance nationally. Contact our regional office closest to you to speak to a counselor.

New York City
917.281.5975

Los Angeles
855.491.3357

Don’t forget to use the resources section of our website. It contains tools to help you make decisions about your health insurance, including new online tutorials on how to choose providers and how to read an Explanation of Benefits. In addition, you’ll find an updated Stage Managers National Health Directory, our national online directory of health care providers recommended by industry professionals that can be used by theaters and touring companies. For these resources and more, visit actorsfund.org/HealthServices. You can also find out more about enrollment assistance and upcoming health insurance seminars near you!