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A Large Bite

Richard Quinn, 2:07 am ET

IN DECEMBER 2020, my wife got an infection at the site of an old root canal. The dentist initially thought it could be treated with medication. Unfortunately, that wasn’t the case, so an extraction and implant were planned.

The process took several visits and several bills, with the charges accumulating along the way. Some of this pain could have been relieved by a modest dental plan that I had from my former employer. That was not to be, as my employer terminated the plan in 2021. What coverage we could then purchase—with money from the company’s health reimbursement arrangement—covers only routine care.

I do have a health care spending account through my old employer. But the way it’s structured—which I designed many years ago—requires clairvoyance. You make an annual election for the amount to be available for bills in the following year. In 2020, I transferred way too little for 2021.

When the dentist gave us an estimate, the figure reminded me of buying my first car. When you think about it, just the fact that you need an estimate tells you something. The good news: He gave us a senior discount—without regard to our ability to pay, I might add. Later, after the post was installed, he offered a further discount if we paid cash. Usually, I like to pay bills with a credit card to earn rewards. In this case, the discount prevailed.

The way this procedure works: You go to the dental surgeon to get the post implanted, and then back to your dentist to have the new tooth attached. The tooth part has yet to be accomplished, so we only have one bill to go by. At this point, however, our cost after discounts is $6,651.67. The estimate for the remaining work adds another $1,500. Over $8,000 for one tooth.

Two thoughts come to mind. First, admonishing retirees to have an emergency fund is good advice. Second, with all the talk about adding dental coverage to Medicare, will it include dental implants at $8,000? Don’t count on it.

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Ron Sheldon
Ron Sheldon
8 months ago

Many Medicare Advantage health plans provide a dental benefit. Mine covers 100% of specific dental procedure annual expenses up to $1,500. And, the expenses are computed at insurance company in-network dentist negotiated rates which, in my experience, are usually at least 50% less than the dentist’s standard rates for the procedures and materials. For example, I had a cracked molar with pre-existing filling. The dentist had prepare the molar for a crown, build and install a tempoary crown, and obtain and install a permanent crown. My dentist’s standard fee for these procedures was $2,038. The procedures all fell within the scope to the insurance dental benefit with the insurance company paying the dentist in full the negotiated contract fees of $573, or less than 30% of the dentist’s standard fees. I had to pay nothing for the procedures, as well as nothing for twice annual cleaning, exams, x-rays, and other other covered dental procedures totaling less than $1,500 per year.

In my opinion, it is worth considering and investigating the varying additional benefit coverage provided in different Medicare Advantage health plans as well as the potential medical health care savings.

In my case, my annual medical expenses are much less than if I had standard Medicare Parts A, B and D with a supplemental Medigap Plan F or G. [I’ll digress: The only difference between G and F is that with G you need to pay the annual Medicare Part B deductible, $203 for 2021, before insurance pays 20% coinsurance you would pay without Medigap Pan F or G. Typically, the 12 month premium savings from the same insurer for Plan G versus F is several hundred dollars more than the cost of the annual Part B deductible.]

In addition to the dental benefit in my Medicare Advantage plan, the plan provides benefits for eye exams, eye wear, hearing exams, discounted hearing aides, up to $100 a quarter for non-prescription health related items. My plan includes a drug benefit at no additional premium cost. My five maintenance medications are all preferred generic, generic or preferred name brand drugs provided at 90 days supplies by mail order at no cost to me. Best of all, I have no annual deductibles to meet, a $4,100 out of pocket annual limit on all medical expense that would be included under Medicare Part A or B, and I do pay nothing as an additional premium for my Medicare Advantage insurance — all is included in the standard Medicare Part B premium deducted from my monthly Social Security benefit. However, I do have a $30 co-pay for each specialist visit, but nothing for primary care visits, and have a few minor charges for some tests, etc. typically totaling less than $200 to $400 per year,

To get near equivalent benefits under original Medicare Parts A and B, I would need to pay an additional premium for Medicare Part D prescription drug plan and possibly some cost for the drugs. And to protect against unlimited original Medicare out-of-pocket expenses, I would need to pay $1,500 to over $3,000 per year for a Medigap Plan F or G. And I would still need to pay out-of-pocket for all my dental, eye care, hearing exams, non-prescription health related supply needs.

While Medicare Advantage plans require use of In-Network health providers, I have yet to encounter an In-Network provider that isn’t qualified and competent. I believe too much is made of possibly having to use In-Network services and providers as a Fear, Uncertainty and Doubt factor causing people not actually shop well for their medical insurance needs. I find that most services and providers I use or would use, and many of those I know already use, are included in existing Medicare Advantage insurance networks. Thus, the need to switch physicians and service providers is usually infrequent if at all.

Medicare open enrollment starts Oct. 15th and continues through early December. In my opinion, it is well worth the time to explore, preview and compare the various Medicare Health and Drug Plan options at Medicare.gov for your zip code. Then do do in-depth investigations of those plans of most interest to you via links to insurance provider websites and insurance representative staff inquiries to be certain of the plan’s premiums and other potential costs; all the benefits; the physicians, hospitals, clinics, dentist, etc. that are in-network and proximity to you; your current drugs, their inclusion in the plan’s formulary,mail order and local in-network, and the drug costs, and, much more..

R Quinn
R Quinn
8 months ago
Reply to  Ron Sheldon

Provided you are willing and able to use only network providers and facilities.

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