Tag Archives: dentist

Are We Losing Money On Our Dental Plan Because of Orthodontic Coverage for Our Children?

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A few years ago, my husband’s employer was taken over by another company. It didn’t take long for the benefits to get cut: we went from having good dental and medical coverage, and high life and disability insurance to being told we could buy selected benefits using a “shopping cart” funded with a percentage of his annual salary. Sound familiar to anyone else? Anyway, while reading the benefits info again recently, I began to wonder if we are actually losing money on the orthodontic coverage provided for our children.

Dental Plans May Strictly Limit Reimbursement for Orthodontic Work

The problem for the insurance company is that orthodontic work is expensive. It’s also becoming very common: to the point where no one teases kids about their braces any more because they see them on teeth in dozens of mouths. In fact when one of my children’s friends had braces put on, many of her classmates didn’t notice, and even when they did they couldn’t remember if she’d had them on for a year or if they were new.

So to reduce how much dental insurance plans have to pay out, or conversely to keep from having to raise the premiums unacceptably high, many plans limit the coverage for orthodontic work.

Our plan pays nothing for orthodontic work for adults.

For dependant children, it has set a maximum lifetime claim of $1500 per child.

Have you checked the price for a regular course of treatment for orthodontic work? Let’s just say $1500 isn’t going to get you through the first appointment much less the following two years.

How Our Dental Plan and Premiums Work

Our dental plan has another interesting twist:

If you want ANY dental coverage for your child, you have to insure all of your children and you must pay the orthodontic premium for each child.

That sounds reasonable at first glance: they don’t want you only paying premiums for your child with enamel problems and teeth coming in everywhere but where they are needed, and not paying premiums for your three other children who have perfect teeth and never need even a filling or a polishing.

It’s when you look into the details of that “orthodontic premium for each child” that you wince.

And they charge an orthodontic premium for each year of your child’s life until they are 19.

How Much Premium Will I Pay for Orthodontics?

Under our plan, for our family, the orthodontic premium is currently $140.40 per year.

So someone with two children enrolled from birth till when the premiums stop being applied when each child turns 19, should expect to pay $2667.60 or more in premiums.

That doesn’t even assume that the premiums increase. For us, it’s increased, of course, even in the four years we’ve had this insurer from $111.36 to  $140.40 per year. That’s about a 26% which is well above the rate of inflation these past 4 years.

Will We Lose Money Paying Our Orthodontic Premiums for Our Dental Plan

If we had been enrolled in this plan for years, then yes, we would definitely have lost money. We would have paid over $2667.60 in premiums to get a maximum reimbursement of $1500 for our one child who needs orthodontics.

In our case, though, we were only forced into this plan when our children were older. Will we still lose money?

Yep. Assuming no further premium increases, and based on the actual premiums we’ve paid to date, we will pay $1508.64 in premiums to get back the $1500 for which our one child is eligible.

Sigh.

Benefits? Who called this beneficial? For us to have to give money to the insurance company?

I can just imagine how any employee feels who has several children who never need orthodontics!

Admittedly, there should be a benefit to someone who has several children who need orthodontic work done.

Why Would We Get Dental Coverage for Our Children If We’re Going to Lose Money on the Orthodontic Premium?

First, in our plan you can’t opt out of coverage for your children unless you can prove they have coverage under another plan. (I’m not sure whether you could fight this in a court or not.)

Second, the dental insurance also provides coverage for all of the other more routine dental work a child needs: cleanings, fillings, x-rays, examinations etc.

I believe we are saving money by having coverage for those procedures although I would have to start adding up our bills to be sure as our children have been blessed with very healthy teeth.

Well, at least we’re saving money–unless we could not convince our dentist to drop his billing rate…. Some dentists will charge less for the same procedure if you have no insurance. They don’t have to, of course, but they may.

Keep an Eye on Your Benefits and Make Sure They’re Benefitting YOU and Not the Insurer

This review has taught me that it’s important to keep an eye on our benefits. For example, if I was a younger parent I might very well be lobbying our HR department to make changes to this Orthodontic insurance premium. Like dropping it altogether!

I think I’d better check our Eye Health coverage next. Something makes me wonder if we’re breaking even on that coverage or not. And at least that coverage can be waived if we’re losing money!

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Do you ever check your benefits to determine if you’re paying more than you’re getting back? Have you successfully lobbied for changes in coverage? Please share your views with a comment.

Budgeting for Retirement: Dental Costs for Hygiene, X-Rays, and Fillings

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Another perq we won’t have in retirement is a corporate dental plan. Given the way they savaged our plan to almost death during the latest round of work budget cuts, it won’t make that much difference. The big change will be there won’t be any pay cheques coming in to fill the cavity in the bank account after the appointment. Here’s what I’m considering for our retirement budget for our basic dental costs for hygiene appointments, X-rays and fillings.

What Does It Cost Us Now for Basic Dental Care?

If anyone ever told you basic dentistry was cheap, they didn’t live in southern Ontario. My family has what most dentists would consider “average” teeth: No weaknesses; no caps; no implants; no dentures; no grinding; no serious alignment issues. We brush and floss daily. (Yes, I do floss daily (or more) now. Yes, I hate it. But if you want your kids to do it you have to lead by example.)

Yet here are our costs so far this year, not including the kids:

  • Hygiene appointments: $165 x 2
  • Recall dentist exam: $31
  • Exam of special area: $60
  • Composite Filling: $225 (Keeping my wisdom teeth was an expensive choice, apparently.)
  • 4 radiographs (bitewing X-rays): $45
  • Panoramic radiograph: $108
  • Polishing: $18 (No, they didn’t look any different afterwards.)

What Did Basic Dental Care Cost Us in 2009?

Does anyone else remember when dental offices were gloomy small rooms above retail stores that had a shabby carpet in the waiting room and worn linoleum in the dentist’s office? I even remember when the dentist did the hygiene work not a lower-paid assistant. Of course the best thing about visiting the dentist in those days was he also stocked the waiting room with a huge pile of comic books. Now I’m stuck watching my BNS stock plummeting on the omnipresent TV: hardly as amusing.

Anyway, I dug through some old records to find out what we were paying for our basic dental visits in 2009.

  • Hygiene appointments, each: $149.72
  • Filling on one surface: $125.94
  • Filling on two surfaces: $185.33
  • Recall exam: $54.38
  • Full radiographs: $112.10

What Should We Budget for Basic Dental Care in Retirement?

Ok, now the guessing game begins.

How many hygiene appointments will we be able to afford when we retire? How many should we have? We’ll have to plan on somewhere between those two extremes of 0 and 6.

How about

  • 1.333 hygiene appointments per year? (Assuming one visit every 9 months.)
  • 1 recall exam per year
  • 1 polishing per year (so skip it at some of the hygiene appointments)
  • 4 radiographs per year
  • 0.5 cavities per year (we can hope, right? We do have years now with no cavities but I’m assuming things get worse.)

Now we have to double it for the two of us.

  • 2.666 hygiene appointments @ $165 = $439.89
  • 2 recall exams @ $31 = $62
  • 2 polishings @ $18 = $36
  • 8 X-rays @ $45/4 = $90
  • 1 cavity @ $225 = $225

That comes to a nasty total of $852.89.

But that’s in 2014 dollars.

It’s hard to estimate how fast that will go up because I’m not sure what the inflation rate is for dental work.

What Rate of Inflation Should I Use for Dental Expenses?

Dental costs are quite often set by what the insurance companies will accept which is based on a table of charges. It’s not very predictable. Unfortunately, I don’t have many directly comparable bills from 2009 and 2014.

The only bill that I have that claims to be identical is the cost for hygiene visits. For the same amount of time and the same procedure, the cost was $149.72 in 2009 and $165 in 2014. That’s an increase of $15.28 over 5 years. That’s a little less than 2.5% per year.

So for pension planning, I might want to increase my $852.89 annual cost by 2.5% a year for each year.

Remember this doesn’t include any money for

  • Root canals
  • Extractions
  • Caps
  • Implants
  • Gum transplants, etc.

So we’d better hope our teeth stay fairly healthy.

What Can I Conclude About Dental Budgeting?

  • I’d better hope that they come out with an alternate to the internet that’s much cheaper than we have right now. Because as it stands now I’ll have to give up the internet and a bit of something else to pay for our dental costs.
  • I may want to start checking whether any dentists near here have lower fees or have a lower fee for patients without a dental plan.

Related Reading
Other articles in the Budgeting for Retirement Series:

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Have you considered how you will pay for dentistry when you’re retired? Are you already struggling to pay for it even though you’re still working? Please share your views with a comment.