For many of us, paying for a filling or root canal can be painful. And if you're like me — one of the 23% of folks without dental insurance — going to the dentist costs a small fortune.
Without any issues, I shelled out $380 for dental care last year. That's $155 for two cleanings, plus an extra $70 for x-rays. Other than a small gum graft and a couple of cavities, I've avoided any major dental problems.
Based on my history of "good teeth," I've skipped paying for dental insurance myself for 11 of the past 12 years. But what happens if things get worse? I did some research to find out when dental insurance actually pays off.
What most dental insurance covers
According to the National Association of Dental Plans (NADP), most policies cover the following areas:
- Preventative care (cleaning and routine visits)
- Restorative care (crowns or fillings)
- Endodontics (root canals)
- Oral surgery (minor surgeries and tooth removal)
- Orthodontics (braces)
- Periodontics (scaling or root planning)
- Prosthodontics (bridges or dentures)
If you have an individual policy, there's typically a one-year waiting period for the last three. Also, you may need an extra rider to have orthodontics coverage.
How much your provider will pay
Like other types of insurance, it's rare for a policy to cover everything for the more expensive procedures. Here's what they usually pay for:
- Preventative care - Most plans cover 100%. This usually includes cleanings, oral evaluations, x-rays, and sealants for certain age groups.
- Basic procedures - You can expect plans to cover 60-80% for basic procedures. This includes office visits, extractions, fillings, periodontal treatment, and root canals.
- Major procedures - Many plans only cover 50%. Bridges, crowns, dentures, inlays are all major procedures. It's possible your plan may put some basic procedures — like root canals — into this category too.
Only half of dental PPOs will cover more than $1,500 per year. The other half cap annual benefits below $1,500.
How much dental insurance costs
If you have dental insurance, it's likely through your company's group plan. Premiums range from $14.06 to $30.57 per month or $168.72 to $366.84 per year. Family plans are more expensive — ranging from $27.08 to $56.73 per month — or $324.96 to $680.76 per year.
Unfortunately, there isn't recent data on individual dental plans. When I searched my Marketplace, individual dental insurance plans ranged from $13.19 to $46.57 per month.
Analyzing my own dental plan options
When it comes to healthcare, I stay with the same doctors for as long as I can. When I searched Nashville's Marketplace, only two plans covered my dentist. The monthly premiums for these plans are $26.03 and $32.79.
One first covers preventative care at 70-90% The second pays 100% for the same services. Both plans have an annual limit of $1,000. Choosing the more expensive plan means paying $13 more per year. The benefit is 60-80% savings on basic services and 50% savings on major services. Insurance kicks in after a $50 deductible for both of plans.
I am unlikely to use basic or major services, so I have skipped dental insurance again for 2020. I will pay my $380 out-of-pocket with my health savings account.
Is dental insurance actually worth it?
In an ideal world, a crystal ball could predict your future health care needs. But reality looks a lot different. You need to consider a plan's annual premiums and what you get for paying them. Be realistic about your upcoming needs.
The policy's annual limit and how much it covers may help you decide. It's difficult to predict the future of your teeth, so you may need to rely on your dental history. Based on your past experience, you can assess how risky it may be to skip insurance.
Oral care needs
Whether you budget week-to-week, or plan to use your FSA for bigger things, our weekly Real Money column will help you maximize your flex spending dollars. Look for it every Tuesday, exclusively on the FSAstore.com Learning Center. And for the latest info about your health and financial wellness, be sure to follow us on Facebook, Instagram and Twitter.
Winter is one of the most common times for people to get sick, and it's also one of the worst due to the hectic holidays. But here's the good news—with a little bit of planning, you might be able to avoid getting sick or feeling worse.
We're not doctors (and you should always defer to one before making a health or lifestyle change) but coming from experience, here's some handy tips you should know about getting ahead of nagging winter ailments
Preventive care is the best care
Even though it might seem difficult to find time for doctor appointments during the rush of the holidays, the truth is that proactively visiting the doctor will save you time in the long run.
It might seem counterintuitive, but visiting your doctor requires about an hour of your time, but if you get sick, you could lose days or even weeks to fatigue. Because of that, it's important to prioritize holistic care this winter.
If you feel congested or itchy during winter, you might have seasonal allergies. Most people associate allergies with warm seasons like summer and spring, but of the 50 million people who suffer from allergies, a large percentage suffer during the winter months due to drier air and an increase in time spent indoors.
If you have a history of feeling congested or suffering from sinus pain during the cold months, it might be a good idea to visit your doctor or see a specialist to get help. Luckily, doctor visits are eligible, so don't forget to use your FSA funds to pay for copays or other fees.
If you already know that you have winter allergies or have been previously diagnosed, be sure to get the remedies you need.
Seasonal affective disorder (SAD)
Seasonal affective disorder, a type of depression related to seasons, affects 6% of the U.S. population. Most people with SAD experience depression during the winter months, which are colder and darker. In addition, 14% of the U.S. population suffers from a lesser form of seasonal affective disorder known as the "winter blues."
If you notice that you feel depressed or down during the dark and cold winter months, it is a good idea to talk with your doctor. Your doctor might recommend medication, talk therapy or even light therapy.
You've probably heard that you should get a flu shot before the winter flu season, but that doesn't necessarily mean you've done it. In fact, according to the Centers for Disease Control and Prevention, more than half of Americans didn't get a flu shot last year. The good news is that it only takes a few minutes to get one and it is FSA-eligible.
Here's the deal—dry skin, eczema, itchy skin and even acne are all associated with the dry air and cold temperature of the winter months. If your skin is painful during winter, it might be a good idea to make an appointment with a dermatologist.
If lotion and other FSA-eligible over the counter treatments aren't helping (note that some may require a prescription with your FSA), then it's a good idea to see a specialist and get the help you need. Even though it may not seem like it, the truth is that painful skin doesn't have to be a normal part of life during the winter.
What to do if you're already sick
Unfortunately, sickness is sometimes inevitable. If you find yourself feeling ill or struggling with a particular ailment, the first step is to visit your doctor. After that, follow your doctor's instructions and rest. Your body will be back in action in no time.
Don't waste time hunting for ways to spend your tax-free funds. In That's Eligible?!, we'll bring you these updates every Monday, so you don't have to. And for all things flex spending, be sure to check out the rest of our Learning Center, and follow us on Facebook, Instagram and Twitter.
For most Americans, healthcare comes through their employer, and prices for expenses -- like copays and doctor visits -- are largely determined by the available plans, before you even sign up.
But with the rising cost of healthcare in the U.S., skipping treatments or postponing doctors' appointments has become an unfortunate -- and unnecessary -- reality for some Americans.
Don't let these price increases affect your health when there are many ways to cut the costs of medical care! For this week's FSA Friday, we're going to explore some easy, money-saving tips to boost your finances.
1. Check prescription drug prices
We covered this in last week's column, but you may be spending more than you should for prescription drugs by not paying with cash. Pharmacy benefit managers (PBMs) may sometimes negotiate higher prices for co-pays than the actual cost of the drug, so you should always ask your pharmacist first if there's a difference between cash and insurance-covered prices.
2. Use free preventive care options
The Affordable Care Act mandated that insurance plans must offer a minimum standard of preventative services that are free of charge to the participant, as long as they stay within their insurance networks. Healthcare.gov has a full listing of these services, which includes vital screenings like colonoscopies, vaccinations, blood pressure testing, and more.
3. Enroll in an FSA/HSA
Maybe we're partial, but if you're offered an FSA or HSA option through your employer, this is one of the easiest ways to cut costs by reducing your taxable income. The money contributed to your account is exempt, so every purchase you make, whether it's sunscreen, co-pays or OTC medicines, is covered by tax-free money. That's way better than paying out of pocket!
4. Consider generic drug options
When you purchase name-brand medications, you're usually paying a premium for the name on the bottle. Over-the-counter (OTC) medications like pain relievers and antihistamines have identical generic versions that can offer real cost savings.
Another note -- be wary of pricey combo drugs. Instead of buying a less-effective combination cold and allergy medicine, check ingredient lists. It's often far cheaper (and effective) to buy a standard decongestant and a separate allergy medication. Of course, check with your doctor if you're unsure of how much you need of each active ingredient.
5. Track your health spending
This sounds like a no-brainer, but tracking spending is a major consideration if you have a deductible.
Let's say you anticipate having a medical procedure sometime over the next year. You can use this opportunity to make a huge dent in your deductible so that insurance can cover unexpected expenses later in the year.
Another option is to hold off on the procedure until later in the year, after you've met your deductible, when your insurance might possibly cover the whole cost. Both options make sense, as long as you track your costs so you can time your healthcare costs to match your insurance coverage.