Keep You Smiling

It’s open enrollment, and I’ve come across a new dental plan that may be of interest and keep some of you smiling

I have talked extensively in the past about weighing up the value of having dental insurance. And that point is still true because, for some people, it just doesn’t make sense to pay for dental insurance. Some people, however, feel more comfortable having dental insurance, just in case something happens. The other main factor to weigh up is how often you’re going to actually use that coverage.

I am excited about a new dental plan that has become available. This new plan is through Physicians Mutual, but don’t be put off by this. Yes, Physicians Mutual is a big player in the Senior Market, but they currently have a revamped dental plan that has four levels, that can be used by anyone, not just seniors. The plan starts at about $30 a month and goes all the way up to $56 a month. You can choose which level you’d like, which is something that we evaluate based on your needs.

Other key points about this plan:

  • On all levels, preventives are covered at 100%, if you use their network provider (Emeritus Merchants Classic Network), which is nationwide.
  • They’ll still pay 100% of what they would have paid if you choose to you an out-of-network doctor, and then you just pay the difference.

But the thing that really interested me about this plan is their yearly maximum. If you have had dental insurance before, you will know that 9.999 times out of 10, all dental plans have a yearly maximum of what they will pay. I’ve seen it as low as $1000. The average is about 1$500. I’ve seen a few plans at $2000. This Physicians Mutual plan has no yearly maximum.

Yes, there is no yearly maximum. If you need multiple crowns, there will be a waiting period for major work (crowns, root canals, etc.) but, you’ll be able to use your coverage for it.

Basic services and a number of other things are covered right away. But there are still some waiting periods for bigger treatments.

What will they pay out?

Depending on the level of coverage you pick, it can pay as little as 40% of the total cost on the out-of-network pricing, or up to 70% of the network pricing.

The in-network pricing saves you on average, about 36%. So, if you go to an Emeritus in-network provider, you’re getting a 36% discount, plus then it pays 70% of the total cost.

Now that doesn’t come out to 100% of the cost; but if they pay 70% of the discounted amount, that is still a good deal for many people.

Let’s do some math:

Let’s say a crown costs $1000 for example. You decide to go in-network and the discount is 36%. That’s $360 which makes your crown cost $640. Then the plan will pay 70% of the $640, which is $448, meaning that you would only pay $192 instead of $1000 for that crown.

Who is in-network with them?

I did a search of the 78734 area, and there are tons of dentists that accept this plan. I mean, tons. Staying in the network may not be that difficult.

Final points to note:

  • This plan is available to anybody, even those over 65.
  • If you’re under 65 or losing your dental cover, this is also could be a good choice but we’ll evaluate it based on your circumstances.
  • Orthodontics is not covered by this plan.

If you have any questions about this plan or any other, please feel free to reach out to me. I am here to help!

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