If you’ve had access to oral health through your employer, there’s a good chance you haven’t thought about your coverage in a while. If it’s employer-provided, it usually costs just a few dollars out of your paycheck and doesn’t come with that many options. But what happens if you lose that coverage?
If you’re one of the thousands of people affected by recent layoffs, you may be wondering: what do I do now? Don’t worry. There are plenty of options for all kinds of health and financial scenarios and this article is designed to help you find and choose the ones that are right for you and your family.
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How to get oral health coverage
Join an existing plan (held by a family member)
Many dental plans will cover the spouse, partner, or dependent of an existing plan-holder. In many cases, this will increase the premium owed to the plan. Your family member will work with their employer’s HR department or benefits managers to add you to their coverage.
If a dependent loses coverage due to a layoff, that’s a qualifying event and means your family member should be able to add you to their group coverage midyear.
Use COBRA insurance
COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. This law ensures that you can stay on your employer-sponsored group health plan after a layoff or other qualifying events. That means you can maintain similar coverage by self-paying for a limited time, if your group plan has COBRA coverage.
Buy a plan through an Affordable Care Act marketplace
The Affordable Care Act (ACA) allows you the chance to qualify for lower-cost or subsidized care through state-managed insurance marketplaces. This includes dental care.
In order to buy a plan through the ACA marketplace, please see their site for more information. Most marketplaces allow you to start a plan within 30-60 days from when you lose coverage. If you are looking to begin coverage after an open enrollment period, you will have to provide the official letter of termination that your previous carrier supplies you when you lost your coverage.
If you are in Washington State, visit the
Get covered through a benefits company of your choice
Here’s the silver lining: shopping for private oral health benefits outside group coverage or the ACA gives you countless options for coverage types, networks, costs, and more. This sounds like it can get overwhelming but there are a few basics to consider as you begin to determine which coverage and which company suits you best.
What to consider when shopping for oral health coverage
There’s a lot that goes into keeping your mouth clean and healthy. Maybe that’s why it seems so complicated to pick the right dental benefit for you and your family. But the secret is that there are just a few key details involved in narrowing down your choices.
You and your family’s needs
If you are a healthy and under 30 years old with no history of oral health issues, you will likely need a different type of coverage than someone with children who will need orthodontia work this year. As you begin to shop for plans, consider what kind of dental work you’ve already had and what you know you’ll need in the next year. Do you have fillings or crowns that may need expensive maintenance? Or are you cavity-free and just need to schedule a basic cleaning?
Depending on which plan you choose, certain procedures may be fully covered, partly covered, or not included. Read the benefits package of the plan you’re considering carefully and determine if a procedure you will need soon is part of the package.
Cost of coverage
Now that you know which procedures you’ll need covered, let’s narrow down your choices by cost. Very broadly speaking, the higher your premium (how much you pay each month for coverage), the more comprehensive your coverage. But there are a lot of factors that go into how much you’ll end up paying at the dentist’s office for a visit.
1. Out-of-pocket costs
Out-of-pocket costs are whatever money you may spend at the dentist’s office not covered by your oral health benefits. Most often, these costs are copays, coinsurance, and costs above the plan annual maximum. A copay is the cost of any given dental procedure set by your insurance company which you pay directly to the dentist. Coinsurance is the percentage of the cost of a procedure you pay after you’ve met your yearly deductible. The plan’s annual maximum is the most the plan will pay out each year. Everything above the plan’s annual maximum, the patient will have to pay out of pocket.
If you and your dentist had discussed your oral health needs before you lost your coverage, determine how much you can expect to pay out of pocket for those procedures under a different plan. Ask yourself: how much of that procedure does this plan cover? If that plan has a higher monthly premium but lower out-of-pocket cost for a specific procedure, you may save money long-term.
2. Premiums
The premium is the cost of your oral health plan you pay to the carrier. Most premiums in healthcare are monthly, though you may also find some that are semi-annual or annual.
3. Deductible
The deductible is the total amount you must pay for any oral health care services before your plan starts paying. For example, if your deductible is $100, you must pay $100 worth of covered oral health care expenses before your plan will start to pay their share for covered procedures.
Size of the network
If you lost coverage recently, you may have been to the dentist in the last year. Did you like the treatment you received? If so, it may be worthwhile to double check that the dentist you’re used to is in the network of providers that accept the oral health coverage you plan to buy. Different benefit providers have different networks so not every dentist accepts every plan.
Using a broker to find coverage
Does this all sound like a lot? That’s ok! Oral health is important so you should take the decision seriously. If you need more than the most basic benefits package or if your needs are a little more complicated, you can always work with an insurance broker. An insurance broker works for you as an expert who collects information, shops for policies, and aids in your decision-making.
Why get dental coverage?
We know times are a little uncertain right now. And, especially after a layoff, oral health coverage may seem like the least of your worries. But what happens if you chip your tooth or wake up with a toothache? Oral health costs can add up and maintaining a healthy smile is a major component of your overall health.
Delta Dental of Washington wants to keep you smiling. We offer a range of plans for any type of oral health need and can even get you covered within thirty days with a no-wait plan.
Looking for a dental plan?
See available plans
Sources
Norris, Louise. "Involuntary loss of coverage is a qualifying event" Healthinsurance.org
"If you lose job-based healthinsurance" healthcare.gov,
