Oral & Vision Health Blog

Losing Health Insurance? Tips For Finding Affordable Coverage.

Losing health insurance can create challenges. There may be ongoing health issues to manage and unexpected times when you need to go to urgent care or the hospital. 

Understanding that changes in employment, income, or federal and state guidelines can lead to losing health insurance benefits is crucial. A notable example is the gradual phasing out of automatic Medicaid enrollment. This change has affected an estimated 95 million low-income Americans previously enrolled in benefits through Medicaid and CHIP (the Children's Health Insurance Program). As a result, approximately 12 million adults and children have lost dental coverage. Being aware of these changes can help you prepare for any potential loss of benefits.

Finding new coverage can be confusing and daunting regardless of how your insurance changes. However, it's important to remember that options are available to ensure you still have insurance for you and your family, providing a sense of reassurance in these challenging times. 

 

Key takeaways:

  • Anyone can sign up for their health benefits directly through an insurance company.
  • You can also use the state and federal marketplace websites to find insurance – they have specific enrollment dates.
  • Take time to compare insurance options by cost and what they cover.
  • Make sure your regular doctors and dentists accept the insurance you're looking at.

 

You can shop for your plan outside of getting insurance through an employer. Medical, dental, and vision insurance are available directly through an insurance company. You can also look for individual and family insurance through the federal and state marketplaces. Remember, you control your health insurance decisions, and understanding the available options can empower you to make the best choice for your needs.

Looking for insurance is a double-edged sword. There are many plan types to choose from, but there are differences to remember. To help you make the best choice possible for you and your family, we have some tips and tricks you can use.

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What features you should be looking for in a plan

When it comes to health care, having insurance can significantly reduce your out-of-pocket expenses. However, to make the most of your insurance, it's crucial to understand how your plan works. Here are some key points to consider when browsing health insurance plans:

  • Is your doctor in-network? 
  •  You will receive the best discount or rate for dental, medical, and vision insurance by going to an in-network provider. Some plans need to provide coverage for out-of-network providers. So, you will want to make sure your provider accepts your insurance. Some providers only take specific insurance plans or do not take insurance at all.

Will you have a deductible? What is the out-of-pocket maximum? 

 Knowing this information will help you narrow down your choice of insurance. Understanding your plan's deductible and out-of-pocket maximum is crucial for financial planning. This knowledge will make you feel more informed and prepared, ensuring you can maximize your insurance.

What services are covered as preventive care? 

 Medical and dental plans can vary depending on which services are considered preventive care. These services may be available at no cost to you in many cases. They can include routine checkups and dental cleanings. And they can be allowed once or twice per year, depending on the plan. Preventive care can lead to early detection and treatment of medical and dental conditions. It can reduce the need for expensive services and possible emergency room visits in the future. 

What other services are covered under the plan?

  • Essential dental services include extractions, deep cleanings, and cavity fillings. You and your insurance will typically split the cost, which could be 50-80%.
  • Primary dental services: The most extensive dental procedures include bridges, crowns, oral surgery, and dentures. They will have the highest out-of-pocket cost, which the plan will split with you by 30-50%.
  • Anesthesia: Before going in for any treatments or procedures, ask your doctor or dentist if anesthesia will be needed. The plan may have an allowance, or you must pay the total costs. Your dentist may recommend anesthesia for tooth extractions, dental implants, and jaw surgery.
  • Restorative care: This involves extensive dental work, like crowns and fillings.
  •  Orthodontics treats teeth problems with braces, wiring, or brackets. Not all dental plans cover orthodontia, so you will want to know any lifetime maximums, age limits, or other restrictions.
  • Endodontics: These focus on caring for the pulp and roots of your teeth and are generally more complex. A root canal is an endodontic procedure. 
  • Periodontics: This coverage will protect your wallet if you need to treat gum infection and gum disease. Scaling and root planing (or deep cleaning) is the most common type of periodontic treatment.
  • Prosthodontics: These procedures are typically for missing teeth or people not qualifying for dental implants.

Are there waiting periods? 

 You will want to know if you can start getting medical, dental, or vision care immediately or if you must wait. Some insurance plans require waiting until they cover specific treatments or surgeries. Waiting periods can also extend to how often you can receive routine care. 

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Types of plans

 Choosing insurance can be easier when you know what you're looking for. Imagine what pirates could have achieved if they had GPS on their ships. Some of the plan acronyms do sound like ship names. With that in mind, we will look at the types of plans out there:

  • Medical insurance plans have four common types: EPOHMOPOS, and PPO.
  • Dental insurance can be provided in iterations of these six plan types: DPPODHMODEPODPOSDMPO, and Dental Indemnity.
  • Dental Preferred Provider Organization (DPPO): The insurance company contracts with the dentist on these plans, who agrees to set a fee for each service. If the dentist is not contracted with the insurance company, your costs can be higher.
  • Dental Health Maintenance Organization (DHMO): These plan types require you to choose a primary dentist. If you go to your assigned dentist, you will have no cost or a reduced amount for each visit, depending on the service.
  • Dental Exclusive Provider Organizations (DEPO): These plans are like DHMO. However, DEPO plans can offer a more extensive choice of in-network providers. You may need a written referral from your assigned provider to see a specialist.
  • Dental Point of Service (DPOS): You can visit an out-of-network provider. Keep in mind that you will likely pay more for services.
  • Discount Dental Plan (DMPO): Unlike a typical insurance plan, you will instantly receive discounted rates without paying a deductible or out-of-pocket maximum. You can use a DMPO over an existing dental insurance plan to save more money.
  • Dental Indemnity plans are less common. They reimburse the patient instead of the provider. The dollar amount is based on the "insurance company's usual, customary, and reasonable" rates.

And here are some standard insurance terms for good measure. Anchors away!

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Saving on cost

 Some people look at insurance as a financial commitment they can live without. Luckily, multiple medical and dental insurance types suit your specific needs and budget. These plans cost less compared to paying dental fees without insurance. Insurance is also helpful during an emergency. You never know when you'll need medical or dental care. Paying the entire cost upfront can be stressful.

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Working with an insurance broker

You can also work with an insurance agent or brokerage familiar with the health insurance marketplace. This could be one of the best ways to receive guidance, as they can hear your unique needs and lead you to a plan that suits them. They would have already vetted many of the benefits programs out there. 

 

So, yes, losing health insurance is a headache. But you can see plenty of reasons to forge ahead and ensure you still have a form of coverage. It allows you to care for your overall health, provides easier access to necessary treatments, and offers financial protection for unexpected health issues. Remember that dental insurance plans vary in terms of coverage and cost. These tips will make it easier for you to navigate and review the different plans available.

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