As stated above, Dental insurance is really not insurance. It is a pot of money those in the group can use for that year, but if it runs out, it runs out and the plan doesn’t have to pay more even if you have benefits left. Haven’t heard of that happening with the big groups, but it is possible.
That said, in the past I had Met Life (when I worked for the government). It was expensive, but a great plan. It paid almost 90% for my daughter’s wisdom teeth removal, paid for their braces, paid for a LOT of crowns for me. I had Aetna through my medicare advantage in 2024 and it paid for everything until I reached the max, which was $2250 (and then nothing but got the negotiated rate). Now have United through medicare advantage, and same deal, paid 100% up to the max, also $2250.
The complaint I have, through my dentist, is that all plans seem to deny everything and then the dentist has to resubmit. Dentist office knows the drill and just keeps resubmitting until it is paid.
Most private dental practices in my area don’t participate in the personal plans - the chains are more likely to do so. The private dentists are even starting to say no to the employer plans (GD’s pediatric dentist stopped taking most insurance). You may want to ask your dentist (or the person who does the billing) which plans they would recommend. Not all will tell you, of course, but mine would.
Thanks. We have had a great met life plan, but DH is retiring at the end of the month. I am finding that all the personal plans are pretty disappointing. There is one Cigna plan that my dentist is in network with (Cigna Total, not Cigna Advantage) and if nothing else we will get the in network rates, and they claim they waive the waiting periods “for selective services” since we have existing dental insurance. But they don’t cover posts, and my DH tends to need those. Oh well. Fortunately, like you, we have a great dentist with a great office manager.
Our medical plan provides SOME dental coverage. We never bought a vision nor dental plan because both seemed to offer limited benefits for premiums charged.
@kelsmom no my Medicare Advantage is not through an employer or union. I was advised to get on my plan by three different financial counselors who do Medicare counseling at local hospitals.
As for dental coverage, it is under “medical” insurance and not a separate dental plan, in my Medicare Advantage. The $700 “flex card” can be used toward things like crowns, extra eyeglasses, extra audiology and so on.
It was great that you did the research, and your choice has worked out well for you.
We have a flex card - and I didn’t even think about it when DH had a crown with quite a bit of out-of-pocket. He isn’t using the gym, but it is automatically deducting out of his flex account. So we could have used the flex card balance.
When I reach age 65, I will have the option of employer sponsored Medicare Advantage PPO plans (Essential or Enhance). For retirees who still have funds left in my employer sponsored future health account fund at age 65, using it is the only way to tap those fund. Per posts in retiree/benefit FB group for retirees of my big corporation, it’s a pretty decent plan… and retiree coworker friends in my area like it. I’m burning through my fund balance pre-65, so no worries about “leaving money on the table” if I do traditional Medicare.
When planning for the future, I prioritize simplicity and frugality. That is for benefit of me and the kids someday if they need to help me. MA gets some points lower cost and no extra bills. But… I have more confidence about not having to fight claims with traditional medicare, esp someday if rehab needed. Today employer offers retiree MA/PPO, but no guarantee will be same in 20+ years.
I do plan to use a Medicare broker when the time comes. Would love to use same one my husband used, but that brokerhas retired. I have heard that some brokers push hard on MA. In my case it will be interesting to see the analysis since they won’t have any incentive to recommend my employer MA/PPO plan. (Brokers are free to the user, but they do get commission.) Ideally they will make an honest assessment.
In my area we don’t use brokers. There is the SHINE program and hospital financial counseling offices that provide help.
With my Medicare Advantage I have not had to fight for any coverage, for meds, procedures, imaging or appointments. I do get prior authorizations for imaging and some meds (infusions) but that has not been difficult. I don’t need referrals from PCP to see specialists and with a PPO have seen MD’s in different systems.
I have a question. With traditional Medicare and a Plan G, which has been mentioned, is there a cap on out of pocket expenses per year? Mine used to be capped at $4900 but I recently got an EOB that had the info that the cap is now $6k in-network and higher ($9k?) for out of network costs. So far my out of pocket is very low but I did like having a cap. One of my kids had a $400k hospital bill after an accident.
While I don’t think there is an OOP maximum
With Medicare part G you pay the deductible (? Maybe $237?) and the 20% copay is paid by the supplemental plan you purchase. Most (not all) providers and facilities take traditional
Medicare so the OOP would likely be quite small. Drug plans are separate. Mass. Has a unique/different Medicare arrangement so it’s hard to compare.
My MA plan has a $3900 OOP max per year and that includes the 20% co-pay on Part B drugs (which is my eye injections, which is more than I can afford so don’t get them; I’m hoping to get into a drug trial this week). I have no premium per month so it is basically a $3900 max per year. Regular prescription drugs have the new $2000 OOP max, but United health calculates it differently so I’ll pay about $800 this year for prescriptions. This year I’ll only pay about $300 in OOP copays ($20 for specialists) and that’s mostly for some PT I’m using (totally optional)
My friend has a traditional program with a supplement and then a drug plan. She pays $140 per month, then had about a $250 deductible and then pays nothing else for medical, so about $2000 per year OOP max, but has a lot of trouble getting in to see doctors. She has no eye or dental coverage so her OOP for those is much more than mine.
I know last year before the $2000 OOP max for prescriptions she paid thousands for prescriptions. She has an inhaler that isn’t covered and costs a lot and she used to buy them in Mexico to save money. Now she uses a different type of inhaler that is covered. I think she paid $8000 in drugs last year.
I remember my broker saying that if I didn’t get a MA plan there was no max OOP, but I don’t think she explained it well that the traditional can have a supplement plan that caps that.
So basically she pays $2000 no matter what, and I pay $0 unless I go to a specialist, need surgery, or a Part B drug. I also get vision and dental of about $3000 per year.
I have never heard of anyone having a more difficult time getting an appointment with a doctor based on being covered by Supplement vs Advantage. That’s not an issue where I live. In fact, the doctors I know prefer Supplements because some of the Advantage plans are very slow to reimburse them … but they don’t let that influence whether they take a patient sooner rather than later.
Comparing what one person spends is like comparing oranges to apples.
What one person’s medical needs and medication needs are completely different and hard to compare.
My medication needs are less than $100 a year. My husband’s, it’s more than $100,000 a year. We have insurance now with a $9500 deductible, $2000 sounds pretty good. We are very grateful to have good insurance and be able to pay. Both when working, in early retirement and now Medicare. The biologic is not available cheaper anywhere.
My new annoyance. We have a marketplace plan. It’s a plan for both my husband and I. He is going on Medicare September 1. I have to call the marketplace on exactly Sunday August 31 to cancel. Of course our premium is due August 25.
The advice I got, don’t pay the premium and hope that they don’t cancel both of you. Or pay the premium and ask for a refund after September 1.
The good news is that I can afford to pay a premium and wait for the refund
My drug has to be ordered by the doctor in the office, so not available at a pharmacy. It is a part B drug, not a pharmacy benefit. Eylea, as you’ve seen advertised on TV. Why on TV when YOU can’t get it? Do doctors watch that much TV to be influenced to prescribe it? No. It is just to run up the prices. Believe me, there is not a single person seeing this ad on TV who says to the retinologist “Oh please, let’s use Eylea and I’m dying to pay full price for this drug that costs $5600 per dose!” Oh, two eyes, that’s $11,200 per month! (admittedly, some drug plans do cover it but no MA plans do) Medicare does limit the price of the drug to about $1600/dose, but I’s still have to pay 20% of that on part B until I reached the $3900 OOP max.
In her case, she claimed the inhalers weren’t covered at all on her plan so she had to pay full price. She found it cheaper in Mexico (and she goes there a few times per year) but then finally the doctor prescribed a different drug. I told her this year, because of the $2000 max that it might be cheaper to pay full price in the US (Mex price is still pricey) for a few months (plus she has other drugs to reach that max quickly) but she said it wouldn’t work. I think she’s wrong and as long as it was prescribed that she’d get credit for paying full price but now she’s using a different inhaler. It’s her money.
My drug is the only issue I’ve had with MA, and that ER visit copays don’t count toward the OOP maximum. Why? I don’t know but they don’t.
Before the $2,000 cap on medication, to have a treatment on the medical part of your insurance was preferable to going into the donut hole and running up huge bills on medicine.
The $2,000 cap has changed things immensely for those who have expensive medicines.