When you retire, it seems your teeth, eyes, and ears seem to retire as well. We need to pay a little more attention to their needs as we get to our fun years. It also seems when we leave our career and plan for our retirement adventures, we lose all of the plans that we would use to take care of ourselves, such as health, dental, and vision insurance.
Here, I am going to go over the details that help my clients during this transition from group insurance to Medicare 65-plus, or group insurance to private insurance pre-65. Hopefully this helps!
1. Portability
The first thing I always ask my clients to do is call their current providers and ask if plans are “portable.” The reason for this is that most new dental plans have what is called a “waiting period.” This means that you may have to wait up to 12 months on your plan to get certain plan benefits. These are usually major services such as crowns, root canals, or bridges.
If the plan is portable, then you can use it just as you would normally and receive any major services or basic services done with no waiting periods. The one downfall of this process is that you will typically have a much higher premium. In a lot of cases, the employer is paying half, if not all, of the premium for your dental and vision insurance. You will now have to pay the entire premium for this plan but it could be cost effective — especially if you have some upcoming dental work.
2. Network
A lot of people get confused when purchasing dental and vision plans. They expect most or all doctors to be in-network. That may not be the case. Even if you have a Preferred Provider Organization (PPO), you need to pay close attention to the out-of-network benefits. Several companies have much lower benefits and higher coinsurance for out-of-network coverage. There are several great PPO policies that have the same coverage in- and out-of-network, so be sure to check your coverage. Vision and hearing insurance almost always are non-PPO and network-based even when bundled with a dental plan.
3. Waiting Periods
If your current plan is not portable, then you may have to deal with waiting periods. The typical waiting times for specific services include:
- Preventive Services (Cleanings, Exams, X-rays): No waiting period
- Basic Services (Fillings, Extractions, Sealants, etc): after 6 months
- Majors Services (Crowns, Root Canals, Bridges, etc): after 12 months
Major services are what people are looking for in their dental policies and are upset to find in some cases they are not covered, especially for high-dollar procedures. As these are typical waiting periods, there are some plans that have no waiting periods or that may pay a smaller percentage until you reach your waiting period. Again, I suggest you really dig into the plan for those details. The good news is that vision and hearing usually start paying on day one with no waiting periods.
4. Waived Waiting Periods
If you have been a dental insurance champion for years, you may be rewarded for your tenacity. A lot of well-established dental insurance providers will honor the waiting periods of other providers. Make sure to ask your agent if your new provider will waive your waiting period. Most will waive waiting periods for basic services. Few will waive major services, so be sure to double-check before making the jump.
5. Annual Max
This is something that can very easily be overlooked. An annual max is in reference to the max amount the insurance company will pay every year towards your coverage. When this amount is reached, providers will pay $0 to any other covered services for the rest of the year. The normal amount is typically $1,000 for most plans, but there are plans that have annual max amounts that grow with the policy and can receive as much as $3,500 a year for dental work after 3 years.
6. Plan Benefits
Now to the meat of the plan! I think this is the easiest option to review. There are usually three types of plans — preventive, preventive-basic, and comprehensive — and they are pretty self-explanatory. Obviously, they increase in price with the more benefits you get. Preventive usually just covers cleanings and X-rays. Basic plans will cover your preventive care as well as extractions and fillings. Comprehensive will cover all of the above, as well as things like crowns, oral surgery, root canals, and bridges up to your annual max. Some plans even cover dentures and orthodontia at the comprehensive level. Your plan’s summary of benefits will outline these items.
7. Medicare Part C
Do you have or are going to have an advantage plan? I have a secret for you… your plan probably already has dental, vision, and hearing included. Advantage plans have a lot of extra built-in benefits. These benefits vary from every carrier, so check your plan details. Not all plans are created equal. You can also add additional dental, vision, and hearing coverage to an advantage plan. Medicare usually pays first, then your other policy picks up after it. So, if you already have a policy and want to keep it, you sure can. You will, however, get a larger annual max amount to work with. Just make sure both plans are covered by the same provider.
Dental and vision coverage are a definite necessity during retirement. It’s not if you are going to have a dental procedure, it’s when. Making sure you are covered and using some of these steps can help you save those retirement dollars you so tirelessly earned. So take care of those pearly whites and peepers because they have a whole lot to see. How are you going to eat 7 of the worlds strangest foods without those chompers?
For more healthcare advice in retirement, check out our Retirement Awaits hub: