I re-watched part of The Incredibles yesterday, which was a mistake since I needed to look over a dental plan option today. In The Incredibles, the dad of the family works for an insurance company, and legitimate claims are being denied left and right, and the boss keeps saying he doesn't care if it's a legitimate claim, DENY IT!! Make it IMPOSSIBLE for the clients to figure out how to get what they paid for!! Or else you're FIRED!! (The Incredibles dad eventually loses it and throws the boss through several walls, which is satisfying.)
Anyway, the forms. I can't tell if it's worth it. FIRST, the dental plan collects $1,700 per year from us. (There's no employer contribution, though it's "through" the employer.) THEN, if I understand the simple, easy-to-read charts correctly, they cover what they feel like covering, at the percentage they feel like covering it, up to a maximum of $1,000/year per family member. And next year, we'll get a letter from HR saying that the rates have doubled. Is that a good deal, or not?
We might have economies of scale going for us, here, since the amount per year is "per family." So, for a family of four, maybe they don't use more than $1,700 in coverage (plus the co-pays and deductibles) most years; but for a family of seven, we can use that in annual check-ups alone. BUT: although the cost is per family, the limit is still per person.
AND: it doesn't cover our dentist. Or any dentist I've ever heard of. So we'd have to switch from the dentist we like to an unknown dentist, and then we add to our lives the SHEER RAGE of finding out after every check-up that we weren't covered for what we thought we were covered for. Not to mention that I don't see how I can get two check-ups/cleanings/x-rays and maybe a filling per year and still have much left of my personal $1,000 maximum to pay for, say, a crown.
Also, if we have insurance, the dentist will switch their view of us from Poor Unfortunate Uninsured mode to Milk-Cow mode. Currently, our dentist looks at our file and says "...Oh. No insurance. Well, if you like, we can wait on those x-rays until next time." Or if I don't want a certain procedure considered essential for EVERYONE living in a country that has already greatly shifted the definition of "basic care," I can say regretfully, "No dental insurance," and they back right off: I mean, you either have that kind of money or you don't. But as soon as I have insurance, it doesn't matter if it costs $1,700/year before I get any benefit at all, and it doesn't matter that a procedure isn't covered or is only covered once every four years at 50%, suddenly we "have dental insurance!" Which sounds like "Everything's free!" to us, and like "Switch to Luxury Level dental care because everything's paid for!" to the dentist.
And it's hard to collect information from other people about whether coverage is worth it or not, because hardly anyone (including me) sits down and figures out the math. So if I asked you right now if it was worth it, you might say "OH, yes, TOTALLY!"--and yet you could be WRONG WRONG WRONG. Say for example you've for years been spending $1,700/year on coverage for $1,000/year of benefits (in other words, losing $700 a year on the deal), but then one year you needed a $4,000 procedure and 80% of it was covered so you only had to pay $800, WHEW. You no longer even notice the monthly payment taken out of your check, but you DID notice the huge relief of not having to pay the $4,000---so you might feel as if the insurance was totally worth it. And yet you wouldn't even have broken even: your costs would still have exceeded your benefits. (And now you're not eligible for that $4,000 procedure for another 6 years.)
(And also, even THIS happy story wouldn't apply to the plan I'm looking at this morning, since benefits cut off at $1,000/year/person, so that $4,000 procedure would be covered at $1,000 minus the dental care covered that year---or, about $700, say, at absolute most, with the other $3,300 due to my dentally-insured self.) (This really isn't sounding like it's worth it, as I type it out.)
It's also complicated because with health and life insurance, you may have heard the expression "a gamble you WANT to lose": that is, we don't mind if we put in more money than we get out, because the only way for the insurance to be a good deal is if we have a serious problem---and we'd rather lose money on the deal than get cancer and/or die in order to come out ahead. This is NOT the case with dental insurance: especially with a $1,000/year maximum per person (i.e., when we can't think of it as "But in a big dental crisis, we'd get a huge benefit out of it"), we DO need to come out ahead for it to be worth it.
I am going to see if I can do this math.
$1,700/year for $7,000/year maximum coverage
but the $7,000 is misleading because it's $1,000/person
and most of us won't get anywhere near $1,000 in a regular year
and remember we sometimes have to pay a percentage of a procedure
but we get our xrays/cleanings 100% covered
(as long as we don't get them done too often)
and if we needed fillings, we'd get more benefit
but sealants are already done for $20 through the school system
and we'd have to switch dentists, which I don't want to do
but soon Paul and I will be needing more serious work
but it's still only $1,000/year coverage for each of us
No wonder nobody does the math. It's not math, it's a LEAP OF FAITH. A leap of faith into the arms of companies we know make a huge profit. And that profit is COMING FROM SOMEWHERE, which is an equation I CAN do.
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