Hi Im new here and I just want to know how insurance works. For example I need insurance that will help pay for braces for adults(im 19). Delta Dental seems to have a pretty good plan. However its a bit confusing. The annual prepaid premium is around 100 bucks for me, no ortho waiting periods. So if I pay the $100 I can just go get braces and theyll spend thousands of dollars to help me pay for it? It just sounds TOO good.
Please help me! I dont want to pay the hundred bucks and end up being ripped off.
Also I wont use the insurance for anything else other than ortho, because I am under both of my parents(divorced).
How does dental insurance work?
Moderator: bbsadmin
Hi OMgDom,
If you are a student and 19, Delta Dental should cover your braces. Before giving the ortho any money, it would be wise to call Delta Dental to see exactly what coverage you have. At first Delta said they would pay $1000.00 toward my braces, but since I was 34 at the time they considered it to be cosmetic.
Could you have your parents call? If you are still covered under their insurance, Delta should cover it. Usually, the orthodontist bills the insurance and they pay for it. There is no money out of your pocket.
Hope this helps! Good luck!
If you are a student and 19, Delta Dental should cover your braces. Before giving the ortho any money, it would be wise to call Delta Dental to see exactly what coverage you have. At first Delta said they would pay $1000.00 toward my braces, but since I was 34 at the time they considered it to be cosmetic.
Could you have your parents call? If you are still covered under their insurance, Delta should cover it. Usually, the orthodontist bills the insurance and they pay for it. There is no money out of your pocket.
Hope this helps! Good luck!
Hi there 
I just went the rounds with Delta regarding ortho coverage myself. I'm not sure exactly how your plan works, but I would call them and make sure of exactly what codes they cover. I called mine and my ortho's office called, and at first glance they stated that they did cover ortho, up to 50% of the total, paid over 3 payments, 50%, then 25%, then 25%. However!
They only pay for traditional braces treatment, meaning metal or ceramic fixed, and I would still have been responsible for the other half. Therefore, I don't technically have ANY ortho coverage because I opted for an activated retainer and eventually an inman aligner. Be careful with Delta, they seem to only allow/cover extra appliances if they are inserted along WITH traditional fixed braces. They do not pay anything towards invisalign, just retainers, RPEs, or other functional or removables.
I wish there was a way to get JUST ortho coverage where you'd pay a premium for the year, a copay amount, and then they'd cover the rest of the cost of the braces but I'm guessing something like that doesn't exist because they'd never make money. If it were included in my medical coverage because we never use it, that'd be great because I'm sure over the last 7 years we've paid more than several thousand into medical that has never been used lol.
I just went the rounds with Delta regarding ortho coverage myself. I'm not sure exactly how your plan works, but I would call them and make sure of exactly what codes they cover. I called mine and my ortho's office called, and at first glance they stated that they did cover ortho, up to 50% of the total, paid over 3 payments, 50%, then 25%, then 25%. However!
They only pay for traditional braces treatment, meaning metal or ceramic fixed, and I would still have been responsible for the other half. Therefore, I don't technically have ANY ortho coverage because I opted for an activated retainer and eventually an inman aligner. Be careful with Delta, they seem to only allow/cover extra appliances if they are inserted along WITH traditional fixed braces. They do not pay anything towards invisalign, just retainers, RPEs, or other functional or removables.
I wish there was a way to get JUST ortho coverage where you'd pay a premium for the year, a copay amount, and then they'd cover the rest of the cost of the braces but I'm guessing something like that doesn't exist because they'd never make money. If it were included in my medical coverage because we never use it, that'd be great because I'm sure over the last 7 years we've paid more than several thousand into medical that has never been used lol.
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Snowglobe32
- Posts: 1224
- Joined: Fri Oct 02, 2009 9:05 pm
I take it you do not have dental insurance now...
You said you are under your parent's, does that include dental?
Usually when you buy an individual insurance plan, you pay a monthly premium for the plan.
When you go to the dentist the first time for the calendar year, you pay your annual deductible ($100.00).
When it comes time for ortho, they usually cover only some of the ortho costs. My Delta plan only covered $1500.00. So more than likely you will still pay for the majority of your treatment cost.
I would look into getting onto one of your parent's plans, if they have dental.
You said you are under your parent's, does that include dental?
Usually when you buy an individual insurance plan, you pay a monthly premium for the plan.
When you go to the dentist the first time for the calendar year, you pay your annual deductible ($100.00).
When it comes time for ortho, they usually cover only some of the ortho costs. My Delta plan only covered $1500.00. So more than likely you will still pay for the majority of your treatment cost.
I would look into getting onto one of your parent's plans, if they have dental.
Well heres the thing. Generally your insurance benefit for ortho is paid over the length of treatment. You have to keep paying premiums in order for them to keep making payments. So if your sole reason for buying the coverage is for the ortho insurance you would be actually losing money assuming your treatment time is longer than 15 months. At 15 months, you would have paid 1500 for your plan, meaning you would just cut even. If your treatment is longer then the payment is stretched even thinner and your paying maybe 2k 2500, or 3k, for a 1500 benefit. Not worth it.
This is of course excluding the other benefits of dental plan, if your going to the dentist too that helps make use of it.
Unfortunately the fact is unless you are pushing your maximum annual limits each year, insurance really doesn't help you as the premiums end up costing more than the actual benefit if you aren't really using it. Its just there to "soften" huge dental bills
This is of course excluding the other benefits of dental plan, if your going to the dentist too that helps make use of it.
Unfortunately the fact is unless you are pushing your maximum annual limits each year, insurance really doesn't help you as the premiums end up costing more than the actual benefit if you aren't really using it. Its just there to "soften" huge dental bills
Well heres the thing. Generally your insurance benefit for ortho is paid over the length of treatment. You have to keep paying premiums in order for them to keep making payments. So if your sole reason for buying the coverage is for the ortho insurance you would be actually losing money assuming your treatment time is longer than 15 months. At 15 months, you would have paid 1500 for your plan, meaning you would just cut even. If your treatment is longer then the payment is stretched even thinner and your paying maybe 2k 2500, or 3k, for a 1500 benefit. Not worth it.
This is of course excluding the other benefits of dental plan, if your going to the dentist too that helps make use of it.
Unfortunately the fact is unless you are pushing your maximum annual limits each year, insurance really doesn't help you as the premiums end up costing more than the actual benefit if you aren't really using it. Its just there to "soften" huge dental bills
This is of course excluding the other benefits of dental plan, if your going to the dentist too that helps make use of it.
Unfortunately the fact is unless you are pushing your maximum annual limits each year, insurance really doesn't help you as the premiums end up costing more than the actual benefit if you aren't really using it. Its just there to "soften" huge dental bills
See thats what I dont get. How would I be losing money? I thought the annual premium was paid at the beginning because its prepaid. So for the entire year I would only pay a hundred bucks. So if Delta pays lets say 1500 towards my ortho over a two year time period, I would only be paying two years worth of premiums ($200).fosterp wrote:Well heres the thing. Generally your insurance benefit for ortho is paid over the length of treatment. You have to keep paying premiums in order for them to keep making payments. So if your sole reason for buying the coverage is for the ortho insurance you would be actually losing money assuming your treatment time is longer than 15 months. At 15 months, you would have paid 1500 for your plan, meaning you would just cut even. If your treatment is longer then the payment is stretched even thinner and your paying maybe 2k 2500, or 3k, for a 1500 benefit. Not worth it.
The way your making it seem is that the annual premiun ($100) is monthly. 15 months = $1500. Is that how it works?
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Snowglobe32
- Posts: 1224
- Joined: Fri Oct 02, 2009 9:05 pm
OmgDom. wrote:See thats what I dont get. How would I be losing money? I thought the annual premium was paid at the beginning because its prepaid. So for the entire year I would only pay a hundred bucks. So if Delta pays lets say 1500 towards my ortho over a two year time period, I would only be paying two years worth of premiums ($200).fosterp wrote:
The way your making it seem is that the annual premiun ($100) is monthly. 15 months = $1500. Is that how it works?
If you buy dental insurance on your own, you have to pay a premium every month, just like car insurance, unless you can pay the entire year at one time.
Are you are confusing premium with deductible?
On my insurance plan, my yearly deductible is $50. So for my first visit each calendar year, I pay $50.00 regardless of what is done. If the plan you want is $100 for a year, there has to be a cost for services. You can't just pay $100 and then go to the dentist any time you want and pay nothing.
I have dental insurance through work. I pay $20 something dollars every month just to have dental insurance. Then when I go to the dentist, I pay whatever portion my insurance doesn't cover.
As for ortho, my braces cost almost $7000. Delta paid $1500, so I am left to pay the rest.
In Jan. I went for my cleaning, the hygienist found a cavity. My total bill was $95.00, $50 for my deductible and $45 for the cavity. (My insurance paid the cost of the cavity up to a certain amount, my portion was $45.00.
I find it hard to believe that a yearly cost of a dental plan would be only $100.00, if that were the case, everyone would have that plan.
Do you have a link you can post?
Yes I do.Snowglobe32 wrote:OmgDom. wrote:See thats what I dont get. How would I be losing money? I thought the annual premium was paid at the beginning because its prepaid. So for the entire year I would only pay a hundred bucks. So if Delta pays lets say 1500 towards my ortho over a two year time period, I would only be paying two years worth of premiums ($200).fosterp wrote:
The way your making it seem is that the annual premiun ($100) is monthly. 15 months = $1500. Is that how it works?
If you buy dental insurance on your own, you have to pay a premium every month, just like car insurance, unless you can pay the entire year at one time.
Are you are confusing premium with deductible?
On my insurance plan, my yearly deductible is $50. So for my first visit each calendar year, I pay $50.00 regardless of what is done. If the plan you want is $100 for a year, there has to be a cost for services. You can't just pay $100 and then go to the dentist any time you want and pay nothing.
I have dental insurance through work. I pay $20 something dollars every month just to have dental insurance. Then when I go to the dentist, I pay whatever portion my insurance doesn't cover.
As for ortho, my braces cost almost $7000. Delta paid $1500, so I am left to pay the rest.
In Jan. I went for my cleaning, the hygienist found a cavity. My total bill was $95.00, $50 for my deductible and $45 for the cavity. (My insurance paid the cost of the cavity up to a certain amount, my portion was $45.00.
I find it hard to believe that a yearly cost of a dental plan would be only $100.00, if that were the case, everyone would have that plan.
Do you have a link you can post?
http://www.deltadentalins.com/ca_indiv/index.html
Thanks for the help!!
Be very careful with this insurance. While it appears very affordable, it may be more problematic than you think.
First, this is specific to the state of California, not sure where you are, but if in CA you are set there.
Second, this insurance will make you go see a dentist that is in there list of dentists' that are under contract for this plan. This dentist is 100% in charge of everything that you get done to be covered under this insurance. This means if you go see the dentist, who will ensure you pay him for services, and he/she determines that orthodontics are not "needed" in their words, then you don't get treatment.
Next, assuming that your contract dentist agrees that braces are "needed", he will refer you to an orthodontist that is part of this contract also. Whether you like this individual or not, this is your Orthodontist and you have no control over that at all.
Then, lets say you gat through all of that red tape and are going to get your braces from the contract ortho. Your portion of treatment is $2800 for a maximum of 24 months. You go beyond that, which I can tell you does happen ( my son is over 24 months in now and may have another 6-12 to go) you are now subject to additional monthly charges up to $125. When insurance companies use the words subject to additional charges, they mean you will be paying these, and up to means that they will get you for that amount. After active treatment you will pay $250 for retention with removable retainers only. if you get any permenant retainers, that cost will be yours. Then there is additinal charges of $200 for any procedure that is not spicifically called out in the benifit plan, which means you could get charged $200 to take the molds, $200 for an x-ray, etc.
If this all works out for you, it may be a great deal, but you will have absolutly zero control of any of it.
You mentioned that you are still on your parents dental insurance. Check to see if they have coverage for you as long as you are in school. Many insurances do this.
First, this is specific to the state of California, not sure where you are, but if in CA you are set there.
Second, this insurance will make you go see a dentist that is in there list of dentists' that are under contract for this plan. This dentist is 100% in charge of everything that you get done to be covered under this insurance. This means if you go see the dentist, who will ensure you pay him for services, and he/she determines that orthodontics are not "needed" in their words, then you don't get treatment.
Next, assuming that your contract dentist agrees that braces are "needed", he will refer you to an orthodontist that is part of this contract also. Whether you like this individual or not, this is your Orthodontist and you have no control over that at all.
Then, lets say you gat through all of that red tape and are going to get your braces from the contract ortho. Your portion of treatment is $2800 for a maximum of 24 months. You go beyond that, which I can tell you does happen ( my son is over 24 months in now and may have another 6-12 to go) you are now subject to additional monthly charges up to $125. When insurance companies use the words subject to additional charges, they mean you will be paying these, and up to means that they will get you for that amount. After active treatment you will pay $250 for retention with removable retainers only. if you get any permenant retainers, that cost will be yours. Then there is additinal charges of $200 for any procedure that is not spicifically called out in the benifit plan, which means you could get charged $200 to take the molds, $200 for an x-ray, etc.
If this all works out for you, it may be a great deal, but you will have absolutly zero control of any of it.
You mentioned that you are still on your parents dental insurance. Check to see if they have coverage for you as long as you are in school. Many insurances do this.
