Discover A Viable Dental Insurance Plan For Massachusetts Residents

Updated: March 15, 2024 at 5:34 pm

Are you a Massachusetts resident looking for affordable dental insurance plans, offering good value?

Yes. I can’t find anything good.

I know what you mean. I’m a Massachusetts resident, too.

Unfortunately, not as many dental insurance carriers operate in Massachusetts. We will get to why in a minute.

Obviously, that doesn’t leave many options for Massachusetts consumers.

The good news is that we work with a dental insurance company that offers good dental benefits and value.

Continue reading Discover A Viable Dental Insurance Plan For Massachusetts Residents

Yes, Dental Implants Are Covered By Insurance | The Ultimate Guide To Getting Dental Implants Covered By Dental Insurance

Updated: August 18, 2023 at 7:18 am

You’ve lost a tooth, and now you wonder if dental implants are covered by insurance. Am I right?

Yes, John. I am hearing that dental insurance doesn’t cover dental implants.

That isn’t necessarily true. We work with many dental insurance plans that cover dental implants.

The short answer: it depends on your coverage. It also depends if your plan contains the missing tooth clause. We will get more on that in a minute.

But, even if your dental insurance doesn’t cover dental implants, you can still get coverage.

Continue reading Yes, Dental Implants Are Covered By Insurance | The Ultimate Guide To Getting Dental Implants Covered By Dental Insurance

Here’s How To Avoid The Missing Tooth Clause | We Discuss What The Missing Tooth Clause Is And 3 Options To Avoid It

Updated: July 29, 2023 at 6:46 pm

missing tooth clause

Let me guess. You’ve never heard of the missing tooth clause until your dentist’s office manager told you about it, right?

If so, you are not alone.

The missing tooth clause, common in many dental insurance plans, borders on unfairness (more on that in the article). I understand, but it is in place for a reason. We will get to that in a minute.

You think you are covered for a pre-existing missing tooth until you go to the dentist. The dental office checks your dental coverage. They inform you that the carrier won’t cover your bridge or implant.

In this article, we discuss the missing tooth clause and how to best avoid it. Note that all the solutions herein are not perfect.

First, let us answer the question, what is the missing tooth clause?


What Is The Missing Tooth Clause?

The missing tooth clause in dental insurance policies states that the insurance company will not cover the replacement of any missing tooth or teeth that occurred prior to the start date of the policy.

In other words, if you currently have a missing tooth, that missing tooth is a pre-existing condition. While many dental insurance policies cover pre-existing conditions, they generally do not cover the replacement of a pre-existing missing tooth,

The reason for this is because of cost. The cost of dental implants, bridges, root canals, etc. is high. Additionally, without that clause, people with pre-existing missing teeth could buy dental insurance, get the implant (or partial denture or bridge), then cancel the dental insurance.

That is unfair to everyone including current dental policy owners. Today’s dental plans really don’t cover a pre-existing missing tooth.

You really have to read the fine print in a dental insurance plan to even know the missing tooth clause exists. Here is one example of the missing tooth clause:

an example of the missing tooth clause.

You can see that the fine print is “sneaky” and doesn’t directly call out the missing tooth clause. However, this is the missing tooth clause.

Let’s give an easy example of the missing tooth clause.

Example Of The Missing Tooth Clause

You put off purchasing dental insurance for a while now. But, your bicuspid fell out. Now you need to get that fixed. You just purchased dental insurance and go to the dentist. Your dentist is in the plan’s network, and that makes you feel good because you’ll save more money that way. The dentist suggests a removable partial bridge. The office manager obtains a pre-treatment estimate and submits the dental claim.

However, you turn upset when the office manager informs you that your partial bridge won’t be covered. The reason, she tells you, is because of a “missing tooth clause” with your dental insurance. You’ll have to pay 100% out-of-pocket expense for the cost of your tooth replacement.

So, to recap, if you have a missing tooth or teeth, the cost to replace these teeth with a crown, bridge, implant, or some other device won’t be covered IF…

…the missing tooth or teeth occurred BEFORE the insurance begins.

Think of this as a pre-existing condition in dental insurance.

Of course, if the missing tooth or teeth occurred AFTER the insurance begins, you have coverage according to your plan’s provisions. Look at the excerpt above. It clearly states that a missing tooth is covered as long as the missing tooth occurred while coverage is in place.

Typically, dental implant procedures, bridges, etc. are all major work. Depending on the dental insurance plan you have, the cost of these major services may push you up against your plan’s annual maximums. The annual maximums for a typical dental plan is usually $1,500 to $2,000. We at My Family Life Insurance do work with plans offering $5,000 annual maximums and even a few at $10,000!


3 Ways To Avoid The Missing Tooth Clause

The missing tooth clause creates a financial challenge for many people. There are, however, ways to avoid the missing tooth clause within your dental insurance policy. We discuss these next.

Get Dental Insurance Before “Now”

We receive a lot of phone calls from people needing major dental procedures done “now”. Like, tomorrow. They need a crown put in or are missing teeth. They put off purchasing dental insurance. Now, they have a dental problem. They decided to go to the dentist for dental treatment. Additionally, they don’t have any dental insurance coverage.

Honestly, if this is you, this is a self-inflicted problem. You can avoid this problem.

A simple way to avoid the missing tooth clause is to purchase dental insurance before you need it. Again, see the excerpt above.

Really, this is the easiest solution. If you have a missing tooth or teeth after you purchase the policy, the insurance covers the replacement of your tooth.

For seniors, the best time to purchase dental insurance is a year before you go off your company’s dental insurance plan as you enroll in Medicare.

It may seem like a waste of money to pay premiums for insurance you don’t need right away. But, many dental insurance plans have waiting periods of 12 months for major services. Moreover, if you do lose any teeth, the plans cover the replacement of your teeth. Getting dental insurance now minimizes potential, huge out-of-pocket costs down the road.

The cost of NOT having dental insurance is potentially greater than having it.

Dental Discount Plans

Dental discount plans might help. There is no missing tooth clause as a dental discount plan is not dental insurance. It is simply an agreement that the dentist will charge you less than their “retail” price and honor the procedure.

I like discount dental plans. I think they can work if you find the right dentist who accepts them. That leads me to my point. Many dentists do not accept discount dental plans. If you really want a discount plan, be prepared to switch dentists or go out of your way to find one.

You can search for dental discount plans here: www.dpbrokers.com/170829.dp

Just enter your zip code to find plans available in your area.

Moreover, dentists who accept dental insurance already agree to a discount from their retail cost.

Nevertheless, a discount dental plan is an option. We outlined several ways a discount dental plan is better than dental insurance. The moral of our article, however, is finding the right dentist for you who accepts the discount plan. If he or she is great and knowledgeable, then likely the discount plan and your situation are a great fit.

As always, if you find a dental discount plan and a dentist in your area, please contact the dental practice before enrolling. It is good practice to confirm that the dentist accepts the dental discount plan.

Purchase Dental Insurance That Avoids The Missing Tooth Clause

As we stated, many dental insurance companies have missing tooth clauses. Even if you had the dental insurance for years…if you had a missing tooth prior to coverage, the insurance won’t pay.

Sure, you can try to have your dentist submit the claim to your insurance. Chances are, for something like this, the carrier will request your dental records. In those dental records will be a note of your missing tooth or teeth. So, there is no getting around it.

We only know of one dental insurance that does not have a missing tooth clause. That is right. It will cover the replacement of missing teeth for any teeth missing PRIOR to coverage starting.

However, the replacement of missing teeth is a major service. This policy has a 12 month waiting period for major services.

This means you have to pay the premium for 12 months before you can use the policy for a pre-existing missing tooth.

Nevertheless, it will cover the replacement of a missing tooth or teeth once this 12 month period is met.

We are not contracted with this particular carrier, so please contact us through our portal if you would like more information on this carrier.


Frequently Asked Questions About The Missing Tooth Clause

We answer some frequently asked questions about the missing tooth clause.

Isn’t The Replacement Of A Missing Tooth Covered By Medical Insurance?

Not usually. Your medical insurance generally won’t cover a pre-existing missing tooth unless your mouth or teeth got damaged in an accident. Consult your medical insurance policy for more information.

Can I Obtain Dental Implant Insurance?

Dental implant insurance really doesn’t exist as a stand-alone insurance. Many dental insurance plans now offer dental implant coverage, up to annual maximums or lifetime maximums. For example, a dental insurance plan may offer a $5,000 lifetime benefit for dental implants.

Contact us if you would like to learn more.

What If I Have A Congenitally Missing Tooth?

A congenitally missing tooth is a missing tooth that was not formed at birth. Some plans may cover congenitally missing teeth. Contact us to learn more.


Now You Know How To Avoid The Missing Tooth Clause

I hope you are now more knowledgeable about the missing tooth clause common in many dental insurance plans. We discussed options to avoid the missing tooth clause.

Do you have a missing tooth? Do you want to know your options? Or, do you want to get started and simply figure out the right plan for you?

Contact us or use the form below. Unlike other agencies you read about, we only have your best interest first. That means if there is a plan available that better fits your situation, we will tell you that. We will also do our best to put you in contact with them.

Learn More

Are you interested in learning more about the information in this article? Please fill out the form below, and we will email you additional information or give you a call. We always work in your best interest. By entering your information, you are providing your express consent that My Family Life Insurance may contact you via e-mails, SMS, phone calls, or prerecorded messages at any phone number(s) that you provide, even if the number is a wireless number or on any federal or state do-not-call list. Additionally, you understand that calls may be placed using automated technology, and that consent is not a requirement for purchase. Your information will NOT be sold and will remain private. However, you may opt out at any time. We respect your privacy first and foremost. By contacting us, you agree to receive text messages from our number (800) 645-9841. If you no longer wish to receive text messages, you may opt out at any time by replying "STOP".

How Do Dental Vision Hearing Insurance Plans Work Approved Now | We Go Into Detail About These “Combination” Plans And If They Are Right For You

Updated: February 22, 2021 at 4:48 pm

You’ve heard of dental vision hearing insurance (DVH insurance), and you think it is too good to be true. Am I right?

It sounds good. It is like a “swiss army knife”. You can use any combination of dental, vision, or hearing needs under one insurance.

How great is that?

However, many agencies focus on one popular plan, but we focus on three.

Yes, three.

All three have different attributes. We discuss them here. Why? So you can make the right decision.

In this article, we discuss:

Let’s discuss how these dental vision hearing insurance policies work.


What Are Dental Vision Hearing Insurance Plans And How Do They Work?

The easiest way to describe these plans (also known as DVH insurance – for short) is using an analogy.

You know what a swiss army knife is, right?

Yes, you have a million combinations of tools to help you out.

If you need to open a can, you have a can opener!

Additionally, if you need to affix something together, you have a screwdriver!

Of course, you have the main tool…the knife…

A combination dental vision hearing insurance plan works similarly.

You can pick an annual benefit…like any dental insurance option. Remember, annual benefits typically come $1,000 and $1,500, but there are a few carriers that offer $2,000 and more.

Think of the annual benefit as a bucket of money.  For example, let’s say you pick a $2,000 annual benefit.

You go to the dentist, and the plan pays $500 to the dentist. Your remaining annual benefit is $1,500.

Next, you have an eye exam. The plan pays the optometrist $50, so your remaining benefit is $1,450.

Your doctor says you need hearing aids. The plan pays $800 towards that. Your remaining amount is $650.

You have a cavity and a cleaning done. That is $600 and your remaining amount is $50.

The “bucket” resets to $1,500 at the new year.

That is pretty much how DVH insurance works.

So, John. I have the chance to maximize my annual benefit every year?

Yes, that is right. These insurances combine your dental, vision, and hearing insurances all into one.

Additionally, they can save you money. However, we discuss further in the article where these plans are useful.

Let’s discuss the attributes of these plans next.


Attributes Of Dental Vision Hearing Insurance

Just as the name sounds, dental vision hearing insurance covers:

  • Dental
  • Vision
  • Hearing

In our estimation, there are 5 carriers that offer DVH insurance. However, we only work with 3 of them. Why? The other two, in our opinion, do not provide as much benefit for the premium. For example, one plan that we don’t use or recommend pays at 75% of UCR. You probably don’t know what that means yet. It’s not good, in our opinion.

The three plans we use have different attributes and limitations.

For one, none of the plans cover serious dental needs, like implants. You need to enroll in a more traditional dental insurance if you want that kind of coverage.

Additionally, these plans all have waiting periods. A stand-alone vision insurance plan, for example, typically does not.

Another important attribute is they are all guaranteed renewable. What does this mean? It means that as long as you pay the premiums, you have the DVH insurance for life. You can have the dental vision hearing insurance until age 96, for instance, as long as you continue to pay the premiums.

Finally, most of these plans allow you to go to any dentist. While that sounds great, that type of freedom comes at a cost. Your cost! You will have to pay more. Thankfully, most of these plans now do utilize a dental network. Using a dental network allows you to save more money. If you do go to an out-of-network dentist, expect to pay more.

Below is a snapshot of the three plans. We do not address them specifically by name because of marketing contact reasons. Contact us if you want to learn more.

to show dental vision hearing insurance attributes on 3 plans that work well for families


Comparable Costs For The DVH Insurance Plans

Sounds great, John. I am interested, but I’d like to know the costs?

Sure, we can give you an idea. Here is the comparable cost for a 35 year-old person living in Illinois:

to show the costs of the three dental vision insurance plans we like for families

 

As you can see, Carrier B is the least expensive. Carrier C is the most, but they offer a 10% household discount of 2 or more people signing up. Moreover, they also have 90% coinsurance by the carrier come year 4 of the plan. That is unheard of in the dental insurance industry.

Carrier A is the most “middle of the road”.

Contact us if you would like to talk specifics.


How To Choose The Right Dental Vision Hearing Insurance

We arrive at the purpose of our article topic. The decision is really a balance of premiums and coverage. The right choice depends on you and your needs.

The 3 carriers presented in this article offer the best value of premiums and benefits, in our opinion, of course. You can see Carrier A is “middle of the road”. Carrier B is cheaper. Carrier C is more expensive, but has more coverage, especially with basic and major dental services.

We discuss later in the article where these plans fit well. Contact us if you have any questions. Let’s answer some frequently asked questions about dental vision hearing insurance plans.


Frequently Asked Questions About DVH Insurance Plans

Do I need to use an in-network dentist, optometrist, or audiologist to receive a benefit?

No, you don’t. However, you save more money by going to an in-network provider. Note: the insurance does not contain networks for vision or hearing services.

Medicare covers hearing, vision, and dental needs, correct?

Not really. Original Medicare (Parts A and B) does not cover dental, vision, or hearing services. CMS makes that abundantly clear.

However, some Medicare Advantage plans do provide dental, vision, or hearing services. Stop for a second if you feel that gets you covered. These plans sort of do. Medicare limits coverage dental, vision, and hearing services. See this snapshot of dental, vision, and hearing services attached to a Medicare Advantage plan. It is limited to in-network only. Moreover, the benefits are rather slim. However, in this unique case, they don’t cover dental needs except for a rider, which costs an additional $45 per month.

The same goes for vision and hearing. Most Medicare Advantage plans might cover an annual eye exam, if that. Additionally, many Medicare Advantage plans do not cover hearing aid needs.

What if I need vision or hearing surgery? Do these DVH insurance plans cover?

No, your underlying health insurance, including Medicare, covers any surgery on your eyes or ears.

What if I need oral or dental surgery? Will these dental vision hearing insurance plans cover that?

Generally speaking, yes. However, your underlying health insurance pays part of the surgery as well, depending on the situation.

Are these robust plans?

Yes, but they do have limitations. Other agencies won’t tell you this. The dental portion usually doesn’t cover implants. Additionally, they all have a missing tooth clause. The vision benefit is rather limited, depending on the carrier you select. Nevertheless, they do cover. Expect to pay / have an out-of-pocket expense. Moreover, definitely review the limitations and exclusions.


Where These DVH Insurance Plans Fit Very Well

Most people purchase dental vision hearing insurance plans as a stand-alone plan. That is fine. However, did you know these plans work great as secondary or supplemental dental coverage? Same for vision and hearing, too. That means you might have an almost “net zero” premium payment and greatly minimize your out-of-pocket expenses.

How is that, John, you ask? I don’t want to pay double.

Let’s show an example. Maybe that will clear things up.

Example On How Dental Vision Hearing Insurance Coordinates With Your Other Insurances

The title of the section is a little misleading because…these DVH insurance plans don’t coordinate with any underlying or primary dental, vision, or hearing insurance you have. Let’s give an example.

Let’s say you have primary dental insurance with a $2,000 annual benefit and costs $37 per month. Your vision insurance costs $11 per month. You don’t have hearing insurance. Hearing insurance really does not exist. Additionally, you are also in year 3 of your DVH insurance plan. We will use carrier A from above for our example. You select the $1,500 for $40 per month.

So, all told, you pay $77 per month for your total dental, vision, and hearing needs.

You have a cleaning and office visit. The dentist’s “retail” cost of the visit is $312. The contracted insurance cost is $192. Since this is preventative care, the carrier pays 100% of the cost, so your primary dental insurance annual benefit decreases from $2,000 to $1,808. You, in turn, file a claim with the DVH insurance plan. Let’s say you receive $240 from carrier A. You keep that money. Your dental vision hearing insurance plan bucket decreases from $1,500 to $1,260.

See how that works?

You then go to your optometrist. You pay the $10 in-network copay. That amount is reimbursed to you, so the remaining benefit in your DVH insurance is $1,250.

You decide to get new frames and glasses. The retail cost of the frames and eyewear is $500, but you end up paying $250 through your primary vision insurance. The dental, vision, hearing insurance pays you back $400.

The remaining amount in your dental vision hearing insurance is $850. If you go to the dentist again for a cleaning, you’ll receive another $240 back.

How Does Hearing Insurance Part Work?

Many people don’t realize that hearing aids aren’t really covered by medical / health insurance. Some states require health insurance to cover hearing aids for children, but not for adults. Regardless, the general consensus is health insurance – even Medicare – does not cover hearing aids.

Let’s say you need one, and you have this dental vision hearing insurance. Your hearing aid cost is $850.

You submit a claim with the DVH insurance carrier and receive $680 back (80% X $850).

So, to summarize:

  • You pay $37 per month for dental
  • $11 for vision
  • $40 for the combination dental vision hearing plan

Or $1,056 annually.

 

You receive back:

  • $240 for the cleaning
  • $410 for the eye wear
  • $680 for the hearing aids

Or $1,330 in total.

This is an easy example, but you can see how this plan works. Moreover, you won’t always come out ahead. However, it does work well as a secondary insurance plan.


Now You Know How Dental Vision Hearing Insurance Plans Work

Now you know how dental vision hearing insurance plans work. These are nice “combination” plans. The ones we like offer nice benefits for affordable premiums. Moreover, they can work well as a secondary insurance plan.

Do you have any questions? We are happy to answer them. Contact us or use the form below. Unlike other agencies, we aren’t beholden to an insurance carrier. We work for you. Additionally, we always have your best interest. So, when you contact us, there is no risk. If we can’t help you, you’ve learned a little more, and we will part as friends.

Learn More

Are you interested in learning more about the information in this article? Please fill out the form below, and we will email you additional information or give you a call. We always work in your best interest. By entering your information, you are providing your express consent that My Family Life Insurance may contact you via e-mails, SMS, phone calls, or prerecorded messages at any phone number(s) that you provide, even if the number is a wireless number or on any federal or state do-not-call list. Additionally, you understand that calls may be placed using automated technology, and that consent is not a requirement for purchase. Your information will NOT be sold and will remain private. However, you may opt out at any time. We respect your privacy first and foremost. By contacting us, you agree to receive text messages from our number (800) 645-9841. If you no longer wish to receive text messages, you may opt out at any time by replying "STOP".

How To Save More Money With The Clever Rx Discount Card [Potentially Save More Money Compared To Other Discount Cards]

Updated: August 4, 2020 at 7:59 pm

to show how clever rx beats the other discount cardsI know there are a billion prescription pharmacy discount cards, but one that stands out to us is Clever Rx. Here’s why.

You simply, on average, save much more money on prescriptions compared to other prescription discount cards.

Continue reading How To Save More Money With The Clever Rx Discount Card [Potentially Save More Money Compared To Other Discount Cards]