Is dental, eye coverage with the expense?

Is dental insurance worth the cost?Insurance professionals and employee-benefits consultants say it’s sometimes not worth it for people who need only preventive dental treatments.
With average premiums running from about $22 for an individual and $60 for a family, the annual premium may exceed one or even two trips to the dentist.
Industry experts say that most people who sign up for coverage expect to have some dental work done in the coming year, while those who opt out of the plan need only preventive care.
Delta Dental Plan, the largest exclusive dental-insurance provider in Colorado, will begin providing coverage to City of Fort Collins employees on Jan. 1, said Dennis Phillips, vice president of marketing in the company’s Denver office.
He said 408,000 individuals are covered by Delta Dental in Colorado. “We offer it to groups with 10 or more employees,” he said.It’s a numbers game
The company does not offer dental coverage to an individual, because it would be too difficult to underwrite, he said.
“It’s purely numbers. The people who don’t use it pay for the people who do,” Phillips said. “It’s spreading the risk out, just like auto insurance.”
Delta Dental is a nonprofit company that operates nationwide. Separately, the parent company also operates Delta Dental Plan of Wyoming, he said
The company contracts with local dentists who accept reduced fees for serving Delta Dental patients, he said.
The plan also reimburses members who prefer to choose dentists who are not affiliated with Delta Dental, Phillips said.
“Dental service is difficult to insure. It’s different than medical coverage,” he said.
While most people want medical insurance in the event of an unexpected illness, many people will not take out dental insurance unless they know that they need some dental work in the coming year, he said.
“People will take medical coverage and hope they never get sick,” he said. “Some people are so afraid of dentists that they won’t take coverage.”
However, as an employee benefit, “it ranks up there in popularity,” he said.
Phillips said employees who need only dental cleanings may compare the cost of the premiums and decide they’ll come out ahead just paying for dental work out-of-pocket.
He said his company’s insurance premiums range from $18 to $24 a month for an individual employee, depending on the group size.
“It can almost even out if they just need a cleaning. It may not be worth it,” he said.
A standard plan usually includes cleanings, X-rays and exams at 100 percent coverage, he said. Dental fillings and oral surgery are usually covered at 80 percent, while major services, such as crowns and bridges, are covered at 50 percent.
Orthodontic work generally covers children at 50 percent, and there’s often an add-on to the dental plan for this type of treatment, he said.
Overall, dental-insurance premiums are increasing depending on the type of plan, said Bob Powers, owner of Administrators and Benefit Consultants in Fort Collins.
Many employees at large companies opt out of dental coverage unless they have dental needs in the next year, he said.Vision plan usually inexpensive
Like dental care, vision care is tacked onto other medical-insurance plans, and it usually is fairly inexpensive, he said.
For example, FHP of Colorado Inc. offers eye-care coverage for about $2 a month per individual. That includes an eye exam and credits the member with an eyeglass purchase of up to $125 every 24 months, he said.
“That’s one of the better plans out there,” he said.
A spokesman for FHP said premiums for the company’s vision and dental care have remained stable in last few years, primarily due to the company’s large purchasing power.
FHP started its own dental program 2 1/2 years ago because there was a great demand for dental services. Currently, the program has 100,000 members.
Powers said some insurance companies provide dental coverage to businesses with as few as five employees.
He offers a dental plan through American Dental Group of $7.75 a month for an individual or $13.75 a month for a family.
“That covers crowns to root canals,” he said. “Each procedure is broken down individually.”Small markets targeted
T.J. McGinty, president of American Dental Group, based in Colorado Springs, said the company began offering its program in Fort Collins last summer. American Dental’s average group size is about four people.
The 5-year-old company provides service in Colorado, Maryland and Wisconsin.
McGinty said the company focuses on smaller markets and noted that about 75 percent of employees in this country work for companies that employ fewer than 25 people.
However, most of the competition in the dental-insurance business concentrates on corporations with at least 100 employees, he said.
“What we do is contract with a dentist in the area,” McGinty said. American Dental sets a fee schedule for various procedures, giving members a reduced price on dental care.
“We’re not an insurance company. We’re a marketing entity for dentists,” he said.Although dentists receive a reduced fee for services by participating in the program, they can save up to 60 percent on lab fees and other costs of operating a practice because of American Dental’s volume discounts, he said.
McGinty noted a new trend in which corporations now contribute only to the employee’s premium and not to his or her family’s.
“The employee pays a $22 premium and can opt for family coverage and pay an extra $30 to $50,” he said.
He said the national average for a dental premium for an individual is about $22 and about $62 for a family.
Today, about 70 percent to 80 percent of employees nationwide have some kind of dental insurance, McGinty said.Dental fees heading upDental fees are increasing with the expansion of dental-insurance coverage. Until about 10 years ago, there was very little dental-insurance coverage in this country, he said.
“The average insurance payout to a dentist is over 100 days after the time of service,” he said. “The dentist loses money, so he has to increase his fees. ÿ