Dental coverage changes after leaving active duty. When my husband retired, we had to figure out what worked for our family. Shopping for insurance is no joke! So many options, and I had a lot of questions.
What worked while you were serving may not be available after you separate or retire. The right option depends on several factors, including your veteran or retiree status, VA enrollment, family needs, location and the type of dental care you expect to need.
For some veterans, the first step may be determining whether they qualify for dental care through the Department of Veterans Affairs (VA). Others may find that a dental insurance plan through VADIP, FEDVIP, an employer or another source makes more sense.
No single dental plan is right for every veteran. The goal is to understand your options and compare them based on what you actually need.
What are you eligible for?
When you’re looking for dental coverage, it’s tempting to start comparing insurance companies. But before you look at premiums and plan features, figure out what coverage you may already qualify for.
Start by checking whether you qualify for direct VA dental care. VA dental eligibility is separate from VA medical eligibility, so don’t assume it’s automatic.
If you don’t qualify for direct VA dental care, or if you’re looking for additional dental coverage, you may also be eligible for the VA Dental Insurance Program (VADIP). Eligible veterans enrolled in VA health care can purchase private dental insurance through participating providers.
Military retirees and eligible family members may also have access to dental coverage through the Federal Employees Dental and Vision Insurance Program (FEDVIP). The Office of Personnel Management provides current FEDVIP eligibility information.
Depending on your circumstances, you may also have access to dental coverage through:
- Your current employer
- A spouse’s employer
- An individual or family dental insurance plan
- Community or reduced-cost dental programs
Programs such as VETSmile may be available in some locations, but availability and eligibility can vary. Verify what’s offered in your area before relying on a particular program.
Understand the Terms
When it was time to shop for dental insurance, I was surprised by how much of the terminology was new to me. Here’s a quick guide to some of the terms you’ll see when comparing plans.
Premium: The amount you pay for your dental insurance, usually each month.
Deductible: The amount you may have to pay for covered services before the plan begins paying according to its benefits.
Copayment: A fixed amount you pay for a covered service.
Coinsurance: The percentage of a covered service you are responsible for after meeting any applicable deductible.
Annual maximum: The maximum amount the insurance company will pay toward covered dental care during a plan year. Once you reach that amount, you generally pay additional eligible costs yourself.
Waiting period: The time you may have to wait before certain services are covered.
In-network and out-of-network: Dentists who participate in a plan’s network may have negotiated rates with the insurer. Seeing an out-of-network dentist can mean higher costs, depending on the plan.
Exclusions and limitations: Services the plan doesn’t cover or restrictions on how frequently certain services are covered.
Pre-treatment estimate: An estimate of what the insurance plan may pay toward a planned procedure. It can help you understand your potential out-of-pocket costs before treatment.
If you’re unfamiliar with dental insurance terminology, this guide on choosing a dental insurance plan can provide additional information.
Calculate the Likely Annual Cost
A common mistake is to compare plans based only on the monthly premium. Instead, estimate what each plan could cost you over an entire year.
Start with 12 months of premiums. Then consider what you’ll likely spend on preventive care, deductibles and your share of any planned procedures.
For example, if you know you’ll need a crown, several fillings or periodontal treatment, look at how the plan would handle those services. Consider the annual maximum, too. A plan that covers a high percentage of a procedure may still leave you with high costs if you’ve reached the plan’s annual limit.
Also account for potential out-of-network charges and waiting periods.
The plan with the lowest monthly premium isn’t necessarily the plan with the lowest total annual cost.
When I was looking for dental coverage, I looked at the monthly premiums, then considered the percentage they covered versus my out-of-pocket expenses for certain procedures. I also considered orthodontia coverage, because I already had one child in braces and knew two more would need them.
Match Coverage to Your Anticipated Needs
Once you’ve reviewed the basic costs, think about the dental care you expect to need.
Ask yourself questions like: Do I primarily need preventive care such as exams and cleanings? Does the plan cover my spouse and dependents? Does the plan provide coverage for specialists if I need one? And am I willing to change dentists if necessary? Your answers can change which plan makes the most sense.
Someone who primarily needs preventive care may have different priorities than someone who knows they’ll need extensive restorative work. A military family that moves frequently may also value a broad provider network more than someone who expects to remain in one location.
Compare VADIP Providers Fairly
For veterans considering VADIP, Delta Dental and MetLife both participate.
Rather than choosing based on a familiar name or a plan summary, compare the plans. Look at everything, including premiums, deductibles, annual maximums and covered services.
The details can change, so don’t rely solely on an older article, brochure or comparison someone posted online.
You can review Veteran dental plan options through Delta Dental’s current VADIP information.
Steps to Take Before Enrolling
Before you click “enroll,” take a few minutes to verify the details. Make sure you meet the program and plan requirements.
Then, confirm your dentist’s network participation. Call the dental office and ask if they currently participate in the specific plan you’re considering.
Double-check your research by reading the exclusions and waiting periods and verifying the annual maximum. You can also get estimates for known procedures.
Save your enrollment and plan documents. Keep copies of the information you receive when you enroll so you can refer to your coverage details if questions come up.
Choose Coverage That Fits Your Life
Leaving military service brings plenty of changes, and dental coverage is one of them. You don’t have to choose a plan simply because it’s the first one you find.
I did this backward. I wanted the coverage and premium that fit my needs and budget, then I considered the dentist. Because of that, I’ve switched dentists a few times, but it was worth it to keep the dental insurance plan that worked best for my family.
The best dental plan isn’t necessarily the one with the lowest premium. It’s the one that fits your eligibility, your providers, your anticipated care and your overall budget. Take the time to compare your options so you can choose coverage that works for your life after military service.
Read the full article here
