gdazn
Lv 5
gdazn asked in HealthDental · 1 decade ago

Individual dental insurance for braces (re-post)?

Sorry, Yahoo Answers won't let me extend this question anymore so I am going to repost this question and wait for more answers.

What is a good "individual" dental insurance if I were to get braces? I have done some research and nailed it down to DeltaCare and Pacificare. So which dental insurance is better, or any other suggestions? Pacificare cost slightly less than DeltaCare as far as co-payments go. Both are HMO plans, all the PPO plans covers little to nothing for braces, so HMO seems to be the only way to go for an individual plan. DeltaCare seems to be more reliable since it's associated with Delta Dental, a little more costly also.

I'm more concerned about the "quality" of the services as far as making claims and such. So DeltaCare, Pacificare, or ay other dental insurance/plans? Any personal experience with either of these companies? I am in San Francisco, California.

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  • 1 decade ago
    Favorite Answer

    Well, I called both companies today and asked them several detailed questions about braces and co-pays. You are right that Pacificare is a little bit cheaper but not by much. The cost for my 11 year old son to have braces is $4770. The co-pays as you probably discovered are broken down into start-up costs, coverage for 24 months, retainers, final records, final retainers and any additional items like an RPE in my son's case (rapid palatal expander).

    DentalCare coverage co-pays are as follows:

    startup: 200

    24 month coverage: 2500

    (any additional amount after 24 months is $75 a month

    and in my son's case he needs an additional 6 months

    or 450 more)

    retainers: 250

    RPE that he needs is an additional 400

    Total is 3800 for co-pays

    Total cost from the orthodontist is 4770

    So, possible savings of 970

    Keep in mind that additional dental services for the family plan

    cover all kinds of dental services but co-pays are still required. A family plan is 225 a year and this includes the orthodontic treatment I mentioned above.

    Now for Pacificare DHMO:

    The co-pays for braces:

    startup: 250

    24 month coverage: 1895

    (you will have to pay any additional monthly amount that your orthodontists requres---no coverage or co-pays after 24 months)

    retainers: 250 past the 24 months

    150 for final records

    RPE that he needs is an additional 400

    Total for copays---hard to get an exact amount as it depends on your dental office charge per office visit after 24 months but you can get a rough idea based on what I provided above. It is a little cheaper than DeltaCare but not by a whole lot.

    Now some very important things to remember:

    DeltaCare is 225 for a family plan and Pacificare is 400 for a family plan for a year. While Pacificare is more expensive---almost double---it is more benefit reach with regard to much lower co-pays on a lot of dental work. For example, a root canal molar is a 400 co-pay with DeltaCare but only 175 with Pacificare. For a filling with a resin-based composite--3 surfaces, anterior is 85 with DeltaCare and with Pacificare it is 25.

    Now while it may seem to you that Pacificare is better with regard to being cheaper with braces and better overall co-pays for other dental services there is a catch----and it is a big one! With Pacificare all work has to be done with your general dentist and not a specialist like an endodontics or periodontics dentist. If the general dentist cannot do the work and refers you to a specialist you have to pay everything out of pocket---no co-pays or anything. This is scary considering that many general dentists are either unable, unwilling or not skilled enough to do a root canal and usually more complicated root canals like a molar which is very expensive. Also, with Pacificare you cannot even refer your kids to a pediatric dentist. They also have to go to the general dentist. On top of that it is about a 175 more a year for the premium than DeltaCare.

    DeltaCare on the other hand lets your primary dentist refer you to a specialist if they are unable to do the work. They also let you refer your kids to a pediatric dentist as well after their first visit to the general dentist.

    So there are so many details to consider and after all this discussion I am still not sure which dental HMO is better here??

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  • smiley
    Lv 4
    1 decade ago

    I have Safeguard HMO and it covered a good portion of my braces. I have had this plan for many years and never had any issues with claims or anything else. ( i think metlife bought out safeguard)

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  • 1 decade ago

    my mom has deltacare and it is horrible they never let her pay for my dentist appointments and freeze her account and say that she ows them money when she doesnt sooo yeah!!!!!! thanks for the 2 points!!!!

    Source(s): hahahahahahaha
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