Dental Insurance With No Copay

Posted : admin On 1/1/2022

Health insurance with no deductible is one of the most comprehensive forms of medical coverage. It is available for individuals, families, businesses and self-employed persons that purchase their own coverage and want little or no out-of-pocket expenses coupled with high-quality benefits. Although not all major insurers are able to offer a zero deductible plan, many states have various options either on or off the Marketplace. By eliminating a deductible, benefits can be used quicker and thousands of dollars may be saved.

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Mostly available through employer-group plans, there are also some private contracts (Platinum and Gold Exchange plans through Open Enrollment) that offer first-dollar coverage. You can request free quotes on all types of plans at the top of this page. Immediate benefits are usually paid when you buy coverage. There also may be a “stated amount” of dollars paid for certain claims on non-compliant policies. Often, you will need secondary coverage with these policies since there may be high coinsurance or co-payments. It is important, however, to always consider the plan maximum out-of-pocket expenses (MOOP).

HMO Plans

2 American Dental Association; Dentists: 'Doctors of Oral Health', American Dental Association, Chicago, IL. 3 Based on internal analysis by MetLife. Negotiated fees refers to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing and benefit maximums. DeltaCare USA is Delta Dental’s dental HMO, which offers low-cost dental coverage with a focus on preventive care. Enjoy minimal or no copayments for preventive care and choose from a network of dentists to manage your dental needs. Delta Dental Patient Direct Delta Dental Patient Direct is a dental service discount plan.

The most common form of this type of coverage is an HMO (Health Maintenance Organization) plan. Instead of the typical amount on large claims (often ranging from $500 to $10,000) sometimes, there is simply no deductible that is required to be met. Coinsurance can vary between 10% and 50%. A PPO or EPO can also have a $0 deductible although they are not as common.

Thus, a $10,000 bill resulting from a covered accident or injury, could possibly cost the insured very little…perhaps less than $2,500. Each HMO is different and there are many state variations. Note: It is not unusual for a carrier to an HMO plan through the Marketplace, and a PPO plan off-Exchange or through a Group plan.

Although there may be “daily copays,” these are usually capped after 4-7 days. Maternity benefits are also included on all Marketplace HMO plans, although there may be a separate small copay or other out-of-pocket amount. Aetna, UnitedHealthcare, Cigna and many of the Blue Cross companies offered these types of policies. Sometimes “low” deductible options are offered with amounts of $250 or $500 available. Zero-deductible plans are offered in many states, although maximum-out-of-pocket expenses may reach the allowed maximum of $8,550.

There are also non-HMO plans that will waive many costs. These PPO policies feature immediate benefits for large or small healthcare expenses, without having to meet an immediate copay or coinsurance. Most stated expenses are covered at 100% regardless of the number of claims submitted. However, with any plan, there still could be specific exclusions that may not be covered, such as cosmetic surgeries.

Since these types of policies can get a bit pricey, especially in some of the Northeastern states, considering a small deductible (vs. no deductible) instead, may substantially reduce the policy premium. For example, a $2,000 deductible vs. a $500 deductible could easily reduce the yearly cost of a family policy by as much as $2,000. So, if you were to submit several large claims per year (which is unlikely), you will still have more money in your pocket at the end of the year. And after many years, the difference could be dramatic.

New Marketplace Policies

Eliminating out-of-pocket expenses, including deductibles, copays and coinsurance, was very rare prior to the ACA legislation. Companies feared their customers would submit too many claims, with the insurer paying almost all of the claim. But that changed when federal tax subsidies, Open Enrollment, and Metal tier plans became household words. The $5,000 and $6,000 deductibles are still available but much lower options have become much easier to obtain.

Silver, Gold, and Platinum Exchange plans feature much lower out-of-pocket costs than Bronze and Catastrophic contracts. Often, a low-deductible option is available along with several policies that completely eliminate the major medical deductible. Although each state offers different policies, providers, and of course, prices, $0 deductible plans are offered in most states. However, maximum out-of pocket maximum expenses often reach the allowed 2021 policy maximum of $8,550. It is expected that the policy maximums will reach $9,000 by 2024. If a “public option” is approved by Congress, the deductible will also likely be very high.

Large City Example

Our example assumes two married persons (both age 45) that live in Columbus (Ohio). They have two teen-aged children (ages 19 and 20) so there are four members of the family. The household income is $70,000. The federal subsidy is approximately $10,900 per year and it instantly reduces the cost of coverage.

An Oscar Bronze Classic Next 2 plan offers a $0 deductible at a monthly cost of $484 per month. PCP and specialist office visit copays are only $30 and $50 respectively. Molina offers a $0 deductible plan (Constant Care Silver 1 250) at a monthly rate of $606.

Gold and Platinum-Level policies are the most expensive, but will minimize any cash outlay other than the premium. However, as previously discussed, often enrolling in a less-expensive plan (especially Silver-tier) are a more cost-effective choice.

Dental Insurance With No Copay

Senior Medicare Advantage (MA) Plans With RX Benefits And 0 Deductible

Listed below are options with no deductible. MA plans should be compared with other Medigap options since benefits and network availability will vary.

Illinois – Aetna Better Health Premier Plan, Aetna Medicare Prime, Aetna Medicare Value, Ascension Complete AMITA Health Secure, Blue Cross Medicare Advantage Basic, Blue Cross Medicare Advantage Plus, Blue Cross Medicare Advantage Premier Plus, Blue Medicare Advocate Health, Bright Advantage, Cigna Preferred Medicare, Cigna Premier Medicare, Clear Spring Health Essential, Humana Gold Plus, MoreCare For You, WellCare Absolute, WellCare Essential, WellCare Value, Zing Essential Wellness, and Zing Choice.

Texas – AARP Medicare Advantage, AARP Medicare Advantage SecureHorizons Plan 1, Allwell Medicare, Amerivantage Classic, Amerivantage Classic Plus, Care N’ Care Choice, Care N’ Care Choice Plus, Care N’ Care Classic, Clover Health Choice, Clover Health Classic, Humana Gold Plus, Imperial Insurance Company Traditional, Imperial Insurance Value, Prominence Plus, WellCare Texas Plan Classic, WellCare Value,

Student Plans With Low Deductibles

For a student, rates are much less expensive. Assuming the same area of Ohio, a 21-year-old student with $18,000 of income, would only pay $74 per month (after the subsidy is applied) for the same Silver-Tier Molina policy with a $250 deductible. And Aetna offers a fairly similar plan for $92 although the deductible would increase to $1,000.

Depending on where you live and the school or University you attend, it may be possible to purchase a student-health plan with low out-of-pocket expenses at a reasonable cost. An inexpensive supplementary contract can help reduce unexpected accidental expenses. These types of contracts are often offered by the University to be used in conjunction with the primary coverage.

Fixed Benefit Policies – Warning

There is one particular type of health insurance we don’t endorse or recommend…unless you can’t qualify for any other type of medical insurance, you have been previously declined after submitting a short-term application, or you are either not eligible or missed Open Enrollment in your state. We are referring to a “Fixed-Benefit” policy, which is not offered by all companies. However, most of the carriers that offer this policy seem to be reputable and you do receive cash benefits for covered expenses.

Fixed Benefit Health Plans May Give You A Headache

Fixed Benefit medical plans are not always expensive. Often, the rate is less than $100 per month for a single person and less than $300 per month for an entire family. Of course, the older you are (especially if you are over age 55), the more expensive rates will become. For office visits, instead of a “copay”, often you received a “fixed” (of course!) payment in the range of $40-$75.

But usually there is a limit of 2-4 visits per year and it’s probable that the cost of the visit will be more. Sometimes it is difficult to find a doctor or specialist that accepts the carrier. The same may be true for hospitals.

Prescription benefits are either just discounted or have a maximum payout per year…perhaps $500 to $1,000. These are far lower benefits than you would enjoy under most other standard contracts. And it is very important to understand exclusions on these types of policies, because they are plentiful.

Surgery Limitations

Fixed Benefit plans also limit inpatient and outpatient surgery coverage and related expenses. More than likely, if you use these benefits, you won’t have enough coverage. Emergency room and Urgent care benefits are often covered, but with very low amounts. The same applies to long hospital confinements which could result in large bills that are not covered. Depending on the severity of the confinement, it would not be unusual to owe tens of thousands of dollars in uncovered medical bills.

While choices like this have many gaps and limitations, if all other alternatives have been exhausted, the no-deductible health insurance plan should be considered. Missing Open Enrollment may force you to view these types of options. However, if you choose to purchase a policy, benefits will not come close to matching a standard Exchange contract.

Copay

Impact Of Legislative Changes On The Deductible

One important change is the mandated provisions and essential health benefits that became a requirement on most policies beginning in 2014. At that time, the “zero” or “no” deductible policies were mostly offered on “Gold” and “Platinum” options that were earlier discussed. That situation has not changed, although there are far fewer policies that now waive a deductible. However, there are many $250, $300, and $500 deductible options.

Each state has some variances, but the “Platinum” plan always offers the richest coverage. For instance, in California, several Platinum plans feature no deductible and a $2o copay for primary care physician office visits and $40 for specialists. But they are also the most expensive plans offered (Molina Healthcare 90 HMO, Health Net Platinum 90, and LA Care 90 HMO).The maximum out-of-pocket cost on these three policies is $4,000.

In Pennsylvania, there are many plans without a deductible including the UnitedHealthcare Gold Compass 0-1, UPMC Advantage Silver $0/$50, Keystone HMO Platinum, Independence Blue Cross Platinum Personal Choice (and Complete), and Keystone Gold. However, depending on the plan, you still may pay up to $6,850 in coinsurance costs.

Many other states only offer policies without a deductible, although that does not mean there are no out-of-pocket expenses. A “No Deductible” plan provides exceptional first-dollar coverage. But you must be aware of what comes next. Sometimes, even if you have major health problems, a higher deductible and lower premium combination may save you money.

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Dental Insurance With No Copay

For Marketplace coverage, the maximum out-of-pocket cost limit has increased to $6,850 and fewer plans are available with no deductible or extremely low MOP (maximum out-of-pocket expenses). Selecting a Silver-tier policy can often result in finding the “sweet spot” for price and out-of-pocket cost.

2021 rates have decreased in many states. UnitedHealthcare has also re-entered the Marketplace in several states.

There are many different types of dental insurance plans. Some cover the basics and others cover more extensive care and treatments, sometimes referred to as, “full coverage.” What is full coverage dental insurance? What does it cover, and what does a full coverage dental plan cost?

What is full coverage dental insurance?

Full coverage dental insurance includes plans that help cover you for preventive care, as well as basic and major restorative care, and in some cases orthodontic treatment. The term, “full coverage” means you’re getting benefits for a lot of different types of dental treatments and procedures. For example, you may have coverage for more costly things like root canals, bridges, and implants, as well as coverage for your preventive dental care. Full coverage does not mean your plan covers 100% of all costs, however.

What are the main types of full coverage dental plans?

Many types of dental plans provide coverage for services and treatments that go well beyond preventive care. These are considered full coverage. Dental PPO (DPPO), Dental HMO (DHMO), Dental EPO (DEPO), and Dental POS (DPOS), may all provide coverage for a wide range of dental services and treatments.

They can differ greatly, though, in covered services, costs, and limitations, even between insurance carriers.

Dental Insurance With No Copay Fees

What types of services and treatment does a full coverage dental plan cover?

The services and treatments covered under a full coverage dental plan depends on the type of dental plan you choose.

Typically, full coverage plans go beyond preventive care. They may also offer coverage for the following:

  • Basic restorative care: This usually includes things like fillings, extractions, and non-routine X-rays.
  • Major restorative care: This includes things like bridges, crowns, and dentures.
  • Orthodontic treatment: This includes things like space maintainers, braces, and other devices used to align your teeth.
  • Preventive dental care: This includes regular teeth cleanings, routine X-rays, fluoride treatments and sealants as indicated by age and frequency. Many dental plans cover 100% for preventive dental services with the exception of a copay at the time of the visit.

When choosing a full coverage dental plan, read the details carefully. Dental plans can vary even between insurers.

What's the cost for full coverage dental insurance?

Full coverage dental plans vary in cost depending on what type of plan you choose. For example, DPPO and DHMO plans may offer coverage for many types of dental services, but their costs can be quite different.

  • Deductible: This is what you pay before your plan begins to pay. Some dental plans have deductibles, such as DPPO plans. While many DHMO plans do not.
  • Coinsurance: This is the percentage of costs you and your plan share, typically once you’ve met your deductible. If your plan doesn’t have a deductible, like a DHMO, you will pay a flat fee for the services you receive.
  • Annual Maximum: This is how much your plan agrees to pay toward your dental care in a plan year. If you go over this amount, you may be responsible for the out-of-pocket costs.
  • Premium: This is what you pay monthly for your plan. Some plans, like DPPOs, tend to have a little higher premium because they offer you a lot of choice. DHMOs tend to have lower premiums because you are more limited.

Can you get full coverage dental insurance without a waiting period?

Yes, there are full coverage dental plans without a waiting period. A waiting period is the period of time between your plan start date and when you are actually covered to receive certain kinds of care.

Often a plan will cover you for preventive care right away, but ask you to wait a certain amount of time before it will cover you for more complex and costly care. So, for example, you may be able to get your teeth cleaned once your plan begins, but you may have a waiting period before you can get something like a crown.

Can you get full coverage dental insurance without a maximum?

Many types of dental plans set an annual maximum—this is the most your plan will pay for dental procedures and treatments over the course of the plan year. Dental HMO plans, or DHMOs, typically do not have annual maximums. This means you don’t risk running out of benefits. DHMOs are a good fit for some people, but offer fewer choices.

That said, you can shop for other dental plans with higher annual maximums, which means they cover you for a lot more. It’s important to anticipate what type of dental care you may need in the upcoming year and choose a plan with an annual maximum that’s right for you. Or, explore the value of a DHMO for a full coverage dental plan.

Where can you buy a full coverage dental plan?

You can get a full coverage dental plan in one of the following ways:

Affordable Dental Services

  • Enroll in a dental plan offered through your employer. Your employer may offer you options in insurance coverage through a particular insurance carrier.
  • If you don’t have coverage through an employer, you can buy a full coverage dental plan on your own either through a private insurance carrier or the Health Insurance Marketplace.

You will also find dental plans that cover you for basic preventive dental care. It’s important to know the difference.

How To Afford Dental Work Without Insurance

When you’re considering full coverage dental insurance plans, make sure to read the details. What does each cover? Are there limits on age and frequency? Is there an annual maximum that’s right for you and the dental care you expect to need during the plan year? Plans can vary by type, DPPO vs. DHMO for example, and also by insurance carrier. Before you enroll, make sure you understand how much your plan will cost and what it will cover.