Ah, braces —the rite of passage that every kid (and some adults) in North Central Washington dreads. If you’re wondering whether dental insurance will help you foot the bill for straightening little Dillan’s teeth, you’re in good company. This question comes up all the time at Wenatchee Insurance, especially when people start tallying up the cost of those shiny metal brackets like they were made of gold.
Orthodontic / Braces Coverage Basics
Dental insurance can cover orthodontics, but it’s not always a guarantee. It’s a bit like assuming all apples in Wenatchee taste the same—they don’t! It is tough to eat a Red Delicious from cold storage. Orthodontic coverage depends on your plan, and most plans that do cover it will only do so for kids under 18. The magical phrase is “Medical Necessity” especially if there is an Apple Health Plan in play.
If your parents couldn’t get you braces when you were a kid then there are a couple of individual unicorn plans available. Suzie and Matt went hunting for plans that could be purchased by the individual for this purpose and they have some restrictions.
How Much Is Covered?
If your plan does cover braces, it typically covers a percentage of the total cost—usually around 50%. So, if little Billy’s braces cost $6,000, your insurance might cover $3,000, leaving you to pay the rest. It’s like getting a discount on a family-sized apple pie at the local bakery—not free, but better than full price.
Example
Let’s take young Emma from Omak, who needed braces but didn’t want to look like she had a mouth full of railroad tracks. Her mom found a dental insurance plan that covered clear aligners instead of traditional braces. Now Emma’s teeth are straightening out just in time for high school, and she can smile confidently in all her Instagram pics—no filters required.
At Wenatchee Insurance we have found that exploring some of your options early can have some of the lowest costs for braces. As we get older, it gets a little tough but not impossible for dental insurance to cover orthodontics as adults.
Alright, let’s talk about the million-dollar question—well, hopefully not literally. “How much does dental insurance cost?” It’s a question that keeps people in North Central Washington up at night, somewhere between worrying about deer in Grandma’s flower garden and whether The Wild will have a winning hockey season. At Wenatchee Insurance, we get it.
First things first: the monthly premium. This is the amount you’ll pay each month, kind of like your subscription to that jam-of-the-month club. Except this time, it’s your teeth getting the care they need. Depending on your plan, premiums can range from about $15 to $75 a month. It’s like choosing between the extra-large caramel apple from the Grant County fair or just a bag of organic Fuji apples—both will cost you, but which one will make you feel better about your choice? Freedom is important.
Deductibles and Co-Pays
Next, we have deductibles and co-pays. If you’ve ever had to pay to park at Leavenworth during Oktoberfest, you know what these are. A deductible is what you have to pay out-of-pocket first before your insurance kicks in, and co-pays are the little bits you pay each time you visit the dentist. Imagine going to the local cider mill and having to pay a few bucks just to get in—that’s your co-pay. Most deductibles range from $50 to $150 annually, while co-pays can be $10 to $20 per visit for most plans.
October is when we can offer next year’s plans.
Funny Example
Take our pal Farmer Fred from East Wenatchee. Farmer Fred figured he’d save some dough by skipping dental insurance altogether. After all, how bad could it be? Well, that was before Farmer Fred’s epic caramel apple incident last Halloween. One crack of that candy-coated delight and Farmer Fred was down two teeth and up several thousand dollars in dental bills. Now, Farmer Fred’s a dental insurance convert, paying his monthly premiums like clockwork, and sticking to softer treats—like apple pie.
Major Work: Crowns, Implants, and More Dental Insurance
For major work, the cost can be higher. We’re talking crowns, root canals, and implants—like if you decided to replace your old beater with a brand-new truck. The insurance might cover 50% to 80% of the cost after your deductible, leaving you to pick up the rest. These are the services that often have waiting periods. But trust us, it’s a lot better than footing the entire bill yourself.
Protip: Be aware of plan dollar maximums per person per year. This is the amount that the insurance plan will help with before wandering off to the next year. Some plans have them and some do not.
While we do a lot online at Wenatchee Insurance, we especially like to go over coverage with clients. We have some new clients that want to shop by brand name not realizing there can be significant differences for each product. We have encountered people who didn’t realize they had current coverage and others who did not know there was an add-on available from their insurance plan.
When it comes to health insurance for seniors, Original Medicare is a popular choice. Millions of Americans select it every year. It offers coverage for many essential health services. There are some gaps in coverage for Original Medicare that you need to be aware of.
Here are five key things that Original Medicare does not cover and some examples to help illustrate these gaps.
1. Routine Dental Care
Dental Care is one of the top requested needs. This can surprise many who planned on relying only on Medicare alone for their health insurance needs. Original Medicare does not cover routine dental care, including cleanings, gum scrapings, crowns, fillings, and dentures. Suzie has several different Dental Plans to fill in the gap.
Example: Imagine you’re 70-year-old retiree, Mrs. Johnson. You notice some discomfort in your mouth after eating some Quincy Corn and decide to visit your dentist. After the exam, the dentist tells you a filling fell out and the pain is from a root canal you need. This painful surprise is out of pocket because Original Medicare doesn’t cover dental.
2. Vision Care
Original Medicare covers eye exams for people with diabetes and annual glaucoma tests for high-risk patients. It does not cover routine eye exams or hardware like glasses or contact lenses. Are you sensing a trend for medical coverage from the shoulders up?
Example: Mr. Thompson, an 68-year-old retired teacher, starts having trouble reading the Wenatchee World. He schedules an eye exam at the Vision Center at Confluence and discovers he needs an updated prescription. Mr Thompson is paying out of pocket for the exam and glasses because these are not covered by original Medicare.
3. Hearing Aids and Exams
Hearing loss is common among seniors, but Original Medicare does not cover hearing aids or the exams needed to fit them.
4. Long-Term Care
Original Medicare does cover skilled nursing facility care, but only for a limited time and under specific conditions. It doesn’t cover custodial care, which includes help with daily activities like bathing, dressing, and eating if that’s the only care you need.
Example: Imagine you are Mrs. Rivera, 82, and living alone while your kids are living in Montana. After a fall, you find it difficult to manage daily tasks like bathing and dressing. You need long-term care to help with these activities. Unfortunately, Original Medicare does not cover this type of care. This expense is going to add up quickly.
5. Overseas Health Care
Original Medicare generally does not cover health care when you travel outside the United States. This can be a significant concern for those who love to travel or have family abroad. We had to start using a travel insurance exchange to provide options.
Example: Mr. and Mrs. Davis, a retired couple, decide to take a dream safari to Africa. While abroad, Mrs. Davis falls ill and needs medical treatment. Since Original Medicare doesn’t cover international medical care, they face hefty medical bills, adding stress to what should have been a relaxing trip.
Getting Help with Coverage Gaps
Navigating the complexities of Medicare and understanding what it does and does not cover can be overwhelming. This is where Suzie with Wenatchee Insurance comes in. Suzie helps clients understand their Medicare options and then finds solutions to cover the gaps left by Original Medicare.
Suzie can help you explore Medicare Advantage plans, which often include additional benefits. These plans might also provide some coverage for long-term care and overseas health care. Additionally, Suzie can guide you through supplemental insurance options, known as Medigap policies, which can help cover some of the out-of-pocket costs not covered by Original Medicare.
Conclusion
Don’t let coverage gaps surprise you reach out and have a chat with Suzie today and ensure you have comprehensive health coverage for all stages of life. While Original Medicare provides valuable coverage, it’s crucial to be aware that it has limitations.
Routine dental care, vision care, hearing aids, long-term care, and overseas travel health care are significant areas where coverage gaps can occur.
By understanding these gaps and seeking assistance from professionals like Suzie at Wenatchee Insurance, you can find the right coverages to meet your needs.
Topics: Medicare, Original Medicare, Medicare Advantage, travel insurance, Cashmere, Wenatchee Insurance, Suzie, Enrollment, Glasses, Contacts, Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth
Let’s face it, folks—teeth are a big deal. They’re not just there to look pretty in an Instagram Selfie or to chomp down on a monster carrot like some wacky rabbit. Your teeth are a vital part of your overall health, and taking care of them is as essential as, say, breathing or finding out who gets eliminated on Survivor. But let’s be real: dental care can cost an arm and a leg (or should I say a molar and a canine?). That’s where dental insurance gives your dollars a Nitrous Boost. And who better to help navigate you through the different dental plans than Suzie with Wenatchee Insurance?
A Toothsome Tale: The Importance of Dental Insurance
Picture this: you’re munching on an ear of Quincy Corn and crack! Your tooth breaks. Panic sets in. You imagine living the rest of your life toothless, subsisting on mashed potatoes and smoothies. But wait! With dental insurance, you can call up your dentist, and get that chomper fixed, and get back to your crunchy snacks without a second breath. Dental insurance isn’t just about emergencies; it’s about prevention too. Regular check-ups, cleanings, and those pesky but necessary X-rays can all add up. With the right coverage, you’re not just saving money—you’re saving your teeth.
Why Suzie with Wenatchee Insurance for Dental Insurance?
Now, you might be wondering, why Suzie? What makes her the go-to gal for dental insurance in Central Washington? Well, let me break it down for you:
1. Expertise You Can Sink Your Teeth Into
Suzie isn’t just any insurance agent. She’s the queen of coverage, the Sultana of Smile, the Boss of Benefits. With her extensive knowledge, she can help you navigate the confusing world of dental plans. PPO, HMO, DHMO—Suzie knows all the acronyms and what they mean for your wallet and your teeth.
2. Local Wisdom
Suzie understands the unique needs of Central Washingtonians. Whether you’re in Wenatchee, Ellensburg, or Omak, she’s got the scoop on which plans are accepted by the best local dentists. You won’t be stuck driving miles away for a simple cleaning because Suzie ensures you get a plan that works where you live.
3. Personalized Service
Let’s be honest: calling a 1-800 number and talking to a scripted robot about your teeth or wanting braces isn’t exactly a cup of hot chocolate. Suzie offers personalized service whether it is over the phone or in our office at 413 N Mission, Wenatchee. She takes the time to understand your needs and finds a plan that’s as unique as your dental history.
The Suzie Difference
Suzie is committed to making sure you understand your dental insurance. She breaks it down into bite-sized pieces, and if you have questions she will circle back to answer them. No tooth emergency necessary.
Conclusion: Don’t Be Toothless in Central Washington
In conclusion, dental insurance is crucial in this picture-perfect world. It’s not just about avoiding those hefty dental bills; it’s about maintaining your overall health and well-being. And who better to help you find the dental plan than Suzie with Wenatchee Insurance? She’s knowledgeable, local, and committed to giving you the best service possible. Give her a call today and ensure that your teeth are in good hands. After all, a smile is the best thing you can wear in Central Washington!
Topics: Health Insurance, Apple Health, Ambetter, Lifewise, Community Health Wenatchee Insurance, Delta, Dental Toothache, Braces, Suzie, Dentists Enrollment, Contacts, Chelan County, Okanogan, Grant County, Douglas County, 509, Leavenworth
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For nearly a decade we have assisted with Health & Medicare Solutions. We are proud to be selected by the Washington Healthplanfinder to be one of ten Enrollment Centers located in Washington State.
