My mom is eligible for Medicaid, but it doesn't cover dental and she hasn't been to a dentist in many years. She has profound dementia and will require a special dentist facility. She has very little money in savings and I don't want to spend it out on dental work. So, I'm going to look into dental insurance but it seems even more varied and less coverage than regular health insurance and I don't know if it's generally worth it to just ask the dentist for a payment plan. Anyone have experience with this? Thanks so much!
If your mom has profound dementia, please, please, please before you sign up & start payments, think about if mom can totally on her own......hold a small cup with water, sip, swish & spit on command; lay at an incline for 30 minutes to an hour; can bite & hold an X-ray plate and be still long enough to get bitewings & other X-rays done; stand & hold still for the panoramas; hold her mouth open & fixed in one direction for a full 5 minutes; and would she be able to have the wet, oozy and odd tasting form used to get impressions go into her mouth & sit for the length of time needed to pull a clean impression (this last one can be impossible). If not, it's going to be costly epic fail imho.
Also can she (& you) be able to do the series of timed appointments needed for many procedures?
Also look carefully at policies. Most dental insurance is geared to paying for twice a year cleaning & exam, annual bitewings at full coverage; filings into sound teeth with healthy gums have good coverage as well. But coverage on work done by endodondists, oral surgeons or other specialists may be less than 1/3. Often policies do NOT pay the dentist until the full treatment is done, so a lot of dentists -especially those specialists that require several visits to complete a treatment - will not participate with some insurers because of this.
One bright spot in this is if, there is going to be anesthesia needed (like for extractions or bone work) then your medical insurance may cover all or part of the anesthesia if done by a oral surgeon.
For my mom, spend-down on dental was well worth it as it just sped up her eventual eligibility for NH Medicaid and she was able to have a pretty normal diet and bite into food till really her last month or so. The whole cut up or hold food then bite /chew /swallow helps to help keep them cognitive & have a more varied diet & they need teeth to do this. My mom was fortunate to have had $ to pay dental costs & she had pretty sound teeth & good gums to start with. But if she hadn't had the $, and had teeth issues, she probably would have done full dentures which I believe Medicare will pay for. Really look carefully at what the costs could be and whether mom can actually participate in the care needed before she gets on the hook for costs. good luck.
Then I did a break-even analysis to find the point at which the insurance would actually offer enough that it would be justified.
My determination was that it was justified for both of us, but after a year of so as the premiums were increased, my breakeven point changed and the insurance was no longer cost effective. And remember that the premiums likely will increase annually.
As pointed out, it doesn't cover everything the first year, nor does it cover higher cost procedures. So you'll need to review your bills for the past few years and determine whether, thus far, the needs appear to be for the bascs, or for extraordinary expenses like root canals, bridges, and more.
https://www.dhs.wisconsin.gov/medicaid/index.htm