Dental Plans (HMO & PPO)

THE DENTAL HMO HAS UNLIMITED ANNUAL BENEFITS:

When considering a dental plan for yourself and or family, the first plan you should look at is an HMO dental plan, for one primary reason; it has unlimited annual benefits.

I can email you a list of network dentists in your area.

Any PPO plan you look at will typically have annual benefit limits between $1,000 to $1,500.  A crown or root canal will eat up these amounts in the first visit.  While an HMO will provide unlimited benefits throughout the year.

  • Implants – are covered with the Blue Shield Dental HMO.
  • All Ages – are able to enroll with the Blue Shield Dental HMO plans.
  • Rates are at the bottom of this chart:

ANTHEM – has several Dental plans to choose from; PPO, HMO, individuals, seniors and group dental plans for employees.

Most of the Anthem plans are for Under-age 65. Anthem Extras PPO is for the 65 and older person.

If you are under age 65 and want dental insurance for yourself or family, the Anthem Dental Prime PPO is the plan to look at. Also available is the Dental Select HMO, which you can view below.

Age 65 and above, then the plan is Anthem Extras, which is a Dental PPO plan with the option to add Vision coverage as well.

All Dental plan are “stand-alone” plans which means you can enroll in a dental plan by itself, no need for other Anthem products.

  • PPO Dental = massive local, state and national networks to freely move around.  Most likely your dentist is contracted with a Dental PPO.
  • HMO Dental = a fraction of the price and with unlimited annual benefits.  Although you are not allowed to move freely among network dentists. If you change a dentist or dental office, the effective change typically starts the first of the next month.

How does a PPO Dental Plan work?  Most PPO dental plans allow you to move freely to any dentist, in-network or out.  Although the plan will pay much more if you see a contracted in-network dentist.

First, the total bill will typically be reduced by 25% to 40% depending on the service provided, because of the network contracted dental rates.  Instead of a crown costing $1,200, the plan rate may be $850, then the insurance pays 50% of that which equals $420.

PPO Dental plans provide flexibility, allowing you to see different dentists within a PPO dental network.  Most PPO plans will say you can see any dentist, in or out of the network, although is is very important to stay within the network of dentists, because you will see the greatest savings when going to a contracted dentist.

29,000 Contracted locations in California

Most dentists will tell you they accept “All” ppo’s.  This may be true, but the problem with this statement is; if the dentist accepts the plan but is not a contracted dentist for the plan you are enrolled, the amount the plan pays to an “out of network dentist” is greatly reduced.  Always try to see an “in-network” dentist, you’ll pay less.

Anthem Dental Prime PPO (Under age 65)

DENTAL PRIME RATES:

Waiting Periods:  All PPO dental plans will have some sort of waiting period for “Basic” services along with “Major” services.  If you have dental insurance from another company or employer group plan, the new plan will honor the previous coverage and typically waive your new waiting periods.

If you are in a waiting period, you will still see impressive costs savings of 25% – 40% simply by seeing a network PPO dentist.  Because they are bound by the company and plan contracted and negotiated service fees.  Also, over 87,000 contracted dental offices nationwide.

Anthem HMO Dental Select:

(UNDER AGE 65)  With an HMO Dental plan your will need to choose a dentist or dental office when you enroll.  This will be your dental office for all of your dental services. You will not have freedom of choice with different dentists with an HMO plan.  Although your out of pocket amounts will be less with an HMO plan, typically copays for the different dental procedures.

The Anthem HMO dental plan does not have a 12 month waiting period for “major” services.  View the Anthem Dental Brochure for more info.

Anthem Senior Dental PPO (ages 65 & above):

Anthem Extras Dental plans, you do not need other Anthem insurance to enroll in one of these dental and or  vision plans. These are “stand-along” plans.

Anthem Blue Cross has the same quality PPO dental plans with optional vision coverage called Anthem Extras, which can compliment all of our Medicare Supplement plans.  Anthem Extras consist of three packages; Standard, Premium and Premium Plus.  All three offer valuable benefits and services.

Anthem Senior PPO Dental & Vision:

Please feel free to reach out to me by phone (916) 682-1117 or email at john@johnconner.com or simply complete the brief information request form below.

John Conner
916-682-1117
john@johnconner.com

Questions & Comments:

Anthem Dental Blue and Dental Prime PPO Plans

Anthem PPO Dental Prime, Dental Blue and Blue View Vision Plans for Individuals and Families.  You do not need an Anthem Health or Medicare policy to enroll in any of the Anthem Dental plans.  It is a stand-alone polcy.

Traditional PPO style dental plans work well as long as you stay within the PPO dental network.

A big advantage of seeing a contracted dentist is, from the very beginning, your overall dental costs can be reduced by 25% to 40%.  Next the amounts you owe for the services, 20% for minor services and 50% for major services, are then reduced because the overall cost is down.

With these lower contracted amounts, you are always going to pay much less then when seeing a dentist without any insurance in place.

Dental Prime for Individuals & Families (under 65)

Access to more then 29,000 dental offices in California, plus Freedom from paperwork – network dentists file claims, and there are no referrals needed.

Example of how “in-network” PPO dental services can lower your costs:

Example: John gets a crown from an out of network dentist who charges $1,200 for the service and bills Anthem for that amount.

Anthem’s maximum allowed amount for this dental service is $800. That means there will be a $400 difference, which the dentist can bill John.  Since John will also need to pay $400 which is 50% of $800, the total he’ll pay the out of network dentist is $800.

Let’s look at “in-network” costs:  

  • Dentist charge for the crown: $1,200.
  • Anthem’s contracted amount: $800.
  • Anthem pays 50%:  $400.
  • You pay 50% coinsurance of the $800 charge = $400.
  • Balance you owe the dentist: $1,200 – $800 = $400.
  • Your total cost = $400.

You’ve probably heard before that dental health is an important part of overall health. In fact, 90% of the body’s diseases first show signs and
symptoms in the mouth.

Looking for Vision Coverage?  You can also bundle the Anthem Blue View vision coverage plan along with your dental plan.

With a Blue View plan you have access to more than 36,000 eye doctors and over 27,000 locations nationwide.  So you can get your eye care and eye wear just about anywhere. You can call or go online at 1-800 CONTACTS®, visit a participating private practice eye doctor, or go in-store to LensCrafters®, Sears Optical℠, Target Optical® and JCPenney® Optical.

Anthem Extras for Anyone over age 65…

Please feel free to call anytime with questions. I will also be happy to check to see if you dentist is in the Anthem network.

John Conner
916-682-1117
john@johnconner.com

Questions & Comments:

Anthem Extras PPO Dental & Vision

Dental 2020:

For ages 65 and above, the Anthem Extras dental & vision coverage for anyone in California looking for quality dental/vision coverage. (Under age 65 dental plans – bottom of this page)

Contact me and I will check to see if your dentist is contracted with Anthem Extras.

Anthem Blue Cross has some new Dental & Vision packages called Anthem Extras, which can compliment all of our Medicare Supplement plans.  Anthem Extras consist of three packages; Standard, Premium and Premium Plus.  All three offer valuable benefits and services.

2 Types of Dental Plans:

PPO Dental Plans … Traditional PPO style dental plan, as long as you stay within the PPO dental network you will benefit from a 25% to 40% discount on your dental services right off the top.

With these lower contracted prices, you then are responsible for 20% to 50% of the cost, depending if the service provided is considered ‘minor’ services or ‘major’ services.  Anthem provides 5 different PPO dental plans and 1 HMO dental plan.

An example of how “in-network” dental services can lower your costs:

Example: John gets a crown from an out of network dentist who charges $1,200 for the service and bills Anthem for that amount.

Anthem’s maximum allowed amount for this dental service is $800. That means there will be a $400 difference, which the dentist can bill John.  Since John will also need to pay $400 which is 50% of $800, the total he’ll pay the out of network dentist is $800.

Now lets look at “in-network” costs:  

  • Dentist charge for the crown: $1,200.
  • Anthem’s contracted amount: $800.
  • Anthem pays 50%:  $400.
  • You pay 50% coinsurance of the $800 charge = $400.
  • balance you owe the dentist: $1,200 – $800 = $400.
  • Your total cost = $400.

Who is Eligible for Anthem Extra’s ..Anyone age 65 or older.  Anthem Extras Plans are considered “Stand-Alone” plans, which means you do not need an Anthem Medicare plan to enroll in Anthem Extras.  All you need to be is 65 or older, that’s it!!  Even if you have a Medicare Supplement plan from another company, Anthem Extras is for you!!  You can enroll or cancel the plan anytime of the year.

And best of all, these packages are available for a monthly plan premiums of: $23, $44 and $63.  The benefits in each package will roll up to one overall premium, and you will receive one ID card for all of these services.

Dental …

  • Annual Maximum Benefit Options: $500, $1,000 or $1,250.
  • Annual Deductible – $0 to $50.
  • Network of Dentists – Dental Blue 100 network.
  • Routine Cleanings, Exams & X-rays – 100% covered when using a contracted dentist (2 cleanings per year)
  • Fillings – 80% coverage (Premium & Premium Plus packages)
  • Endodontics – Root canals, Oral surgery & Simple tooth extractions – 50% coverage (Premium & Premium Plus packages).
  • Prosthodontics – Crowns, Dentures, Bridges – 50% coverage (Premium Plus package only)

Vision …

  • Vision Exam – $10 to $20 copay (in-network providers only)
  • Eyeglass Frames – You pay excess of $100. 20% discount applies to the balance over $100.
  • Eyeglass Lenses – $10 to $20 copay (standard plastic single vision, bifocal or trifocal lenses)
  • Contact Lenses – Conventional lenses ($80 allowance then 15% off the remaining balance) Disposable: $80 allowance, Non elective lenses (covered in full).
  • Coordinate and pay for medical evacuation to the nearest appropriate treatment facility or back home when medically necessary.
  • Schedule a bedside visit for a family member or friend if you are hospitalized for more than seven days, or if you are in critical condition.
  • Access health-related travel planning information and receive assistance in replacing lost prescription medications or contact lenses while traveling, and much more!

Silver Sneakers Fitness Program … SilverSneakers offers physical activity, health education and social events designed just for Medicare-eligible members like you.  You’ll have access to the following valuable services:

  • Fitness – Enjoy basic membership at a participating SilverSneakers location.
  • Fun – Participate in SilverSneakers classes, which are designed exclusively for older adults who want to improve their strength, flexibility, balance and endurance.
  • Friends –  Meed new friends while you exercise.
  • Each SilverSneakers location has a Program Adviser to assist you with enrolling and meeting your health goals.  You can use any of more than 11,000 location across the nation that offer the SilverSneakers Fitness Program.  So if on vacation, see if a location will be near you.
  • Find a Location – www.silversneakers.com

Questions?  Call or email anytime.

John Conner
916-682-1117