Open Enrollment-That “Fun” Yearly Game

Yes, we know the best part of summer is what we are all experiencing right now!  This does mean that Fall is right around the corner.  With that comes the all-important open enrollment time!

For many employers, open enrollment occurs in November.  This is, usually, the one- and only-time changes can be made for the coming calendar year.  For instance, this is the time dependents can be added or removed for your insurance plan.  

For some larger employers, they will offer multiple insurance plans to their employees.  Open enrollment allows you to change your actual plan for the coming year.

Here are some open enrollment tips that we have learned over the years.

  1.  Many large employers offer a “managed care” or DMO plan option.  These can sound amazing because they say you “will have not out of pocket for anything”.  Most dental offices DO NOT participate in DMO or managed care plans.  Our recommendation is to always look for the PPO dental plan options.  The PPO option may cost a little more out of pocket for premiums but is it well worth it.  A PPO plan will give you the most flexibility, especially if we ever need to enlist the help of specialist.
  1. When looking at your PPO plan options, there are a few key things to pay attention to
  • Yearly benefit maximum. Some employers may offer a very low maximum at little-to-no out-of-paycheck cost to you.  This might be tempting, but if you have significant dental needs, a plan like this may be of little financial help to you.
  • Plan limitations.  Every benefit allowed on a plan adds to the total premium cost.  The more that are excluded, the lower the monthly premium will be.  If you have dreams about your teeth, make sure the things you are dreaming about are not excluded.  For instance, orthodontic treatment, nightguards, implants
  • Frequency limitations.  Many adults have some level of periodontal disease.  This requires more frequents visits for periodontal maintenance/recare appointments.  Some plans may limit recare to two times per year, regardless of your periodontal condition.  See if your employer offers a plan with a 3-4 times per year recare frequency.
  • Percentages of coverage/out of pocket expense.  This is something that is becoming more frequently seen.  A plan may have little-to-no out-of-paycheck expense to you, but the amount or percentage that is covered is lowered.  This means you will pay more out of pocket, even when seeing an in-network provider.

One other thing that we wanted to make sure you know.  Necessary dentistry should NOT be a burden.  So, if your plan is still leaving a significant portion out of pocket, you do not have to say no to your health!  Avalon Family Dentistry has partnered with Alphaeon Credit.  They work solely with medical and dental offices to offer patients financing.  Through Alphaeon, we can offer patients 6, 12, and 18 month interest free financing.  We can also offer 24, 36, 48 month extended financing that will give you the lowest monthly payment.  Alphaeon offers you the ability to pre-qualify with them.  The pre-qualification WILL NOT affect your credit score.  You can go to  Our office/store number is 37031.

As open enrollment approaches, do not hesitate to call our resident expert, Cristi.  She will be happy to help you successfully navigate and win the open enrollment game.