Dental Benefits After Job Loss

First Things to Do After Losing Your Job

If your employer has a dental plan and you did not have your employment discontinued because of gross misconduct, you may qualify for COBRA. COBRA is a federal law that allows employees whose work is discontinued (or hours reduced below the level necessary to qualify for health benefits) to temporarily keep their existing health benefits, including dental insurance if the employees already had been receiving this type of employer coverage before COBRA was triggered. The Consolidated Omnibus Budget Reconciliation Act (COBRA) is a law providing employees with the option of temporarily continuing their employer-provided group health insurance coverage after events such as job loss or a reduction in hours. If you enroll in COBRA, your dental coverage will remain the same as it had before COBRA. Practically, this means you have the same services covered, the same co-pays/deductibles/annual maximum benefit, and the same claims process for your dental bills.¹

If you have been terminated by your employer, immediately contact that employer's human resources department to discuss if you are eligible for COBRA insurance coverage. The Department of Labor states that:

You have 60 days to enroll in COBRA, starting from when your coverage ends or when your COBRA election notice is provided to you or mailed - whichever is later. If you elect COBRA, you then have 45 days to make your first payment.²

If you do qualify, you'll need to complete the paperwork to elect the continuation of health benefits (including dental if you had been receiving it through your employer) and make certain the COBRA premium is paid on schedule. Terminated employees may continue their dental benefits through COBRA for up to 18 months. Some other circumstances, such as a divorce or death of an employee, may extend COBRA coverage to a maximum of 36 months.

COBRA Rights

As explained in the prior section, COBRA allows an employee to continue his or her group health benefits from an employer after the job ends or the hours of the job are reduced. Additionally, COBRA also gives eligible individuals the right to:

• Keep family members on the dental plan who were enrolled prior to the use of COBRA
• Keep their deductible status the same as it was right before COBRA coverage began, so if the deductible was already satisfied, it stays satisfied until the beginning of the following plan year

COBRA Alternatives

After establishing your COBRA eligibility, you should also consider whether your household income now qualifies you for Medicaid or a subsidized Affordable Care Act health plan. However, be aware that adult dental benefits may not be included in your state's Medicaid program. With respect to an Affordable Care Act health plan, you can purchase a plan that includes dental benefits or buy a stand-alone plan. If you wish to buy a stand-alone plan, you will likely find more options outside an Affordable Care Act marketplace than inside one. You can use online dental brokerage sites like this website to shop for dental insurance options offered in your region.

When shopping for dental coverage on an online brokerage, you need to consider multiple factors including benefits, total cost, and network.

Benefits

Dental benefits are not standardized in the way that medical benefits are standardized in either Medicare Advantage plans or Affordable Care Act Plans. In the interests of buying a full coverage dental plan, a consumer should look for the following minimum coverage:

• Preventive Care (e.g. annual exam, teeth cleanings & x-rays)
• Fillings and Tooth Extraction
• Root Canal Therapy
• Crowns
• Deep Cleaning
• Implants

* Most dental plans do not cover braces and the few that do often limit orthodontic coverage to minors covered under the dental policy.

Total Cost

Experts suggest that a consumer focus less on monthly premium alone and more on the total cost of dental care the consumer may pay in a year, ranging from insurance expenses to deductibles and copayments. In other words, total cost encompasses:

• A full year's total monthly premiums (i.e. your monthly premium multiplied by the 12 months in a year)
• The deductible and out-of-pocket costs for dental services the consumer is likely to use in a year
• Any costs a consumer should expect to pay for expected dental service outside dental insurance coverage or beyond the plan's maximum benefit
• For example, if a person expects to have $2,000 in crown work done in a year and the maximum benefit on a plan is $1,500, then the additional $500 in out-of-pocket costs should be calculated into the plan's total cost estimate

Insurance company websites as well as DentalInsurance.com can assist you in collecting this information through quoting tools as well as dental plan brochures and plan details pages. If you come across a dental service you expect to get and the plan you are investigating does not cover it, you can get an estimate of its cost using a tool such as the dental expense section of FAIR Health Consumer.

Network

Dentists provide dental care, not insurance companies, so the matter of insurance acceptance by your preferred dentist is a crucial shopping consideration. In other words, a dental insurance plan is only as good as the dentists that accept its coverage.

The first thing a consumer should do when evaluating a dental plan is confirm the plan's acceptance by his or her preferred dental practice. If you use an out-of-network dentist, you may pay higher out-of-pocket costs for covered dental care. In the case of an HMO or dental savings plan, an out-of-network dentist will not be covered at all. If the consumer does not have a dentist, he or she should use a dentist review website (e.g. HealthGrades, Yelp, 1800Dentist) to identify highly rated dentists in the area and then confirm whether they accept new patients as well as the insurance being considered. Dentist location is an often-overlooked issue. If a dentist location is inconvenient to reach from home or work, you may be less likely to attend regular dental care such as annual cleanings.

SOURCES

¹ Department of Labor, "FAQs on COBRA Continuation Health Coverage for Workers."
² Ibid.