Is this even worth it?

Posted by Kromey at 8:31pm Feb 24 '10
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Long story short: Friday I'm going in for oral surgery, and out of the total $2555 cost for the procedure, my lovely insurance policy is paying a mere $255.50. It would normally be higher, and in fact the higher numbers are why I bought this policy - "basic" services are only covered at 50% of the normal benefit for the first year, while "major" services are covered at a mere 20% for the first year and 50% for the second. So let's break this down:

[private]sthesia (basic service):
Cost: $740
Covered (normally): $250
To be paid (50%): $125

5 surgical extractions (major service):
Cost: $1815
Covered (normally): $600
To be paid (20%): $120

Okay, somehow I'm missing $10.50 from what they told my surgeon they'd pay, but this is the closest I can get with the numbers in my insurance contract. Other services I'm likely to get this year: 2 check-ups/cleanings (will be covered for $150 total), and either a bridge (not sure if this will be covered or not, seems like not...) or implants (which are explicitly excluded from coverage). So most likely grand total of coverage this year is (based on my computations, not the quoted $255.50) a whopping $395.

By the end of the year, I will have paid $484.80 ($40.40/month) for this coverage.

But, okay, let's be a little more fair: let's instead pretend that I'm in my third year of coverage now and thus eligible for full benefits. I'm still paying $484.80 for the year, but now they're paying $850 for Friday's extractions, plus the $150 for two check-ups/cleanings this year, for a total of $1000 that year. But, let's also not forget the two previous years' $150 for cleanings, brining total benefits paid to $1300.

By then I'll have paid $1454.40 for this coverage, so I'm still better off just putting this money aside into a savings account (where it would be earning interest for me in the meantime! but we'll just gloss over that to give my insurance plan the best possible outcome here). Given that the previous 9 years I never once sat down in a dentist's chair (except for once to look at my bridge when it chipped, which cost my insurance company a whopping $20) and yet have a very healthy mouth, it's very likely that I'll go the next 10 years with nothing but Friday's extractions, and of course the (uncovered) implants or bridge that I'll need to get subsequently.

I fully understand that the point of insurance isn't to "come out ahead", but rather to have that safety net around for when Murphy comes a-knockin', but 5 surgical extractions is pretty major for the typical person, especially if he (as I fully intend to from here on out) sticks to his bi-annual cleaning schedule. Given that the best case for this plan*, however, is digging way deep into my pockets... the benefits here just don't seem to justify the premiums, especially with the 20%/50% bullshit.

Am I wrong? Is this policy in fact worthwhile? It just doesn't seem so to me right now...

* For completeness, this same procedure in Year 2, when "basic" services are paid at 100% and majors at 50%, would be covered for $550; add in $300 for two years' worth of bi-annual cleanings, and total benefits paid gets up to $850. For two years of coverage, I will have paid $969.60. Any scenario pushing this out even further results in the total premiums paid outpacing the total benefits paid by a further $334.80/year (the difference between the $150 annual cleaning and the $484.80 annual premium).
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