Dental costs can be one of the most predictable health expenses for families. An annual checkup and cleanings are scheduled events, and even restoration procedures like wreaths are often planned in advance. Knowing your anticipated dental care needs gives you the opportunity to plan for the best way to pay them.
There are three ways for federal employees to save on dental expenses: through a Federal Employee Health Benefit Plan (FEHB), through a Federal Employee Dental and Vision Insurance Program (FEDVIP), or through a flexible expense account (FSA).
Benefits of the FEHB diet
Start with your FEHB plan. You will need to know what, if any, dental benefits are offered by your plan. See section 5 (g) of the plan brochure. Virtually all FEHB plans offer accidental dental injury coverage, but many state that they have no other dental benefits. It is not always a complete story because it only refers to “official” plan benefits. Most official services are limited to preventive procedures, but some are more generous.
Some plans offer a dental savings program described in the “Non-FEHB benefits available to plan members” section of the plan brochure. These “unofficial” benefits still require the plan member to use a specific provider network, and you will need to contact the plan to find a list of participating providers and to find out more about available discounts.
Benefits of the FEDVIP plan
Federal Employee Vision and Dental Plans are stand-alone dental plans offered to federal employees and administered by Benefeds. Unlike the FEHB schemes, there is no government contribution to the premium. Employees pay the premium in full, although active employees pay the premium before tax, which represents a discount of about a third.
In a FEDVIP plan, assuming your dentist is part of the network, you will pay $ 0 for preventive and diagnostic procedures, between 20% and 45% for intermediate procedures, and 50% to 65% for major procedures. The options in the high FEDVIP plan always have lower reimbursable fees for registrants than the options in the standard plan. The FEDVIP brochures show the applicable reimbursable fees for each procedure, so if you know that you will need a particular procedure, you can compare the percentage that will apply to each plan.
Here are some other things to know about how FEDVIP plans work:
- Networked or Off-Network – FEDVIP plans have preferred networks and you will always pay less if you stay networked. Check with your dentist to find out which FEDVIP plans they participate in now and in 2022. If you are off the network, FEDVIP plans are less financially sound.
- Maximum annual benefits – About half of the options in the FEDVIP plan impose a maximum annual benefit. If you are planning heavy dental use next year, be sure to check the FEDVIP plan brochure to see if there is a maximum annual benefit. You can expect to pay a higher premium for plans without an annual cap.
- Orthodontic benefits – Most FEDVIP plans offer an orthodontic benefit, generally limited to children. Some of these plans impose a maximum annual or lifetime benefit for orthodontic services. Once you reach a certain threshold, such as $ 1,500, you are responsible for all other fees. Some impose a waiting period of one year or more after you join the plan before you are eligible for orthodontic services.
Flexible expense accounts
Most registrants will likely have dental expenses payable for the next year. Even if you have a FEHB plan with some dental benefits or have a FEDVIP plan, you will likely be paying something out of pocket. Establishing an FSA is a great way to save around 30% on these costs. In 2022, you can choose to have up to $ 2,850 deducted from your pre-tax paycheck and you can carry forward up to $ 570 of unused funds to the following year. Employees enrolled in a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA) can purchase a Limited Expense FSA (LEXHCFSA) for dental and vision expenses with the same contribution and rollover amounts as regular FSAs. Unfortunately, only active employees, not annuitants, are eligible to create an FSA. The FSA Open Season runs in parallel with the FEHB Open Season and is the only time of the year you can register.
How to compare the dental costs of the FEHB and FEDVIP plans
To see how dental coverage differs between FEHB plans and FEDVIP plans, the “Guide to the Health Plan Checkbook” provides an estimate of the annual costs of low, medium and high dental expenses. The three examples below are from a family of four in the Washington DC area.
Low use of dental care: We define low dental utilization as preventative services only and include annual checkups, x-rays, fluoride treatment, and cleanings. For employees who anticipate this next year, joining a FEDVIP plan and paying that extra premium will be more expensive than joining any of the FEHB plans that cover preventive care, even though the FEDVIP plans provide preventative care. free.
Average dental use: Average dental use includes preventive services in addition to some restorative services, such as fillings. For employees planning average usage next year, a FEDVIP plan may be the cheapest option, but there are still FEHB plans that have good coverage and aren’t far behind.
High dental use: High dental use includes preventive services and restorative services such as fillings, crowns, and dentures. If employees know they will be facing high usage next year, most FEDVIPs have lower estimated costs. However, some FEHB plans will still have lower cost estimates than some FEDVIP plans. High usage is on average much more common among older workers and pensioners than among young families.
Kevin Moss is Editor-in-Chief at Consumers’ Checkbook, publisher of the 2022 Guide to Health Plans for Federal Employees. To verify here to see if your agency offers free access. The Guide is also available for purchase and Government Executive readers can save 20% by entering promo code GOVEXEC at checkout.