Dental cover for major work

The four numbers that decide your bill

For a cleaning, premium is the whole story. For a graft, an implant or a full periodontal course, four other numbers decide what you pay:

• The annual maximum. What the plan will pay in a year, full stop. Everything above it is yours.
• The coinsurance for major services, often around half of the allowed amount rather than the billed amount.
• The waiting period before major services are covered at all.
• The out-of-network reimbursement. Plans pay a set allowance, and your dentist's fee may be well above it.

How plans classify the work

Dental plans sort treatment into classes, and the class drives the coinsurance:

• Preventive: exams, cleanings, x-rays. Usually covered in full in network, and usually with no waiting period.
• Basic: fillings, simple extractions.
• Major: crowns, bridges, dentures, periodontal surgery including gum grafts, and often implants.
• Orthodontia: usually its own lifetime maximum, separate from the annual one.

Where a specific procedure sits is not uniform between carriers. Implants in particular are treated differently from plan to plan, and some exclude them. Ask about the procedure by name and, better, by its dental code.

FEDVIP

• You pay the whole premium. Unlike FEHB, there is no government contribution.
• Enrollment is through BENEFEDS, during Open Season or after a qualifying life event, and it is separate from your health plan.
• Annual maximums vary a lot between the twelve dental carriers, and so do the waiting periods for major work.
• Children are covered to 22, not 26 as in FEHB.
• Dental premiums depend on where you live, through a rating region, so the cheapest plan in one state is not the cheapest in another.

VADIP, if you are a veteran

The VA Dental Insurance Program is a separate route, and many veterans in federal jobs do not know it exists.

• Who qualifies: veterans enrolled in VA health care, and people enrolled in CHAMPVA.
• Two carriers, Delta Dental and MetLife, at negotiated group rates.
• Enrollment runs all year. There is no Open Season, which is the practical advantage over FEDVIP when work comes up unexpectedly.
• It does not affect free VA dental care. If you qualify for VA dental through a service-connected dental condition, a 100% rating, former POW status or another eligibility class, enrolling in VADIP takes none of that away.
• Enrol directly with the carrier, not through the VA.

Check your free-care eligibility class first. Paying premiums for care the VA would have provided is the common mistake here.

Can you hold both?

Nothing prevents holding FEDVIP and VADIP at once, and for a large course of treatment two annual maximums can genuinely help, with one plan coordinating after the other.

Weigh it honestly though. Two premiums for a year to offset one expensive case is sometimes worth it and sometimes not, and coordination between a FEDVIP plan and a VADIP plan is not as tidy as the arithmetic suggests. Ask both carriers how they coordinate before assuming the maximums simply add up.

Planning a big course of treatment

• Get a written treatment plan with codes from your dentist, then send it to the carrier for a pre-treatment estimate. This is the single most useful thing you can do, and most people skip it.
• Split the work across two plan years where clinically sensible. Two annual maximums beat one.
• Check the waiting period before you enrol, not after. If major work is already planned, a plan with no waiting period may beat a cheaper one that makes you wait a year.
• Confirm the dentist is in network for the specific plan option, not just the carrier.
• Ask what the plan allows, not what it pays. Fifty percent of an allowance well below your dentist's fee is not fifty percent of your bill.
• A dental school or a VA clinic can cut the cost of implant and graft work substantially if you are flexible on timing.

Common questions