Today we are going to dive into what should you know about insurance.
Let’s start with…… It is considered a benefit for us. Yet many people work just to have it.
What is Insurance and why do we have it? It is a means of protection from financial loss where in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to hedge against the risk of a contingent or uncertain loss.
An entity which provides insurance is known as an insurer, insurance company, insurance carrier, or underwriter.
A person entity who buys insurance is known as a policyholder, while a person covered under the policy is called an insured. Sometimes they are the same person..
The insurance transaction involves the policyholder assuming a guaranteed, known, and relatively small loss in the form of a payment to the insurer (a premium) in exchange for the insurer’s promise to compensate the insured in the event of a covered loss.
The insured receives a contract, called the insurance policy, which details the conditions and circumstances under which the insurer will compensate the insured, or their designated beneficiary or assignee if it is life insurance.
The amount of money charged by the insurer to the policyholder for the coverage set forth in the insurance policy is called the premium.
For many insurances the premium depends on how much of a risk you are to the insurance company having to pay out. Especially when it comes to life insurance. The greater the risk you are to them having to pay out the more it costs you.
So It is like gambling the insurer is betting the insured will not need to use the insurance. The insured person is gambling if they need it it will save them money in case of a major illness or death.
If the insured experiences a loss which is potentially covered by the insurance policy, the insured submits a claim to the insurer for processing.
A mandatory out-of-pocket expense is required by an insurance policy before an insurer will pay a claim is called a deductible or if required by an insurance policy, a copayment.
Think about how much money insurance companies have? They need a lot just to be able to offer it because they will have to pay out. However they play the odds and it works in their favor more than not.
Take me for example. I have been paying for medical insurance since I graduated in 1988 back then my premium was $150 a month for just me. In a few years it doubled to $320. After my divorce I did not have coverage for a few years. Most dental offices do not offer insurance. I never used my insurance, so I felt why should I pay $500 a month for it on top of all the other insurances I was paying for? I did not see the value. Most dental offices do not offer benefits or insurance. After covid I changed jobs to one that did offer coverage. It was a good thing because two months later I found out I had breast cancer. It is crazy how life works. Cancer was not something I ever thought I would have.
Now it is $670 a month for myself and my daughter to have s PPO so I can see my doctor. Over my lifetime just for medical insurance I have paid over $100,000 dollars.
When I had cancer the costs billed to my insurance company were over $120,000. I paid $10,000 out of pocket. Without insurance I would have had to take out a loan to pay for my care.
There are so many insurance options available these days should you have it and if yes what insurance should you even have?
Selecting the right type and amount of coverage of insurance is based on your specific situation, such as children, age, lifestyle, and employment benefits.
Today I am going to touch on Life, Health and Dental Benefits.
1. Life Insurance
The two basic types of life insurance are traditional whole life and term life.
- Whole Life can be used as an income tool as well as an insurance instrument. It includes a death benefit and also a cash value component. As the value grows, you can access the money by taking a loan or withdrawing funds and you can end the policy by taking the cash value of the policy.
- Term Life covers you for a set amount of time like 10, 20, or 30 years and your premiums remain stable. Commonly the most affordable type of life insurance, a term policy can work to cover the years during which a mortgage loan is outstanding or throughout your children’s college years.
Life insurance is especially important if your family is dependent on your salary. Industry experts suggest a policy that pays out 10 times your yearly income that would support your family if something happened to you.
- Health insurance
Understanding the rules for insurance can be confusing and frustrating.
- Health insurance coverage is no longer mandatory at the federal level, as of Jan. 1, 2019.
- Some states still require you to have health insurance coverage to avoid a tax penalty. It changes all the time so check your state.
- Going without health insurance saves you money since you’re not paying premiums, but it could put you at financial risk if you get injured or develop a serious illness.
You can obtain health insurance through your employer, the federal health insurance marketplace, or private insurance you buy for yourself and your family by contacting health insurance companies directly or going through a health insurance agent.
Only about 9.2% of the American population was without insurance coverage in 2021, the Centers for Disease Control (CDC) reported in its National Center for Health Statistics. More than 60% got their coverage through an employer or in the private insurance marketplace while the rest were covered by government-subsidized programs including Medicare and Medicaid, veterans benefits programs, and the federal marketplace established under the Affordable Care Act.
If you’re on a very tight budget, even a minimal policy is better than none. If you qualify you may be one of the 80 million Americans who are eligible for Medicaid.
If your income is moderate but doesn’t stretch to insurance coverage, you may be eligible for subsidized coverage under the federal Affordable Care Act.
For salaried employees is usually participating in an employer’s insurance program if your employer has one. The average annual premium cost to the employee in an employer-sponsored healthcare program was $22,463 for a family plan in 2022. That is a lot of money just to have insurance especially if you don’t use it.
In some places to even see a doctor you must have health insurance or pay to schedule an appointment. These days you may wait months to even get an appointment.
- Dental Insuranc
According to the CDC, only half of Americans between the ages of 18 and 64 with private health insurance have dental coverage. The important thing to remember is you don’t need dental insurance to visit a dentist.
Some dentists recommend you visit them every six months for a cleaning. Your dentist can advise you best on how often you should schedule a visit. The dentist will screen you for oral cancer and check the health of your mouth so you can prevent future health problems and treat any issues before they get worse. Prevention is the key word. It will save you both time and money in the long run.
Dental insurance generally covers two cleanings per year. Without insurance, the cost of a cleaning can range between $100 and $500 with an exam and x-rays.
Dental insurance is intended to cover healthy mouths. You get a max of $1000-2500 per year, if you are lucky to cover dental expenses there are restrictions.
You are allowed two cleaning a year but that is for a healthy mouth. Pink gums, no bleeding, no bone loss, gum measurements within 1-3 mm. They will usually pay in full but for other procedures like filling and crowns that are covered at 50-80% so there is an out of pocket fee still.
85% of our population has some form of gum disease and dental insurance does not even have a code to cover those cleanings. 4-6 mm probing depth with no bone loss. Your toothbrush can only get 2-3 mm below the gumline but the bacteria can get into places that you can not disrupt so it may be recommended you go more often.
There is a periodontal maintenance code that may cover 4 per year every three months, which is recommended to disrupt up the bacteria before it can cause damage to the bone, but it is only covered if you have had a deep cleaning and a deep cleaning is only covered if you have radiographic bone loss. Which is subjective to the human eye or AI.
If you have waited until there is pain, dental disease is expensive to fix and you will have to pay out of pocket to get back to a healthy baseline. Cavities, bleeding gums and pain are all signs that something in the body is out of balance.
Although poor oral health contributes to heart disease, cancer and diabetes, many in the medical community view dental health as non essential. Covid was proof of how the world looks at dental health.
We had 12 weeks off as we were considered non essential workers. Since wearing masks, no dental care for years, we are seeing just how important our mouth is to our overall health. Yet there is still a divide.
I was shocked to find out most people have no idea that their dental insurance is or what the benefits are. They just know they need to have it or they don’t.
When it comes to insurance I personally think it is crazy that many of us are now working to meet the guidelines set around getting insurance. So many Americans are literally just working to have and pay for insurance.
Insurance that they then do not use because they cannot afford the deductible or the out of pocket expenses that insurance does not cover. So they are working to pay for something they believe they cannot afford to use anyway. How inane is this?
The ironic part is insurance was more affordable for the people that used it before the Affordable health care act was created. Now insurance is supposedly more affordable for the people that previously did not have it, it is on an adjustable scale based on how much money you make, so more people have it now but cannot afford to use it.
Is Insurance Worth It?
There are some instances where any insurance may be particularly worth it, but it depends on your unique circumstances. Let’s take a look at a hypothetical situation. If you could see something similar happening to you, it may be worth it to invest in insurance.
Susie wants her family to have strong oral health, so she schedules appointments for herself, her spouse and her son. She doesn’t currently have dental insurance, so she’ll pay out-of-pocket for their routine checkups. After their appointments, she quickly realizes that preventive care alone can cost hundreds of dollars per person. Other services can further escalate this cost. So you will have to weigh how much are the premiums vs the out of pocket expenses and if you are paying for it will you even use it?
While there are alot of things insurance does cover there are more things that are not covered or are considered electric services.
Teeth whitening is a good example of an elective benefit. Most people want teeth but your insurance will not pay for it. Many feel they still want white teeth and are willing to pay for it out of pocket.
If I had a dollar for every time a patient asked me if their insurance was going to cover something. If it is not covered, I don’t want it. Whatever it is. People often mistake that if the insurance company won’t pay for a procedure then it is not needed.
INSURANCE WAS NOT MADE FOR SICK PEOPLE
IT WAS CREATED FOR HEALTHY PEOPLE.
If you are sick and need to use your insurance the insurance company loses. They are betting you don’t need you and hoping you don’t but it is there if you do.
Why does my insurance not cover it if I need it? This is a great question. After all, the mouth is part of the body! Yet even with insurance it is treated separately. Why?
Insurance does not cover much in the way of prevention. If it did, they would cover sealants for both molars and premolars until the teeth erupt in the mouth and fluoride for adults if they believed it was so beneficial. The best time to apply fluoride for high risk patients is right after they have a cleaning, because that is when your teeth are the cleanest. I have seen hundreds of children who do not get the second molars until 14-16 their insurance only covers sealants up to the age of 13. So that benefit is lost to the patients whose development does not match the insurance criteria.
Dental insurance covers treating disease and usually at only 50% with a yearly maximum of $1000-2000 a year. Which is fine if you have a healthy mouth. 64 million Americans do not have a healthy mouth.
For the millions of Americans who are walking around with an infection in their mouth, their dental benefits are only going to cover half of the expense. Since most people are living paycheck to paycheck, guess what is last on the list of things to do? By the time you pay your bills and the insurance premiums these days there is not much left for extras.
When you have an infection in your mouth you generally do not feel pain until the disease has progressed.
Dental disease is a silent disease most people do not even know they have it.
If you were to compare dental disease to cancer by the time you feel the symptoms you would be in stage four.
If you went to your Dr. and he told you had cancer and recommended a course of treatment……
Would you research alternative treatment options? Would you just go with the recommended treatment? Would you do whatever you can to fight the cancer?
Would you say I need to know what my insurance will cover first? Let me think about it. Having been there the answer is no. Trust is a major issue when it comes to treatment these days. Most people will ask What do I do next?
I chose to go both western and eastern medicine to treat my Cancer which I found in an early stage because I listened to my body. Wll sort of I was tired my hair was falling out I was told it was stress. But when my gums started bleeding and nothing I did helped I knew something was wrong beyond stress.
Studies show that gum disease is linked to several chronic diseases including the leading cause of death in the US cardiovascular disease, stroke, diabetes, and pregnancy complications. Disease starts with how you breath and what you put in your mouth.
This is because your mouth is full of bacteria – both good and bad. Without proper oral hygiene, the bad bacteria can lead to an oral infection. Since the mouth is the gateway to the body, the infection can get into your bloodstream and travel to other parts of your body.
it is all connected, a very synchronized ecosystem. When are we going to start paying attention to our greatest asset and making choices to prevent disease or catch it early so we can change our habits rather than treat the symptoms once they manifest?
Your mouth is a window into the body and some diseases have warning signs that start in the mouth. When it comes to health, the mouth is usually the last place we look. Your dentist is a great source for preventative care.
What is the role of the mouth?
Our mouths and teeth let us make different facial expressions, form words, eat, drink, and begin the process of digestion. The mouth is essential for our survival. With the lips and tongue, teeth help form words by controlling airflow out of our nose and mouth.
The mouth and teeth are an organ that is vital to the well being of the individual. digestion. In a healthy mouth, tissues are moist, pink, firm and pain-free.
Your mouth is part of your digestive and immune systems. This oval-shaped opening in your skull starts at your lips and ends at your throat. Your mouth allows air and nutrients to enter your body, and it also helps you eat, drink, speak, breathe and sleep.
Saliva is produced in the mouth aids in digestion and contains the antibody IgA that lines your oral cavity and helps kill bacteria. This helps prevent cavities and bacteria from being ingested and passing into the rest of the body through the digestive tract.
Throughout history there has been a disconnect between the mouth and the body. “When was the last time a physician asked you about your mouth?
Doctors should be asking about oral health because more and more research has emerged in the last few decades showing the health of the mouth has a direct impact on the health of the body.
Somehow the insurance companies seem to dictate the treatment options especially in Dentistry. Why? Because we let it! Which I cannot wrap my mind around.
Insurance companies would not have so much control if Doctors and Dentists said no to negotiating fees and being the middle men.
Today’s increasing everyday costs mean many Americans are looking for ways to save money. One simple way to save yourself time and money is on your at-home dental hygiene routine. Look at how you are breathing? What are you eating?
Doctors will not make you healthy. Drugs will not fix the root cause they may mask the pain or manage the symptoms. The choices you make will determine your fate, good or bad.
You always get to make the decision. No decision is a decision. If you have insurance, use it when you are paying for it anyway. You can choose to go with the recommendation or not. At least know the health of your body.
There are blood tests, urine tests and hair analysis to let you know what is in balance and not in your body. I wish I knew about these before I have cancer.
Your insurance may or may not cover them. When I was diagnosed with cancer they did not look at the rest of my body they only treated the breast.
They did not scan my whole body? The standard blood work did not check for heavy metals or what was out of balance in my body.
I researched what I can do and found there is much more we can be doing to find out where we are now and take action to get our bodies back in balance before we get a wake up call like I did. I have a friend Melissa Dealy who has a podcast don’t wait for the wake up call. She is a slayer of toxins. Next week’s podcast episode she will be sharing things you can do to get ahead of disease or bring your body back into balance and take action before you are spending your savings on costly treatments to cut out. burn out or poison your body to treat the symptoms not the cause.
My insurance was billed over $120,000.00 for my cancer and it drained my health saving account to pay my deductible and out of pocket expenses to treat my cancer.
I had to fight my insurance company and the hospital for my treatment to run a test that was in my best interest to see if my cancer would respond to chemotherapy. They did not run it automatically because the insurance did not cover it. I had to ask, are you treating me or my insurance company?
I got the test done and I did not need chemotherapy or radiation but would have had it done if I followed the protocols. Not everyone fits into the protocols. You need to be your one advocate and listen to your gut.
I have found alternatives to the standard of care. I want more. I am demanding more. There are tests that are not invasive and can give you answers. If you ask the right questions to the right people.
It becomes a question of even though you have insurance why wont cover what you need or you max out your yearly benefit.
I had a thermography done. It was $475 dollars for my whole body and it showed I had a tooth that was a problem and that the cancer was just in my breast. before the biopsy. There are tests you can do that will cost a lot less than waiting until you have symptoms to find out if you are healthy.
Despite the connection between oral and overall health, doctors and dentists have separated the two. We believe it’s time doctors and dentists work together to improve patients’ overall health care. We encourage you to listen to your body and share information about the health of your mouth with your doctor
You get to choose your path. Your thoughts are what keep you where you are. If you want better you need to make a change in your thoughts, your habits, who you surround yourself with.
Insurance is a gamble how much we pay into what gets paid out. You may need it, you may not? For most Americans taxes and insurance are their biggest expense. They work to pay for both. yet feel they cannot afford to use the insurance because of the deductible and out of pocket expense. We have a broken system and it is so sad to watch so many people struggle just to be healthy.
Why not start with where you are now and what you can do today.
When you focus on problems you have more problems. You get to decide what your habits will be and your habits will determine your future. I am not sure who said this but for me it is true.
If you are depressed you are living in the past, if you have anxiety you are living in the future, if you are at peace you are living in the present.
No matter what the situation, never let your emotion overpower your intelligence.
In the end you have to take the responsibility to save yourself. No one else will.
A healthy mouth is a healthy body and a happy healthy life.
