Looking for the best dental benefits in the federal health program?

Well, wipe that smile off your face.


There are many things that federal workers and retirees want out of their "group" health plan.

Some want a couples-only premium that is less expensive than premiums for families of more than two people.

Some want Uncle Sam to provide coverage, at family rates, to same-sex couples.

Some younger people resent being in a risk pool with older, less healthy retirees. They feel they are subsidizing older folks.

Some retirees wonder why they have to subsidize younger people who are having children, or raising families.

Some people wish some (or all) of the above would get a life!

But whatever your definition of a "group" is, nearly everybody in the federal health program--at some time or another-- wishes they had better dental coverage. Between now and Dec. 13, feds (and retirees and survivors) must pick their 2000 health plan.

Feds in the Washington-Baltimore area have at least 15 plans (seven or more fee-for-service plans and eight health maintenance organizations) to pick from. Premiums in some plans are going up much more than the "average" 9.3 percent. Some are going up less. A few are even cutting premiums. In previous columns, we've listed the premiums in fee-for-service and health maintenance organizations and "best buys" for couples and singles, according to the Washington Consumer Checkbook's Guide to Year 2000 Health Insurance Plans. The handbook rates plans according to total costs--premiums plus any likely out-of-pocket expenses--individuals or families are likely to incur next year.

Most insurance experts recommend that people not pick a health plan for a particular benefit--like dental. They say you should get the best overall plan (that provides the best catastrophic coverage) then look at specific benefits, such as dental.

In the case of dental benefits, get brochures for several plans that otherwise look good to you, then ask your dentist's office which ones work best for you and the dentist.

Walton Francis, author of the health plan guide, says the best dental benefits are all in health maintenance organizations. Best in this case means they pay two-thirds to one-half the cost of some, but not all procedures. Among the HMOs he recommends considering are the Aetna high option, Prudential and George Washington University health plans. The family premium for those plans next year will run between $1,100 and $2,010. But in a year of "average" use, the total cost for a family of four (premiums and out-of-pocket costs) would be an estimated $2,080 for the GW plan, $2,630 for Aetna and $2,310 for Prudential.

Francis says those HMOs require no deductible and impose no minimum benefit and "cover preventive care in full and reimburse most common and inexpensive procedures such as fillings. They cover two-thirds of the cost of most expensive procedures." But none offers catastrophic dental coverage, meaning you could have heavy costs for a major problem such as a chronic jawbone infection.

Plans that will cover about half of most dental costs, he says, include Aetna standard, Free State, Kaiser Permanente and M.D. IPA.

Among fee-for-service plans, Blue Cross standard will pay about 50 percent of the costs of most inexpensive procedures, with no deductible. But it doesn't cover the costs of most expensive procedures, Francis says. The SAMBA plan (special agents) doesn't cover preventive care, but, Francis says, it "is very good for oral surgery.

The Checkbook guide says one way to get 10 percent to 20 percent dental discounts is to "sign up for Delta Dental or GEHA's [Government Employees Hospital Association plan] Connection Dental" to get discounts from participating dentists at no premium cost. GEHA gives "more comprehensive benefits," Checkbook says, "if you pay an additional premium."

Orthodontic Coverage Checkbook says that few plans cover even one-quarter of orthodontic costs, that some have a waiting period and coverage period and that maximum payments vary.

"Even if your family does not need substantial dental work, one of these plans may be worth several hundred dollars per year. . . . For example, each person in a family of four might visit the dentist once each year for cleaning. . . . If each person had one cavity each year, expenses could be about $100 for preventive work, and $30 each for restorative work. About half of this would be covered by many of the national plans . . . even more would be covered by most HMOs."

Mike Causey's e-mail address is causeym@washpost.com.

Monday, Nov. 15, 1999