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NJ Insurance Plans - Mike Sheeran, CFP

New Jersey Health Insurance - Reviews and Recommendations

NJ Dental Insurance

NJ Dental Insurance

Horizon BCBS Dental (Young Grins, Family Grins, Healthy Smiles – Review and Plan Designs)

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Photo by Jon Tyson on Unsplash

One of the most common calls I get are from families looking for dental insurance in New Jersey. There are a few carriers in NJ that offer benefits, but I think Horizon BCBS has the most comprehensive offerings right now. While they offer great options, it can be difficult for most people to figure out what they are buying and what the best choice is without wasting their hard earned money.

What affordable dental plans are offered by Horizon BCBS for individuals? For 2019, the plans are:

  • Horizon Young Grins
  • Horizon Family Grins
  • Horizon Family Grins Plus
  • Horizon Healthy Smiles
  • Horizon Health Smiles Plus
  • Horizon Centurion Dental
  • Horizon Individual Dental

By looking at the names, its not clear at all what plans may be best. In this blog post, I’ll review the networks, cost and benefits for each option so you can make an informed decision.

If you want to want to skip right to the summary pdf of the plans, see the bottom of the post where I will have a link to Horizon’s plan guide.

Horizon Dental Networks

I think the easiest place to start with the review is by going over the Horizon BCBS dental networks. Depending on which plan you buy, you will have access to different providers and also out of network benefits in some cases.

Horizon Dental PPO Network

Normally you expect the PPO network to be larger, but not in this case. The plans that use the PPO network are:

  • Young Grins
  • Family Grins
  • Healthy Smiles
  • Dental Centurion
  • Dentists within 25 miles of 08201: 368

I did a 25 mile radius search from my home zip code of 08201 to give you an idea of the size. Your areas will each be different of course, but one of the keys to not wasting money on dental insurance is to make sure your dentist is part of the network. This will keep your out of pocket costs to a minimum.

These plans also have in-network benefits only so if your provider doesn’t participate, there are no benefits at all.

Horizon Traditional Network

The Traditional Network is Horizon’s premium network for dental plans. Dental plans using this network will have far more in-network benefits, and also you will usually have out of network benefits.

The plans with the Traditional Network are:

  • Family Grins Plus
  • Healthy Smiles Plus
  • In-Network Dentists within 25 miles of 08201: 519. That’s almost 41% more in-network dentists than the PPO.

Horizon Individual Dental

This is one of the older Horizon dental plans and has its own network.

  • In-network dentists within 25 miles of 08201: 93

How to look up your dentist to see if they are in-network

Its a pretty straightforward process.

First go to: https://doctorfinder.horizonblue.com/

In the drop down box for “What are you looking for?”, you will select dentists.

Next you will select your plan in the “Choose a Plan to Start” box and then continue on with your zip code.


Plan Summaries for Horizon Dental Benefits in 2019

I’ll provide short summaries of each of the plans here and will include Horizon’s plan guide at the bottom of the blog post.

Plans with ACA Compliant Pediatric Dental

When the Affordable Care Act(ACA) was introduced, the law required that health plans include pediatric dental as one of the essential health benefits. Each carrier responded differently, and Horizon’s answer was the Young Grins plan and later the the Family Grins and Family Grins Plus plans.

If you purchase individual health insurance through Horizon, you will automatically be enrolled in Young Grins, and will have the option to upgrade to one of the other options. The key thing is that even though everyone is enrolled, benefits and premiums are only for children age 19 on the Young Grins.

If you decide to upgrade, you can cover your whole family, including adults on the the Family Grins and Family Grins Plus.

Young Grins

The Young Grins plan covers preventive care at 100%, basic at 80% and major at 50% for covered services. There is no maximum benefit and they even cover cosmetic orthodontia up to $2,000.

On this plan, they will charge you for up to your three oldest dependents under age 19.

Family Grins

The Family Grins plan has identical benefits for your children under age 19, but also includes some basic benefits for adults.

Adults will get preventive benefits covered at 100%, but everything else will be a network discount. All that means is if your dentist is participating, you will have a lower fee than if you had no insurance.

Family Grins Plus

Of the plans that comply with the ACA, the Family Grins Plus plan is by far the best. If you remember from above, it has the larger Traditional network, it also has national in-network coverage and out of network benefits if needed.

The Plus plan looks a lot like an employer plan with preventive benefits covered at 100%, Basic at 80% and Major at 50%. There is an annual maximum of $1000 per adult(over age 19) so that is where this plan falls a little short in my opinion.

Summary of the ACA Compliant Plans

If you need to waive out of other pediatric dental benefits, these are the only ones that will count. The plans I mention below are not considered as credible waivers as far as the ACA is concerned. It doesn’t mean they are better or worse, the benefits are just different. You will not be fined for not having dental, buy may find yourself paying for more than one plan in some cases.

Non Compliant Dental Plans

With that title, the benefits sound terrible, but these are actually better in some respects. In my opinion, these are better for adults over age 19.

Horizon Healthy Smiles

The Horizon Healthy Smiles plan uses the PPO network.

Horizon offers different levels of benefits for this plan so you have the option of:

  • 100/80/50
  • 80/50/50
  • 100/80/50 without waiting period
  • 80/50/50 without waiting period

The first number is preventive care(cleanings and x rays)

The second number is basic (fillings)

The third is major.

So for a 100/80/50 plan, you get 100% coverage for preventive, 80% for basic and 50% for major. You pay the smaller percentage. If you had a filling(basic), you would pay 20% after any applicable deductible.

Horizon Healthy Smiles Plus

The Healthy Smiles Plus plan is the best option for adults in my opinion. This plan uses the larger traditional network, has in-network benefits nationwide, and also has out of network benefits.

Just like the regular Healthy Smiles plan, Horizon offers multiple options.

  • 100/80/50
  • 80/80/50
  • The same as above without wait.

The Health Smiles Plus plan is only a few dollars more per month than the regular plan so I think this is a solid option.

Horizon Centurion Dental

This is the most basic plan Horizon offers and is also the least expensive.

It uses the PPO network and offers discounted services as long as you use an in-network dentist. Many people think that discount dental plans are the best value overall and I can argue this either way. The Centurion plan is a great way to save some money without overspending on premium.

Horizon Individual Dental

The Individual Dental plan has the smallest network of the bunch, but the benefits are pretty good considering the premium. If your dentist is in-network, its also a good value.

Preventive benefits will be covered 100% in year 1 as well as your basic benefits. Most of the major benefits will scale in with your your out of pocket decreasing over a three year period.

Benefit Comparison with Charts and Premiums

You can download the Horizon BCBS Dental Guide Here.

My Personal Choice

My opinion on dental insurance changes from time to time and my usual argument is that you are just dollar swapping with the insurance company. Meaning, you pay out $400-$500 in premium and they basically pay out the same in benefits. I still hold that opinion, but I believe there is more benefit beyond the numbers.

I see too many people neglecting their dental hygiene and therefore health by not having insurance. So even if you are dollar swapping, it seems people are more likely to make regular visits by having the insurance in place. Also, if you do end up needing some more substantial work done, it will be considerably cheaper by having the insurance.

I would choose the Family Grins Plus Plan for my family. One, because it meets the ACA guidelines and has good coverage for my kids and two because I want the extra benefits for myself and my wife.

Related Questions

What is Horizon Dental Option Plan? The Dental Option plan uses the traditional network, has nationwide benefits and also out of network benefits. Its offered in the small, midsize and large employer market.

What is Horizon Dental Choice? The HDC plan is a DMO. Basically an HMO for dental. You choose your primary dentist and they refer you out to specialists. This plan isn’t offered to individuals. You will usually have very good benefits on these plans, but give up some freedom by needing to get your referrals.

Are dental plans worth it? I think so, especially if you can get it through work. The premiums will usually be lower and you can pay the premiums pre-tax. As an individual, there is a behavior element that I believe makes people see their dentists more frequently, and hopefully lead to better overall health.

Which health insurance offers dental? In NJ, all individual and small group plans must include pediatric dental as either a rider or directly included in health plan.

NJ Dental Insurance – Dental Insurance Options for New Jersey Residents

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NJ Dental Insurance PlansMost doctors would agree that regular dental checkups are important not only for your teeth but for your overall well being. Looking at NJ Dental Insurance plans is a good way to keep your costs down and make sure you can get the care you need it.

I will go over some of the things you should consider when going over the dental plan, some of the companies that sell dental insurance in New Jersey and some other tips to help you out.

horizonblue dental

NJ Dental Insurance Plan Considerations

  1. Dental Network – dental networks can be a bit tricky. A lot of times, the more established dentists will only accept the pricier dental plans. Make sure that your particular dentist is in the network or check if the plan has acceptable out of network benefits. If your dentist does not participate, you should probably skip the insurance altogether or consider switching dental providers.
  2. Plan Design – most plans fit into two broad categories. They are either discount plans or full fledged dental plans. Discount dental plans will provide network discounts for all of your services. Preventive care may be covered 100% but that will be about it. An example of this would be the Horizon BCBS Dental Companion Plan or their PPO Access Plan. A full dental plan will usually cover preventive at 100%, basic at 80% and major at 50%. Decide what level of benefits you are comfortable with.
  3. NJ Dental Insurance Pricing – If you are covered by a group plan, the discount dental options are usually around $10 per single employee and the full fledged dental plans are between $30 and $50 per month. Prices will vary with network, level of coverage etc… An example of what can make the price change can be found here in my article on the UCR and MAC dental options.
  4. Individual vs group – Small business dental plans will provide many more options than the individual dental insurance options. The only individual plans I know of are the Horizon Individual Dental plan and Horizon Dental Centurion. Compare each of your options carefully to see what may be best for you. You may personally find that an individual dental plan will suit you perfectly. See my post here for more information on the .Horizon Individual Dental Insurance Plans
  5. Dental Insurance Price vs Benefits – if you are blessed with good teeth and only get cleanings twice a year, maybe you should reconsider paying for  a plan that is $50 per month. Cleanings twice a year may cost a you a few hundred dollars with no insuranc, so keep that in mind before you spend $600 in premium. Carefully examine a typical year for yourself and compare the premium to the actual benefit you can receive.
  6. Exclusions – before you purchase the plan make sure there are no exclusions for services that you plan on getting. Not all plans cover orthodontia and most if not all won’t cover cosmetic dentistry.
  7. Dental Waiting Periods: Most plans will have a wait period for major services. These can be a year or more. If you purchase a plan to get a crown covered, you are probably out of luck unless you had prior dental coverage. The carriers will impose this wait because they know people will only buy the plan to get the major service covered and then cancel it.

How to Get NJ Dental Insurance

You can see the list of companies that sell plans below, but I have a preferred plan and insurance company. For the longest time, we had very few options in NJ for dental plans, but Security Life of Denver recently added the Garden State to their list of approved states so we now have the option.

It’s not a familiar name like Horizon BCBS or some of the others but it is really convenient to purchase and you can start a plan any day of the month. They also offer a discount plan, a full dental plan as well as vision plans through VSP and Eyemed. They have really done a good job of packaging everything together.

If you want to see more about that plan, you can check my post out and if you decide to enroll, please use my link for Security Life Dental and Vision.

 

Ready to move ahead with your Dental Insurance? Here are some companies that sell small business dental insurance or individual dental insurance.

Dental Insurance Companies

  1. Horizon Blue Cross Blue Shield
  2. Delta Dental
  3. Standard Insurance
  4. Guardian Life Insurance
  5. United Concordia
  6. Oxford Health Plans/UnitedHealthcare
  7. Aetna
  8. Assurant
  9. Aflac
  10. MetLife
  11. Security Life of Denver **Best Dental Plan for Individuals in my opinion

 

Who Should Not Buy a Dental Plan

I’m going to mention this only because this is my most common call and email.. If you were just told that you needed a root canal or crown or something expensive, every single plan will exclude these major services for at least the first six months. The reason being, is that they know people will buy the plan, get their crown paid for and then terminate.

Just like any other insurance, you need to buy it before you actually need it. No surprises here.

Also, if your dentist doesn’t take any insurance or doesn’t accept the insurance you are considering, I would hold off. There is usually some coverage for out of network services, but it makes the whole program not quite as good of a deal. In fact, you may end up spending more in this scenario after adding in the premiums. I would run the numbers and see what you are looking at.

 

 

Need more information on getting dental insurance for yourself or your New Jersey based business? Contact me here for information or a quote.

Read more about the NJ Dental Plans I sell and reviews.

Best NJ Dental Plan for Individuals and Families

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Security Life of Denver – Best Individual Dental Plans for NJ

Finding a good dental plan in New Jersey has been almost impossible up to this point for individuals and families. Yes there is the very basic Centurion Plan from Horizon and their Individual Dental Plan but they are really just ok at best. They are more along the lines of discount dental plans and not something like you would find at your employer.

security life of denver best NJ Individual Dental plan

Not only that, you can also purchase an Individual Vision Plan that uses the VSP Network.. Start with a quote by clicking the image above.

 

How the Security Life Dental Plan works in New Jersey

 

Plan Options

1) Essential Plan – the essential plan is basic coverage with no network restrictions. Its an indemnity plan so you can use it wherever you choose. The benefits are limited to $500 annually but your cleanings are covered 100% and Basic Coverage (fillings/x-rays) are covered at 80%. They pay 80% and you pay the remaining 20%. There is no coverage for major services on this plan.

Security Life Essential Indemnity Plan

 

 

2) Advantage Plus

The Advantage Plus plan uses the Maximum Care network so you will get the most benefit by staying in that network. In fact, if you can’t find a dentist in the network, I wouldn’t recommend the plan anyway so make sure you check that network link out.

Moving on..

What makes this plan great and the best NJ Individual Dental Plan is that the benefits are very similar to group dental plans. It offers 100% coverage for basic, and then then benefits for Basic and Major are enhanced each year as long as you keep the plan. It starts out with an annual $1,000 maximum but you can increase that amount to $2,000 by buying up.  Check out the full benefits below but in my opinion, this is the best plan I’ve seen that isn’t part of an employer based plan.

Security Life Advantage Plus Individual Dental Plan NJ

 

 

Limitations

Ok nothing is perfect. The plan does have some limitations just like any dental plan.

1)Network – make sure your dentist takes it before purchasing the plan.

2)Benefit scales up as you go – If you only want the plan for a year, the benefits aren’t as attractive on the Advantage Plus plan. It gets better after year one as they enhance the benefit.

3)This is just a general limitation on all dental plans.. I get a lot of calls from people who want 100% coverage on day 1 for all their dental ailments. There is no such thing. This is because people wait until the last second to buy their insurance and then expect the insurance company to pay their $1,000 Crown and after which the person will cancel the plan.. Because of this, they uses benefit that increases over time because from a business perspective, they can’t just collect a month of premium and then pay $1,000 only for you to leave the plan a month later. Anyway, read through the benefits on their site..

 

How to enroll in the Security Life Dental Plan for NJ

If you think this is a good plan for you, and enroll through my link below, I am compensated by Security Life. The price is the same whether it is through me or through any other agent or even direct with the company so that is up to you on how to enroll. 

They only do online enrollment which is great and means no paper forms to fill out!! They allow you to enroll any day of the month and the process seems easy and very straightforward.

If you have any questions, you can always contact me at mike@newjerseyinsuranceplans.com and if you want to enroll please use my link below.

security life of denver best NJ Individual Dental plan

 

Read about more dental plans in NJ here.

How to Get Dental Insurance in 5 Minutes – Dental Insurance for Seniors and Individuals

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This will be a quick guide to get the best dental insurance at an affordable price. You can do it all in about 5 minutes!

This will cover dental insurance for seniors and the best indivdual insurance for individuals. I’ll also show you how to package your health and dental coverage and include vision coverage too if you need it.

Five Minute Guide to provide:

  • Best Dental Insurance For Individuals
  • Dental Plans for Seniors
  • Affordable Dental Insurance
  • Or anyone else that needs dental insurance

If you fit the above criteria, here is the plan I recommend.

 

Horizon Individual Dental for New Jersey Residents

dental insurance for seniors

Full Horizon BCBS Summary Here: Horizon Individual Dental

How much is the dental insurance?

  • $180 per year per adult
  • $68.40 per year per dependent child

That comes to about $15 per month for an adult.

Dental Coverage Details

  • 12 month contract – you pay for the full year upfront
  • You must select a primary cary dentist from the list – Horizon Provider Directory
  • Preventive and Basic Care is covered 100%
  • Major Services are covered with a 30% discount in year one
  • Major Discount changes to 40% in year two and 50% in year three
  • Very affordable and one of the few plans available to New Jersey residents to purchase as an individual

 Look Good? Get the Dental Coverage Started in Five Minutes

  1. Download the Individual Dental Kit – this is a fillable pdf – Keep this open.
  2. Look up a primary care dentist and write down the code or put it directly into the kit you just downloaded – Horizon Directory – use the advanced search options to select “Horizon Individual Dental” from the plan options. This will only search dentists accepting this plan.
  3. Finish filling in the rest of the applicatoin that is in the kit.
  4. Print sign and mail.
  5. That’s it. If you mail it in before the 15th, the coverage will start on the 1st of th next month. If after the 15th, it will start the following month.

 

Package Health and Dental Coverage

If you are also needing individual health coverage,  we can take care of that too.

Your options for individual health:

  1. COBRA or NJ Continuation
  2. Individual Health Program – Horizon BCBS – Amerihealth – I would look at the Amerihealth PPO, Horizon Direct Access Plan A and the EPO Plus Plan
  3. Medicare with Medicare Supplement and Part D – NJ Medigap
  4. NJ Protect – if you have been without coverage for over six months.

 

Need Vision Coverage Too?

Go direct through VSP Insurance and purchase an individual vision plan. These are a great deal and just as easy as setting up the dental.

Get VSP Coverage for Individuals

Affordable Small Business Dental Insurance From HorizonBlue Dental

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Horizon DentalLooking for affordable Dental Insurance from HorizonBCBS Dental?

HorizonBlue Dental has recently updated their plan summaries to make it easier to understand the dental benefits.



 

Horizon Dental Summaries

 

Horizon Dental Option Plan

The Horizon Dental Option Plan offers a great way to save premium dollars without reducing benefits. Members have the freedom to receive dental services from any dentist. If you use a dentist who participates with the Horizon Dental Option Plan, you can maximize your benefits and save money. Discounts on participating dentists’ charges range between 10 and 30 percent. You have the option of selecting from over 115,000 participating dental offices nationwide. With any choice made there’s always a dental benefit and you are always covered for eligible services because of the plan’s out-of-network benefit.

  1. Horizon Dental Option 100/100/50
  2. Horizon Dental Option 100/80/60
  3. Horizon Dental Option 100/80/50

 

Horizon PPO Dental Plan

In-Network

The Horizon Dental PPO Plan, a Preferred Provider Organization Plan, offers the lowest fees available to our customers through our Horizon Dental PPO Network of participating dentists. These dentists accept our reduced allowances as payment in full, less any applicable deductible and/or coinsurance.

Out-of-Network

With an out-of-network option, members may go to a nonparticipating dentist and may have to pay the dentist his/her usual fees in advance. Members must then file claims for reimbursement. Reimbursement is based on our reduced allowances, and members are responsible for any charges in excess of these amounts.

  1. Horizon Dental PPO 100/100/50
  2. Horizon Dental PPO 100/80/60
  3. Horizon Dental PPO 100/80/50

 

Horizon PPO Access

The Horizon Dental PPO Access Plan provides 100 percent coverage for the most frequently needed dental services when you visit a participating dentist.

In-Network

The plan covers frequently needed, eligible preventive and diagnostic services, such as exams, cleanings and X-rays, as well as selected basic services, such as amalgam (silver) fillings and space maintainers, at 100 percent. For eligible major or specialty services, such as root canals, crowns and bridges, you’ll pay only a reduced Horizon Dental PPO Plan allowance to participating dentists. There is no annual deductible, no annual maximum and no wait period for major services.

Out-of-Network

The plan allows you to use nonparticipating dentists for certain eligible preventive and diagnostic services, however you may have to pay for any charges above the Horizon Dental PPO Plan allowance, pay dentists at the time of service and submit claims for reimbursement. There is no out-of-network benefit for major or specialty services.

  1. Horizon PPO Access
  2. Horizon PPO Access 1050

 

Horizon Dental Choice

Horizon Dental Choice saves your company money and increases employee satisfaction through its cost-effective design and comprehensive benefits.

No deductibles

No annual benefit maximums

No copayments for most eligible routine services

Low copayments for eligible major specialty services

Horizon Dental Choice is an HMO-type of coverage that features a strictly credentialed network of participating dentists. It’s a great addition to your benefits program, either in combination with another Horizon Blue Cross Blue Shield of New Jersey dental plan or as an alternative to your existing traditional program.

  1. Horizon Dental Choice witht Ortho
  2. Horizon Dental Choice no Ortho

 

Horizon Dental Companion

The Horizon Dental Companion Plan is available only when combined with a Horizon Blue Cross Blue Shield of New Jersey medical plan.

In-Network

The plan covers frequently needed, eligible preventive and diagnostic services, such as exams, cleanings and X-rays, as well as selected basic services, such as amalgam (silver) fillings and space maintainers, at 100 percent. For eligible major or specialty services, such as root canals, crowns and bridges, members pay only a reduced Horizon Dental PPO Plan allowance to participating dentists. There is no annual deductible, no annual maximum and no wait period for major services.

Out-of-Network

The plan allows members to use nonparticipating dentists for certain eligible preventive and diagnostic services, however they may have to pay for any charges above the Horizon Dental PPO Plan allowance, pay dentists at the time of service and submit claims for reimbursement. There is no out-of-network benefit for major or speciality services. The Horizon Dental Companion Plan is available only when combined with a Horizon Blue Cross Blue Shield of New Jersey medical plan.

  1. Horizon Dental Companion Plan

 

 

 

Please contact me for information on adding one of the Horizon Dental plans today. Horizon Dental Quote