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Video: 2025 Benefits changes

VIDEO: 2025 BENEFITS CHANGES

NOVEMBER 2024

The hot list: Benefits changes for 2025

Want to know what’s coming in 2025? Watch this new video so you can learn about the new and enhanced benefits arriving soon.

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Discover new and updated benefits available January 1, 2025

Aetna ID card update*

To ensure that you and your family members enrolled in the Aetna medical plan have access to a primary care physician (PCP), a PCP will be assigned to you and your enrolled family members on your Aetna® ID card. Their phone number will be provided so you can call to schedule your preventive care or a new patient appointment. If you already have a PCP you’ve seen in the last two years, that provider will be the name on your card  

  • If you see a nurse practitioner or physician’s assistant, their supervising physician will be the name on your card 
  • You are not required to see the assigned PCP and can change the PCP on your card at any time 
  • There are no changes to your medical plan — this is not an HMO, so you don’t need to get a referral from a PCP to see a specialist 
  • Contact your Aetna Health Concierge at 800-814-3543 (TTY: 711) if you have questions or you’d like to change the PCP on your card 

Dental incentive*

  • Earn a $50 credit toward your annual medical deductible or coinsurance when you get at least one annual dental cleaning 
  • Available for you and each dependent enrolled in Aetna Medical and Dental® plans  

Maternity incentive*

  • Earn up to a $400 credit toward your annual medical deductible or coinsurance for you or your spouse or domestic partner when you enroll and engage in the Aetna Maternity Program during and after your pregnancy 
  • The earlier in your pregnancy you enroll, the more you can earn 
  • Visit Aetna.com/Maternity or call 855-282-6344 (TTY: 711) to learn more and enroll

Chiropractic visits*

  • You’ll have coverage for up to 30 chiropractic visits per year  
  • You no longer need to meet your deductible or coinsurance for visits
  • Your plan’s PCP copay applies
  • Available for you and your dependents enrolled in an Aetna Medical plan

No-cost visits to 98point6®** 

  • Text-based visits to board certified doctors for a $0 copay
  • Available to you and your dependents age 1+ enrolled in a Costco medical plan  
  • Get visit-ready by registering at 98point6.com/Costco or on the 98point6 app 

FitMyFoot 

  • All employees and their family members can get custom foot insoles for $80 per pair to help with foot, knee or back pain
    • Download the FitMyFoot app to scan your feet 
    • Then visit FitMyFoot.com/CostcoEmployee to place your order
    • Custom foot insoles are shipped to your home address
  • For employees and dependents enrolled in an Aetna medical plan, up to three pairs of insoles per year are covered. Deductible and coinsurance apply.

Alma  

  • Effective January 1, 2025, you’ll have expanded access to mental health providers and a new way to search for a therapist online through Resources for Living (RFL). Alma, available through the RFL website, allows you to search for providers who are in the network and accepting new patients. Also, with Alma, you:
    • Can schedule a consultation with the provider of your choice
    • Receive automatic authorization for 6 free therapy sessions per issue per year for you, all your household members and dependent children up to age 26
    • Filter your provider search based on personal preferences
    • Can view a provider’s profile before requesting a consultation
    • On average, have your first therapy session within 5 days
    • Have access to providers that offer both virtual and in-person support

Well-being coaching

  • You can also talk with an RFL Well-being coach for free and confidential coaching sessions to help with your personal goals, such as:
    • Developing better eating habits
    • Learning better time management
    • Stepping out of your comfort zone
  • Visit RFL.com/Costco or call 833-721-2320 (TTY:711) to learn more

WeightWatchers

  • Your monthly rates are now even lower! $9 for you and $14.50 for your spouse or domestic partner and dependents 18+ 
  • Visit WW.com/Costco or call 866-204-2885 to learn more 

LifeMart

  • Discounts on gym memberships, virtual fitness and childcare** programs 
  • Click here to access your employee savings 

Sleepio

  • A no-cost, online sleep improvement program
  • Clinically proven to help you clear your mind, get better sleep and have better days in just 6 weeks
  • Available to you and your dependents 18+ enrolled in a Costco medical plan
  • To get started:
    • Visit Sleepio.bighealth.com/Costco and complete the coverage check
    • Click the link in the confirmation email you receive to download the Sleepio app and create your account
    • Complete the baseline sleep quiz and start seeing the benefits of Sleepio

Cylinder** Available now!

  • Expert help and support for gut health and digestive issues, no diagnosis needed
  • Available at no cost for you and your dependents 18+ enrolled in a Costco medical plan 
  • Get started at Go.CylinderHealth.com/Costco (access code: Costco) or call 888‑246‑5019

Dependent basic life insurance

  • Your dependents enrolled in a Costco medical plan automatically receive basic life insurance with Unum at no cost to you.
  • Coverage increases from $1,500 to $3,000 for each enrolled dependent

New programs and services are available January 1, 2025. Visit Costcobenefits.com to learn more.

*Available to the Mainland only.
**Not available in Puerto Rico.

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OCTOBER 2024

The top 10 reasons to get regular dental and vision exams

Did you know that getting regular dental cleanings can reduce your chances of ending up in the hospital by up to 28%?

That’s a great reason to schedule your annual dental appointment (and eye exam) before the year is over. If you need more motivation, check out the “top ten” list below. While some of the reasons may be familiar to you, others may be surprising — and may motivate you to get these exams on your calendar every year. 

If you haven’t gotten your two yearly dental cleanings or haven’t had your eyes checked this year, there’s still time to schedule your annual visits. Dental exams and cleanings are covered at 100% when you’re enrolled in a Costco dental plan and see an in-network dental provider. Your Costco benefits also offer an allowance toward your annual eye exam and $175 per year toward the cost of prescribed eyewear (this amount can be spread out over the whole calendar year and doesn’t need to be used all at once).

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10 reasons to get your yearly exams

Dental

Prevents tooth decay

At your teeth cleaning, your dental hygienist removes the plaque and tartar deposits that are too hard to get to during regular brushing. Left unchecked, these can cause cavities, tooth loss, gum disease and other issues.

Catches dental concerns early

Annual visits allow your dentist to catch cavities and other concerns early, when they’re easier and less costly to treat. For example, a simple filling today could require a surgical extraction and expensive implant if left untreated.

Improves cancer outcomes

Recent research shows that people diagnosed with throat, nasal cavity, and other head and neck cancers have a 30% higher survival rate 10 years after their diagnosis if they visited their dentist regularly.1 

Lowers risk of early delivery during pregnancy 

Pregnant women who have good oral hygiene and routinely visit their dentist are less likely to experience premature delivery, a baby with low birth weight and preeclampsia.2

Impacts heart health

Poor oral health can increase the risk of heart disease, such as heart attack or stroke. Research suggests that bacteria present in gum disease can travel through the bloodstream to trigger inflammation and infection in the heart.

Vision

Improves eyesight 

A comprehensive eye exam with an optometrist is the best way to determine if you need corrective lenses and check whether your current prescription has changed. These exams can also identify common conditions such as myopia (nearsightedness). 

Detects eye diseases

Many diseases of the eyes don’t have symptoms but can lead to vision loss if untreated. Your eye doctor can identify early warning signs and help treat conditions such as glaucoma and diabetic retinopathy. 

Identifies other health concerns 

Issues spotted in the eye are often the first signs of medical conditions throughout the body. Some of these conditions include high blood pressure, high cholesterol and diabetes.

Makes learning easier for kids

Good vision is helpful to the learning process. An eye exam can detect any concern that may be getting in the way of your child’s school performance. 

Keeps you safer 

Whether you’re driving a car, operating a forklift or using other machinery, you need to see what you’re doing. Being able to see clearly helps keep you and others out of harm’s way.  

Feeling more motivated? Schedule your exams today. And if you use tobacco or nicotine, read on. 

Quitting nicotine is good for your teeth and eyes, too

If you smoke or vape, you are at a higher risk for gum disease and tooth loss. The risk of developing dry eye syndrome and cataracts also goes up. Try the Costco Tobacco & Nicotine Cessation Program for support to help you quit nicotine products for good. To get started, log in to Costcobenefits.com then click this link. 

Check out the resources below to keep your teeth and eyes healthy. 

1Health. Regular dental visits linked to increased survival rates for head, neck cancer patients.
2NIH National Library of Medicine. Oral care in pregnancy.

Sources:
Penn Medicine. The link between gum disease and heart disease.
American Academy of Ophthalmology. 20 surprising health problems an eye exam can catch.
Oral Health Foundation. Smoking and oral health.
Tompkins Dental. How vaping affects your teeth.
American Academy of Ophthalmology. How do smoking and vaping damage the eyes?

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OCTOBER 2024

Beating the costs of braces

A beautiful smile is priceless. But the money you spend to keep smiles beautiful can add up when you or a family member needs braces. The average cost of traditional metal braces is in the $5,000 – $6,000 range.1 Adults and some teens may be able to use clear aligners, plastic trays that snap onto teeth and gently push them into alignment. Since they’re nearly invisible, aligners are less obvious than metal braces but also can be expensive, from $2,000 – $5,000 on average. 

And then there’s the emotional cost, especially for kids and teens. The fear of looking different can be stressful for young people and may lead some of them to resist treatment.   

Your Costco benefits can help. Read on to learn about the resources available to help bring a new smile to your (or your kid’s) face.

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Braces and kids’ mental health

Wearing braces can be tough on kids and teens. They may be bullied or teased about their appearance or avoid social situations because they’re self-conscious about the way they look. Fortunately, the boost in self-esteem and confidence they feel when they see their new smile emerging can often overtake any negative feelings.  

If your child could use someone to talk to, Resource for Living offers emotional well-being support to parents and children. Teens age 13+ can also access Talkspace for video chat or text  therapy. 

Three ways to budget for braces

Check out these benefit programs to help finance orthodontia treatment. 

Use your dental plan benefits

Orthodontia benefits through your Costco dental plan help make braces more affordable. You and each of your enrolled family members can access orthodontic services up to the lifetime maximum benefit of your dental plan. Visit Costcobenefits.com to find your plan’s orthodontia benefit information.

Plan ahead with a reimbursement account

You can use a Health Care Reimbursement Account (HCRA)* from Inspira FinancialTM to set aside pre-tax dollars for orthodontia or other eligible health care expenses. You can enroll in an HCRA during Annual Enrollment, coming in November. Only a small portion of your HCRA balance can roll over to the next plan year, so you’ll want to think about when you plan to use your HCRA funds.

Improve your budgeting skills

SmartDollar, a free financial well-being program for all employees, offers tools, advice and coaching to help you save for what’s important to you. Create your free SmartDollar account here. Then, follow these three steps:

Step 1: Find Your Why 

What’s your reason for getting braces? Are you looking to correct your kid’s overbite? Straighten crooked teeth? Or just feel more confident in your smile? Every goal needs a why—something that’ll keep you motivated. Try to keep your why front and center.  

Step 2: Know Your Numbers 

Making a budget is a lot easier when you know what numbers you’re working with. Look at your most recent bank statements. Note how much you’re bringing in every month and what’s going out. Prioritize these essentials: food, utilities, shelter, transportation. This gives you a clear view of what money is left over to put toward your goal. 

Step 3: Write It Down 

It’s super important to write down your budget. You can use pen and paper or download SmartDollar’s free EveryDollar budgeting app. A plan, on paper and on purpose, is a great tool to set you up for success. 

Need help getting started? Set up a coaching session with a financial expert at SmartDollar today.

Your new smile, or one for your kids, is within reach with the help of your Costco benefits. Use the resources below to help you make it happen.

1Consumer Affairs. Cost of braces in 2024.
2 Forbes Health. How much does Invisalign cost in 2024?
*Not available in Puerto Rico.

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OCTOBER 2023

Dental health and mental health

Did you know that when you brush your teeth, you’re also supporting your mental health?

“People are often surprised that their mental health is connected with their oral health, and their oral health, in turn, with their mental health,” says Cleveland Clinic Psychologist Susan Albers. “But they’re really interconnected.”

A dental checkup can be an opportunity for a mental health tune-up. That makes seeing your dentist twice a year even more important. Make sure to get your visits in before the end of the year. Your Costco dental plans cover preventive care at 100% when you see an in-network provider.

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How dental health affects mental health (and vice versa)

In a 2015 American Dental Association study, 1 in 5 adults reported experiencing anxiety because of the condition of their mouth and teeth. This is especially significant for young adults, whose oral health concerns led 22% of them to reduce participation in social activities.

“When your oral health is suffering, it can decrease your quality of life,” explains Dr. Albers. “If you feel embarrassed about the health of your teeth, it can trigger social anxiety. You may withdraw. Or it may hurt your self-esteem. This can lead to an increase in some of your mental health symptoms.”

The opposite is also true — your mental health can affect your dental health. The health of your teeth can give clues to your stress level, your anxiety, your mood and the presence of chronic eating problems.

For example, worn enamel can be a big red flag that you’re experiencing high levels of anxiety or stress. Stress can also increase the level of cortisol in your body, weakening your immune system and making you more susceptible to canker sores, gingivitis and gum disease. In addition, if you’re struggling with depression, you may not have the motivation or energy for dental care.

Managing your dental and mental health

Because your mental health and dental health are interconnected, things you do for one also benefit the other. These small changes in your day-to-day life can have a lasting impact.

number 1

Eat a healthy diet

Eating a wide variety of nutritious foods, like veggies, fruit and lean proteins, boosts your mood and protects your teeth and gums.

number 2

Watch out for dry mouth

Certain antidepressants, anti-anxiety medications and mood stabilizers can reduce the saliva in your mouth and cause dry mouth. Since saliva washes away cavity-causing bacteria and germs, this could be a concern. If you think you might have dry mouth from your medication, talk with your dentist, doctor and therapist to make sure it’s not hurting your teeth.

number 3

Practice stress-reduction techniques

Deep breathing, meditation or using an app to help you relax are some of the techniques you can try to reduce stress and anxiety. If you notice you have worn enamel, or that you clench or grind your teeth at night, you may want to try wearing a mouth guard when you sleep. You can get a custom-fitted mouth guard from your dentist, or, for a shorter-term solution, you can look for an over-the-counter option.

number 4

See your dentist

Dentists aren’t just there to polish up your pearly whites. They can also detect when other things are going on in your life. Dr. Albers notes that dentists are often the first professionals to identify and diagnose a mental health issue. And that many referrals to counselors and therapists come from dentists.

“Dentists are very willing to help,” says Dr. Albers. “They’ve seen signs and symptoms of conditions before. And a dentist and therapist working together can help you work through your mental health issues and protect your oral and overall health.”

Sources:
Cleveland Clinic. The link between dental health and mental health: what you need to know.
American Dental Association. Oral health and well-being in the United States.

Use your Costco benefits to support your dental health and mental health. See the resources below to learn more.

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LEARN THE BASICS

OCTOBER 2023

Video: How to floss your teeth

Do you floss every day? If you answered “no,” you’re not alone. According to a survey conducted by the Centers for Disease Control and Prevention (CDC), only 32% of adults said they flossed daily.1

But the benefits of flossing are real. Flossing removes plaque, a sticky film of bacteria and saliva that can collect at the gum line. If the bacteria builds and causes inflammation, you get periodontal disease. And that can lead to receding gums, tooth decay and tooth loss.

Flossing, along with brushing, can help prevent periodontal disease. But it’s important that you floss correctly. To learn how, check out this short video. Once you learn the steps, you may find it easier to make flossing a routine part of your day.

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1NIH. Prevalence of daily flossing among adults by selected risk factors for periodontal disease—United States, 2009–2014.

Sources:
Dr. Mark Nieh. Flossing.
NPR. Are you flossing or just lying about flossing? The dentist knows.

Check out the resources below to learn how your Costco benefits can help you care for your mouth and teeth.

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OCTOBER 2023

Keep your teeth in tip-top shape

Baby boomers are the first generation in which most people will keep their natural teeth for life. This is largely thanks to fluoride in public water and fluoride toothpaste. But we’re not totally out of the woods.

Threats to oral health, like cavities and gum disease, can still lead to tooth loss, especially as we age. Receding gums and decreased saliva production can expose teeth to decay-causing bacteria. It’s also common for other age-related health issues to take precedence over oral health.

Luckily, there’s one tool that can help you maintain strong teeth for the long term — regular preventive care. And your Costco benefits are here to help, with 100% coverage for two annual dental exams and cleanings when you see an in-network provider. If you haven’t had a cleaning in the last six months, you still have time to schedule a preventive dental visit before the end of the year. And if you are enrolled in the Costco medical plan, don’t forget to take advantage of the annual vision exam included in your benefits too.

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Tips for a healthy mouth

Men, in particular, are more vulnerable to dental issues. Men develop gum disease more often than women, due to their hormone differences, immune system factors, differences in oral hygiene behaviors and greater tobacco use.1 They also tend to visit dentists less frequently, and when they do, it’s more often for a longstanding problem than disease prevention.

Fortunately, there are small steps everyone can take to keep their teeth and gums healthy.

  • Schedule your annual dental checkups and cleanings. Two checkups per year are recommended.
  • Brush your teeth with a fluoride toothpaste twice a day and floss daily. This removes the plaque that causes cavities.
  • Limit sugary foods and drinks. The sugar and carbonation in these products can strip away enamel and cause tooth decay.
  • Avoid tobacco. Not only do tobacco products stain your teeth, but they can also increase your risk of gum disease, bone loss and oral cancer. If you smoke or use tobacco products, there are resources available to help you quit. The Costco Tobacco Cessation program can help.
  • Drink plenty of water. The dehydrating effects of alcohol and some medications can reduce the saliva flow in your mouth, making you more susceptible to gum disease and tooth decay.
  • See your doctor or dentist if you have sudden changes in taste or smell. These could be a sign of gum disease or infection.

When surgery is necessary

Even if you practice good dental hygiene, you may still need oral surgery. The most common is tooth removal, or extraction. This is recommended if you experience pain due to severe tooth decay or gum disease. Wisdom teeth may also be candidates for extraction if your dentist determines that they’re likely to cause issues in the future. Other types of oral surgery include root canals, periodontal surgery, dental implants and corrective jaw surgery.

It’s often confusing to know whether oral surgery procedures fall under your dental or medical benefits. A general rule of thumb is that dental insurance covers any procedure directly related to the teeth, while medical insurance covers procedures related to the bones and tissue structures of the face and oral cavity. If your doctor or dentist recommends oral surgery, visit Costcobenefits.com to find information on coverage.

Relief from dental pain

Your care team wants you to be as comfortable as possible when you’re undergoing dental treatment. That may involve prescribing pain relievers, including opioids, which are highly addictive. Ask your dentist about safer pain-management alternatives.

For example, EXPAREL®, a nonaddictive one-time injection, helps to relieve pain for the first few days after a procedure and may reduce the need to take opioids at all. This medicine is covered by all Costco dental plans at 100%. You can also try a combination of ibuprofen (Advil®, MOTRIN®) and acetaminophen (TYLENOL®), which has been shown to be more effective than opioids with fewer side effects.2 Talk to your dentist about your options.

Save more when you stay in network

To keep your teeth and gums healthy, prevention is the best medicine. All Costco dental plans fully cover preventive care, including two annual checkups and cleanings when you see an in-network dentist. Using an in-network dentist usually keeps your out-of-pocket expenses lower and offers a higher annual maximum benefit. You can review your dental plan choices and make changes during Annual Enrollment, starting November 1.

1American Journal of Men’s Health. Men and oral health: a review of sex and gender differences.
2Modern Healthcare. OTC meds more effective for post-surgery pain than opioids, study shows.

Sources:
CDC. Facts about adult oral health.
Cleveland Clinic. Oral surgery.

Be sure to schedule your dental exam and cleaning before the end of the year. For resources to help you review your coverage, find a dentist, or quit tobacco products for good, see below.

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EXPLORE MORE

OCTOBER 2023

Transform your smile — for less

Smile! Or would you rather not? With virtual visits, FaceTime, and selfie-friendly apps like Snapchat and Instagram, we’re all spending more time staring at our faces, and, in turn, our teeth. According to Dentistry Today, that behavior has intensified self-esteem issues regarding crooked teeth. And it’s driven more adults to seek orthodontic care.

Luckily, orthodontia is increasingly affordable. There are innovative orthodontic solutions to help you get the smile you want. And your Costco dental plans are here to help, with orthodontia benefits* for you and your covered family members.

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Braces or aligners?

Braces have been the traditional form of treatment used by orthodontists for decades. Today’s streamlined braces come in a variety of models — stainless steel, tooth-colored ceramic and those that attach behind the teeth.

Clear aligners are plastic replicas of your teeth. Wearing them puts gentle pressure on your teeth, ever so slightly repositioning them. Aligners are virtually invisible and can be removed when you eat, brush and floss. Invisalign® was the only clear aligner treatment available for years. But today, there are many options.

While braces are often better for kids and teens, especially if they have a severe crossbite, overbite or underbite, neither option is necessarily better than the other. The choice is based on your goals and your lifestyle. But some clear aligner options do present advantages, both in terms of their convenience and cost.

At-home treatment

These days, monthly appointments to adjust your braces aren’t a requirement to get a better smile. New online clear aligner services allow people to complete treatment in the comfort of their homes. These options work best for people with simpler corrections.

Some of these services supply you with materials to do at-home impressions of your bite. Once done, you send them in to be reviewed by a licensed dentist or orthodontist. Others work through a certified dentist who creates a 3D image of the inside of your mouth. After your impressions are reviewed, you’re sent a customized set of aligners that will gradually shift your teeth into place.

This do-it-yourself option is a huge advantage for many people, especially those living in the 60% of U.S. counties with limited access to an orthodontist’s offices. But there are other advantages, including:

  • Cost. Traditional teeth-straitening solutions typically cost between $5,000–$9,000. These new orthodontic options, on average, cost between $2,000 and $3,000.
  • Duration. Depending on complexity and your lifestyle choices, these treatments can last, on average, 4–5 months. Treatments using metal braces can take years.
  • Support. Licensed dentists and orthodontists provide virtual support and oversight from beginning to end through dedicated, user-friendly apps.
  • Convenience. Supplies are delivered directly to your home.

Contact your dental plan to find out which options are available to you.

Save more with an HCRA

Only available on the Mainland and in Hawaii

With your Costco benefits, you can open a Health Care Reimbursement Account, or HCRA. This account, administered by PayFlex®, allows you to set aside pre-tax dollars to reimburse yourself for expenses your plan doesn’t cover. You can use your HCRA to pay eligible orthodontic expenses for yourself and your covered dependents. You can also download the PayFlex Mobile® app to manage your expenses on the go.

Budget for your dental costs

Costco offers additional financial well-being tools for all locations, such as SmartDollar®, a free digital program that can help you plan for major dental expenses. This program also offers one-on-one financial coaching to talk you through the process.

*Review your plan documents for benefit details.

Sources:
Dentistry Today. 2022 trends to watch in oral & orthodontic care.
American Association of Orthodontists. Braces vs. clear aligners?

Your Costco dental plan and HCRA (where available) can make orthodontic treatment accessible for you and your covered family members. For resources to help, see below.

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OCTOBER 2022

Choose in-network dental care and save

You’ve probably heard that one of the best ways to save on health care costs is to “stay in network.” But what exactly does that mean? Do you really save money on dental care? What if you need treatment when you’re away from home? Whether your dental plan lets you go out of network or requires you to see an in-network dentist, there are reasons why you should you should always choose an in-network dentist.

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What does “in-network” mean?

A network is a group of health care providers. It includes dentists, doctors, specialists, hospitals, surgical centers and other facilities. For mainland Costco employees who participate in Costco’s medical and dental plans, these health care providers have a contract with Aetna®. (In Hawaii, it’s HMSA. Puerto Rico’s Triple-S plan does not contract with dental providers.)

As part of their contract, they provide services to our employees and their dependents at an agreed-upon rate. This rate is usually much lower than what they would charge if you were not a Costco employee or dependent. And they agree to accept the contract rate as full payment. You pay your coinsurance or copay along with your deductible.

Some plans do not offer any out-of-network benefits. For those plans, out-of-network care is covered only in an emergency. Otherwise, you are responsible for the full cost of any care you receive out of network.

It pays to choose in-network dental care1

table of prices based on plan and network

The Core and Premium (PPO) plans only pay up to Reasonable and Customary (R&C) charges for out-of-network dental expenses. The Core EPP and Premium EPP only pay for in-network charges. If you choose an out-of-network dentist, you’re responsible for all charges.

Why out of network dental care costs more

If you go out of network, your out-of-pocket costs are usually higher. There are many reasons you will pay more if you go outside the network, including:

The health plan pays less

Your Aetna health benefits or insurance plan may pay part of your dentist’s bill. But it pays less of the bill than it would if you got care from a network dentist. Also, some plans cover out-of-network care only in an emergency.

Out-of-network rates are higher

An out-of-network dentist sets the rate to charge you. It is usually higher than the amount your Aetna plan allows. Aetna does not base their payments on what the out-of-network dentist bills you. They do not know in advance what the doctor will charge.

An out-of-network dentist can bill you for anything over the amount that Aetna allows. This is called “balance billing.” A network dentist has agreed not to do that.

Cost sharing is more

The amount you pay an out-of-network dentist over the amount Aetna allows does not count toward your deductible. And it is not part of any cap your plan has on how much you must pay for covered services.

Many plans have a separate out-of-network deductible. This is higher than your network deductible (sometimes, you have no deductible at all for care in the network). You must meet the out-of-network deductible before your plan pays any out-of-network benefits.

With most plans, your coinsurance is also higher for out-of-network care. Coinsurance is the part of the covered service you pay after you reach your deductible (for example, the plan pays 80 percent of the covered amount and you pay 20 percent coinsurance).

You’ll have more work, too

Sometimes Aetna needs to approve some dental procedures before they are done. This is called precertification.

Some common procedures that require precertification include non-emergency surgery, dental implants and TMJ (temporomandibular joint) surgery.

If you visit a network dentist, that dentist will handle precertification for you. If you go out of network, you must take care of precertification yourself. That means more time and more paperwork for you.

You are covered for emergency care

You have this coverage whether you’re near your home or traveling. That includes students who are away at school.

When you need emergency care, go to any dentist. When you have no choice, Aetna will pay the bill as if you received care in network. You pay your plan’s copayments, coinsurance and deductibles for your network level of benefits.

They’ll review the information when your claim comes in. If they think the situation was not urgent, they might ask you for more information and may send you a form to fill out.

1Dental Access Plan — Procedure Price List powered by the Aetna Dental Access® Network. Each dentist has a different price list, but Aetna took averages from Los Angeles, New York, Chicago and Orlando.

Sources: Aetna. Network and out-of-network care.
Aetna. Procedures, programs and drugs that require precertification.

For more information about your Costco dental plan and how to find an in-network dentist, see the resources below.

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OCTOBER 2022

Protect your teeth, your wallet and your well-being

When it comes to oral health, an ounce of prevention can save you a ton of money and much more. By getting regular dental exams and cleanings, you can ensure that your teeth and gums stay clean and healthy. And you can catch problems early, before they get expensive.

With the Costco dental plan, the twice-yearly dental exams and cleanings you need to keep your mouth healthy are covered at 100%, when you see an in-network provider. And that’s good news for your teeth, your wallet and your overall well-being.

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The costs of poor dental health

The costs of poor dental health go well beyond just having bad teeth. They also affect your health, employment and well-being. Not only are there direct treatment costs, but there are also many hidden and unexpected costs of poor oral health.

Potential impacts start early in life

Tooth decay early in life can be especially impactful. According to one survey, early childhood tooth decay has been linked to impaired development, educational performance, poor behavior, family stress, diminished quality of life and even disability and death.

Dental issues can also result in lost school days. A recent study found that 30% of U.S. kids ages 6 to 12 miss more than 9 million school days due to oral health problems. In another study, children with poor oral health were nearly three times more likely to miss school due to dental pain.

Employment costs of poor oral health

Poor oral health can affect people’s job prospects and social lives. Missing or damaged teeth can cause anxiety and undermine self-confidence. According to the American Dental Association (ADA) report, Oral Health and Well-being, 38% of people surveyed feel life in general is less satisfying due to the poor condition of their mouth and teeth. The same report finds that 1 in 5 adults experience anxiety and 23% feel embarrassment due to the condition of their teeth and mouth.

Treatment costs and other health impacts

Direct treatment costs can be substantial for a variety of common conditions that result when oral hygiene or preventive dental care are neglected. Here are a few examples of conditions that can result from poor oral health and their average treatment cost (before insurance):

Average Costs of Dental Procedures1

Filling

Average cost: $204

One-surface resin (white) filling, front (anterior) tooth

Crown

Average cost: $1,312

Porcelain fused to high noble metal (e.g., gold)

Root canal

Average cost: $1,226

Molar, excluding final restoration

Complete upper denture

Average cost: $1,441

(Maxillary)

Dental implant, surgical placement

Average cost: $7,062

(Transosteal)

Prevention is a bargain

When it comes to maintaining good oral health, brushing, flossing and rinsing twice a day, plus twice-yearly dental exams and cleanings are not only essential, they make good financial sense. A recent insurance industry report estimated that adults who practice good preventive oral health care can save 31% in dental costs over five years. Likewise, adults who don’t receive preventive care can expect a 43% increase to their annual dental costs over the same period.

So, spend five minutes, twice a day, on your oral health care. And visit the dentist twice a year for dental cleanings and exams. You can save money — and much more.

1The select regional average cost represents the average fees for the procedures listed above in Los Angeles, Orlando, Chicago and New York City, as displayed in the cost of care tool as of June 2020. Actual costs and savings may vary by provider, service and geographic location. We use the average of negotiated fees from participating providers to determine the average costs, as shown on the chart.

Sources: 1Dental. Dental access plan — Procedure price list
1Dental. How much are dental implants?
University of Illinois Chicago, College of Dentistry. The many costs (financial and well-being) of poor oral health

Learn more about your Costco dental plan, including free preventive care and where to find an in-network dentist, by checking out the resources below.

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OCTOBER 2022

Good health starts here

Regular preventive care, including dental cleanings and exams twice a year, is not just essential for oral health. It’s important for overall health, too. That’s why Costco dental plans cover preventive care at 100% when you see an in-network provider.

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Your oral health affects your overall health

  • Endocarditis. This is an infection of the inner lining of your heart chambers or valves (endocardium). It typically occurs when bacteria or other germs from another part of your body, such as your mouth, spread through your bloodstream and attach to certain areas in your heart.
  • Cardiovascular disease. Although the connection is not fully understood, some research suggests that heart disease, clogged arteries and stroke might be linked to the inflammation and infections that oral bacteria can cause.
  • Pregnancy and birth complications. Periodontitis has been linked to premature birth and low birth weight.
  • Pneumonia. Certain bacteria in your mouth can be pulled into your lungs, causing pneumonia and other respiratory diseases.

And your overall health can affect your oral health

Several diseases and chronic conditions may contribute to poor oral health:

  • Diabetes. By reducing the body’s resistance to infection, diabetes puts your gums at risk. Gum disease appears to be more frequent and severe among people who have diabetes. Research shows that people who have gum disease have a harder time controlling their blood sugar levels. Regular periodontal care can improve diabetes control.
  • HIV/AIDS. Oral problems, such as painful lesions, are common in people who have HIV/AIDS.
  • Osteoporosis. This bone-weakening disease is linked with periodontal bone loss and tooth loss. And certain drugs used to treat osteoporosis carry a small risk of damage to the bones of the jaw.
  • Alzheimer’s disease. Worsening oral health is seen as Alzheimer’s disease progresses.

Other conditions that might be linked to oral health include eating disorders, rheumatoid arthritis, certain cancers and an immune system disorder that causes dry mouth (Sjogren’s syndrome).

Tell your dentist about the medications you take and about changes in your overall health, especially if you’ve recently been ill or you have a chronic condition, such as diabetes.

What can you do to protect your oral health?

To protect your oral health, practice good oral hygiene daily.

  • Brush your teeth at least twice a day for two minutes each time. Use a soft-bristled brush and fluoride toothpaste.
  • Floss daily.
  • Use mouthwash to remove food particles left after brushing and flossing.
  • Eat a healthy diet and limit sugary food and drinks.
  • Replace your toothbrush every three to four months, or sooner if bristles are splayed or worn.
  • Schedule dental checkups and cleanings twice a year.
  • Avoid tobacco use.

Preventive care is your first defense

In addition to brushing and flossing, the best way to ensure that your teeth and gums stay healthy is to stay on top of your twice-yearly dental exams and cleanings. You don’t need to schedule your appointments six months apart either. The timing is up to you. Just make sure to put yourself, and your oral health, on your calendar.

Source: Mayo Clinic. Oral health: A window to your overall health.

Want to learn more about your Costco dental coverage, free preventive care and where to find an in-network dentist? Check out the resources below.