Eye care and oral care are important to your overall health — but they may not be covered by your health insurance. If you’re among the millions without dental and vision insurance, here’s how to find the right coverage.
How Vision and Dental Fits in with Your Health Insurance
One of the requirements of the Affordable Care Act (ACA) is that vision and dental coverage must be available for children covered under marketplace plans. However, adults are conspicuously absent from the requirement.
Workplace health insurance plans for employers with more than 50 employees also aren’t required to offer coverage for dental and vision, which leaves another large group of people without coverage. You may be surprised to learn that Medicare doesn’t provide coverage for most vision or dental needs, either.
In many cases, dental and vision coverage are treated as separate coverages and even when a health plan bundles these additional coverages, they may use third-party specialty providers like VSP Individual Vision Plans, a leading vision insurance provider that sells individual vision plans you can buy on your own.
There are a number of good plans available in most areas. You may even be able to purchase both coverages together, but don’t be surprised to learn that different companies handle each coverage differently.
Related: How does health insurance work?
Dental and vision insurance dovetail with affordable health insurance coverage if you have a health savings account or a flexible spending account. You can use the funds you’ve saved in either type of account to cover your out-of-pocket costs for many dental services, eye exams or for glasses or contacts, as well as for other qualified health care expenses.
These accounts offer the opportunity to contribute before-tax earnings to pay for health-related expenses. In most cases, you won’t be able to use your health savings to pay vision or dental insurance premiums, but your savings can be used to pay for copayments or coinsurance.
Dental and vision insurance plans typically cover routine exams, which also contribute to your overall health. Many dental exams include screening for oral cancer, for example. Eye exams can also find early signs of diabetes, high blood pressure and high cholesterol. Your dentist or optometrist can’t treat these issues, but you might catch some of these conditions in the early stages and hand them off to your doctor.
Choosing the Right Plans
The right dental and vision plans for you and your family may not be the right plan for your neighbor or coworker. It’s important to consider your individual needs carefully. Plan pricing for dental and vision insurance often has a direct correlation with the amount of coverage; plans that offer the most coverage also tend to have higher premiums.
Consider Your Needs
With the selection of plans available in most areas, often there’s no need to settle. You can choose a plan that addresses the unique needs of your household. If you have kids who may need braces, you can choose a dental insurance plan that offers better coverage for orthodontic care. Similarly, if you or a family member need bifocals or special lenses, you can choose a vision insurance plan that provides better coverage for those needs.
Consider making a list of coverages that are important to your family to be sure nothing is overlooked once you begin shopping.
Learn What’s Covered
A mid-tier coverage plan often offers the best value when you compare premiums and out-of-pocket costs to overall savings. You’ll still want to learn what’s covered by each plan. A rushed decision can be costly later if you learn there’s no coverage for a service you need.
Entry level vision insurance plans may only offer coverage for the exam or for the glasses — but not for both, which may make these plans more expensive in the long run, despite their lower premiums.
Vision insurance coverage. Typically, vision insurance plans cover an annual exam as well as lenses and frames. Frame coverage is usually covered by using a $150+ allowance, meaning the vision insurance provider will pay up to a certain amount for frames, after which it’s common for plans to cover a lesser percentage of the frame cost that exceeds the allowance.
Dental insurance coverage. Dental insurance comes in several forms, but the most common structure is what’s called “100-80-50” coverage, which refers to the coverage tiers for the plan. These plans typically cover 100% of the cost for routine exams and cleaning, 80% of the cost for fillings and other basic dental procedures and 50% of the cost for bridges, crowns and some other procedures.
It’s also common to find an annual coverage cap for dental insurance plans. Once you reach this limit, which is often between $750 and $1,500 per person, the plan won’t cover additional claims. However, many plans do not include the cost of preventive care, like cleanings or regular exams, against this limit.
Discount dental plans. Some dental plans are better described as discount plans because they don’t cover any dental services fully and consumers instead pay a discounted price for services that can range from 15% to 60% off the retail price, depending on the service.
Other dental plans have deductibles and annual out-of-pocket limits, much like a health insurance policy. Because dental insurance plans can vary so much in structure, it’s important to learn the details of coverage before making a purchase decision. Vision insurance tends to have less divergence in plan types but also requires a diligent eye to be sure the plan is a good fit.
Indemnity plans. Indemnity plans are also an option for dental coverage. With an indemnity plan, also called a fee-for-service plan or traditional plan, you pay the dentist directly and then the plan reimburses you for a fixed amount based on the services you had performed. You can choose any licensed dentist with many indemnity plans.
Compare the covered services to those you think you’ll need. For some services, you may have to budget separately. For example, vision insurance plans don’t cover LASIK surgery and many dental plans don’t cover braces or limit orthodontic coverage to children only. It’s common to find discounts through your plan for services that aren’t covered, but you’ll still have to pay for the discounted service out of pocket.
Consider the Network
Most dental and vision plans use network doctors and dentists to help keep premiums lower. If you have a favorite optometrist or dentist, check to see if they’re covered by the plan you’re considering. Some plans cover out-of-network services, but costs can be considerably higher. In other cases, out-of-network services may not be covered at all.
When shopping for dental coverage, you’ll encounter terms like HMO and PPO, just like health insurance. An HMO is a health management network and limits coverage to in-network providers. A PPO offers more provider choices, but you can expect to pay more for out-of-network coverage.
The choice of network type is probably of lesser importance for dental coverage than it is for traditional health insurance. Focus your search on vision or dental insurance companies that include your favorite eye doctor or dentist or that offer a wide selection of providers in your area.
Consider Other Payments
Coinsurance and copayments are similar in concept. Both represent the amount you pay toward covered services. A copayment is a dollar-based amount, such as a $15 copay for an eye exam. Coinsurance is percentage-based, meaning the amount you pay is a percentage of the full price. For example, you might pay 50% of the cost of an $800 root canal, or $400.
Annual coverage limits can also be a big consideration, particularly for dental coverage where the cost of services can add up quickly. There are some plans without an annual limit, however. Expect these plans to require a 12-month initial commitment and to work largely as a discount plan or to have larger copays or coinsurance requirements.
The goal of vision insurance or dental insurance is to make eye care and dental care more affordable. It’s easy to overspend on plans that offer more coverage than you need or that still have potentially large out-of-pocket costs.
Often, the best value is found in the mid-tier plans unless you have a specific need for a premium plan that promises more coverage. You’ll probably have some out-of-pocket costs regardless of which plan you choose, so be sure to budget for those costs as well.
Evaluate the annual cost of coverage to be sure the combination of premiums and out-of-pocket costs is a money-saving move for you or your family.
Also, if you have a health savings account or a flexible spending account, you can use your saved funds to pay for your out-of-pocket costs for most dental services or for vision-related copayments. Both types of accounts allow you to build tax-free savings that you can use for qualified health care expenses and help reduce your overall costs for vision and dental care.
Choosing the Best Vision and Dental Insurance
You’ll have fewer big-ticket expenses at the dentist or eye doctor if you split your cost into monthly premiums. Many plans require an initial annual commitment, so you’ll want to be certain that the plan meets your needs before signing up for a full year.
Want to learn more about finding the best insurance? Check out Benzinga's guides to the best affordable health insurance, the best short term health insurance and the best self-employed health insurance.