A Guide to Vision and Dental Insurance

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Vision and dental insurance is an important part of keeping you—and your budget—healthy.


The health of our eyes and mouths is no less important than that of the rest of our bodies. But vision and dental insurance are often excluded from traditional health insurance. 

While a health insurance plan can aid in the cost of a broken arm or a skin infection, a chipped tooth or fading eyesight is left up to dental and vision insurance. 

Vision and dental insurance can come from different sources:

  1. There are health insurance plans that include vision and/or dental benefits. These can be offered by an employer or purchased on your own.
  2. There are separate, standalone plans for vision or dental benefits that can be used on top of a health insurance plan as a form of supplemental insurance. There are even dental and vision insurance “packages” that offer benefits for both.
  3. Medicaid provides vision and dental benefits for children in all states. In some states, Medicaid also provides coverage for adults.
  4. Many Medicare Advantage plans include vision and dental benefits for seniors.

No matter how it’s acquired, vision and dental insurance can be instrumental in helping to keep your health up and your medical costs down. But before you go shopping for plans, there’s plenty you should know about them. HealthMarkets can help you learn what you need to know.

The Two Types of Plans

Dental and vision coverage can come in two different forms. 

Traditional 

The first is much like a traditional health insurance plan. You’ll have a monthly or annual premium (the fee for coverage), a deductible (the amount you have to first pay out of pocket before the insurance starts kicking in), and copayments or coinsurance (your share of a doctor’s bill). 

These types of vision or dental insurance plans can operate as HMOs, PPOs, or indemnity plans. 

In an HMO, you’ll have a primary care physician (PCP) along with a network of physicians and dental or medical facilities approved by your insurance provider. You’ll receive your dental or vision care from those offices as directed by your PCP.  

With a PPO, you are not restricted by a PCP and have some more freedom to visit physicians and facilities outside of the network. 

Indemnity plans reimburse the customer for services rendered once a claim is submitted to the insurance provider. 

Alternative

An alternative to traditional dental or vision insurance is joining a discount program.  Here’s how it works:

  1. You pay a monthly or yearly fee, just like you do with health insurance.
  2. This fee grants you access to a pool of discount offers. Think of the fee as the cost of a “membership” to a club where all the members receive discounted dental or vision services.
  3. Once you’re in the “club,” you can then choose from the selection of discounted services as needed.

Those without the discount plan can receive the same services from the same physicians and facilities, but will have to pay the “rack rate” for those services instead of the discounted rate enjoyed by the program members.

Vision Insurance

People with vision insurance are twice as likely to schedule a routine eye exam as those who do not. And according to Dr. Burt Dubow, a St. Cloud, Minnesota optometrist, “a very thorough eye exam will catch eye disease and discover health issues you may not have known you have, such as high blood pressure, diabetes, even brain tumors.”

 

What Vision Insurance Covers

Like health insurance, vision insurance can aid with the cost of examinations, treatments, prescriptions, surgical procedures, and equipment. Some of the things most commonly covered by vision insurance plans include:

Eye exams. This preventive care measure is generally performed once a year and involves a series of tests to gauge the health of your eyes across several different parameters. The things tested for during an eye exam can include the sharpness of your vision, color blindness, how your eyes work together as a unit, a presence of glaucoma, your range of peripheral vision, and more. Eye exams can be instrumental in providing an early detection of eye disease, any developing vision problems, or a need for corrective lenses. 

Eyewear. Glasses (frames and lenses alike) and contact lenses can be expensive but are often at least partially covered by vision insurance. Some vision insurance plans may limit coverage to eyewear purchased through your optometrist or a network-approved vision center. Sometimes, even prescription sunglasses may be covered. 

Lens coatings and enhancements. Some vision insurance plans can help with the cost of a lens coating. Lenses can be coated with substances to decrease scratching, fog and moisture, reflections, and exposure to ultraviolet rays. 

Surgery. Surgeries that are deemed medically necessary, such as a procedure to treat an eye injury, infection, or disease, will often be covered by a health insurance plan. But corrective surgery, such as LASIK, is generally not covered by health insurance because it is deemed by many insurance providers to be an elective or “cosmetic” surgery. However, there are some vision insurance plans and discount programs that will partially cover such elective procedures.

Cost of Vision Insurance

cost of vision insurancePulling 2015 data from a leading provider of vision insurance, the table below illustrates what you can expect to pay—and save—with a vision insurance plan featuring a $204 annual premium.

Service

Cost without insurance

Cost with insurance

Savings with insurance

Eye exam

$154

$15 (copay)

$139

Eyeglass frames

$159

$9

$150

Eyeglass lenses 

$86

$25 (copay)

$61

Lens enhancements 

$268

$170

$98

Total

$667

$423

$244

Dental Insurance

Dental insurance often comes in the form of “100-80-50.” This means that the insurance provider pays for 100 percent of the cost of preventive care (such as cleanings and routine checkups), 80 percent of the cost of basic procedures (such as fillings or root canals), and 50 percent of the cost of more advanced procedures (such as bridges or crowns). 

What Dental Insurance Covers

woman at dentistSupplemental dental insurance can go a long way in helping to pay for a number of services that range from basic care to advanced surgical procedures. As evidenced by the 100-80-50 model, the more advanced the procedure, the less coverage you might expect to receive from your dental insurance plan. 

These services, in order from the most basic of care (widely covered by dental insurance) to the more advanced (not as widely covered) include:

Preventive care. Routine dental exams and cleanings typically take place every six months and are covered in full by most dental insurance policies. 

Restorative care. Restorative care consists of any minor procedures to treat damaged or decayed teeth, such as fillings.   

Endodontics. More advanced damage or decay will require more involved procedures like root canals. 

Oral surgery. Common oral surgeries include teeth removal, the drainage of infections, and gum tissue biopsies. 

Orthodontics. This includes the installation, maintenance, and removal of braces and retainers. 

Periodontics. Periodontics involves the treatment of gum disease, infections, and lesions. 

Prosthodontics. Fittings and installations of dentures and bridges can be expensive, and you will need a quality insurance policy to help alleviate this cost.

The Cost of Not Having Dental Insurance

Many people avoid the dentist simply because they don’t like going. Others stay away because they don’t enjoy the cost. In fact, some 108 million Americans do not have dental insurance, according to the U.S. Department of Health and Human Services. 

But the ones that do will incur many of the same out-of-pocket expenses as regular health insurance, including premiumsdeductibles, and copayments or coinsurance

While this may seem like a burden, it can pale in comparison to the cost of some dental care services without insurance. 

Listed below are some average shelf prices for common dental services.

  1. Exams (including x-rays and cleaning) = $288
  2. Fillings (single, silver-amalgam filling) =  $50 to $150
  3. Tooth extractions (non-surgical, gum-erupted) = $75 to $300
  4. Crowns (single resin) = $328
  5. Root canals (single, exposed) = $120

“When you go to the dentist, it’s going to be much cheaper if you have dental insurance,” says Dr. Harold Katz, founder of the California Breath Clinics and author of The Bad Breath Bible. “While many people forgo the insurance because of the cost, usually dental insurance will save you money, especially if you have to have any procedure done that is not a regular cleaning.”

examination by dentist

Vision and Dental Insurance in the Workplace

Under the Affordable Care Act, companies with at least 50 employees are required to provide group health insurance for their employees or face a penalty. However, vision and dental insurance are not required as part of this mandate. 

As a result, vision and dental insurance benefits granted by an employer-sponsored plan are the exception, not the rule. In fact, only 53 percent of companies that offered health insurance in 2014 provided any sort of dental benefits, and only 35 percent of such companies offered vision insurance.

Meanwhile, according to a benefits trend study conducted by MetLife, the two most popular voluntary benefit programs for employees are vision and dental insurance.

Vision and Dental Insurance for Children 

While vision and dental insurance for adults is not a requirement of the Affordable Care Act, vision and dental benefits for children is a required benefit offer under all plans that qualify as “minimum essential coverage.”

This means that all children under the age of 19 enrolled in individual, family, and small group health insurance plans must be offered basic and preventive care for vision and dental.

Vision and Dental Insurance Through Medicaid

Dental insurance. Just like the Affordable Care Act, federal Medicaid guidelines only require dental benefits be made available to children. Some states have their own dental requirements for adults under Medicaid, while others do not offer dental insurance to adults at all.

Vision insurance. Medicaid offers coverage of eye exams, frames, and lenses to children under 21, but it’s up to each individual state to determine how much—and how often—the coverage is offered. 

Many state Medicaid programs offer similar coverage for adults and some states even provide coverage of glaucoma testing and treatment and even cataract surgery.

Original Medicare (Part A and Part B) typically does not provide vision or dental benefits but many Medicare Advantage plans do. 

If this all seems complicated, contact a HealthMarkets agent. An agent can help you understand your options today.

Where to Get Vision and Dental

When you’re ready to take the next step toward acquiring vision or dental insurance, let HealthMarkets help. We have over 3,000 licensed agents ready to guide you toward a dental, vision, or another type of supplemental health insurance plan that will fill the gaps in your coverage, fit your needs, and fit your budget alike. Just call (800) 360-1402

We offer thousands of plans from over 180 insurance providers nationwide. To date, we have sold over two million policies and have earned an A+ rating from the Better Business Bureau. 

Contact one of our agents today to get started on your way toward a better vision, better oral health, and bigger savings.

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 Sources:
“Dental Care.” Medicaid.gov. 2015.
“Medicaid coverage.” All About Vision. Nov. 2015.
“Medicare Advantage Plans cover all Medicare Services. 2015.
Holmes, Tamara. “Discount Dental Plans Are Something to Smile About.” AARP Bulletin. 12 Jan. 2011.
Vessel, Madeleine. “Choosing a Vision Insurance or Vision Benefits Plan. All About Vision. Oct. 2015.
"Americans with Stand-Alone Vision Plans are Twice as ..." 2010.
"Choosing Vision Insurance - Benefits Packages ... - AARP." 2012.
Hellem, Amy. “What is Vision Insurance?” All About Vision. 19 Oct. 2015.
"What Is Vision Insurance, and What Does It Cost?." 2006.
“What do dental plans normally cover?” National Association of Dental Plans. 2014.

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