Vision and Dental Insurance: Your Guide to Pick the Right Plan
Health insurance typically doesn’t cover preventive care and treatment for your eyes or teeth. To get coverage for these services, you’ll need to find vision and dental insurance for you or your family.
In this guide, you’ll learn:
- The benefit of having vision and dental insurance
- How to compare coverage options
- Where you can find plans
Wondering how vision and dental insurance can help you?
There’s two big benefits.
- Vision and dental care can protect your eyes and teeth
- Vision and dental insurance can help you save you money on exams, check-ups, surgery or other services you may need.
But wait, there’s more…
‘See’ the need for vision insurance
Did you know about 11 million people in the United States age 12 and over have a vision problem?1
Some people avoid going to an eye doctor because they don’t have insurance.
But even people with vision insurance don’t get exams as often as they should.
About 45% of adults haven’t had an eye exam in the last two years.2
And that’s a problem.
Left unchecked, vision problems can lead to:
- Age-related macular degeneration
- Vision loss or blindness caused by diabetes
4 clear benefits of vision insurance
Fortunately, vision insurance can help keep your eyes healthy, prevent vision loss and treat problems.
Here’s what vision insurance typically covers:
1. Eye exams
Get your eyes tested, even if you think you’re fine. Detecting vision problems early and getting treatment can save your vision later. During an eye exam, a doctor will test you for:
- Sharpness of vision
- Color blindness
- How your eyes work together
- Cataracts (depending on your age)
- Peripheral vision
- Vision impairments
- Other eye diseases
You know…glasses or contact lenses.
- Vision insurance typically covers part of the cost.
- Some plans require you to buy eyewear through an approved network provider.
- You may even be able to get prescription sunglasses.
3. Lens coatings and enhancements
Some vision insurance plans can help with the cost of a lens coating.
- What is it? Lenses can be coated with substances. This helps to decrease scratching, fog and moisture. It also helps reduce reflections and sun exposure.
A vision exam reveals a problem that requires surgery. Your eye gets injured, maybe in an accident. Or you develop a disease that could harm your vision.
Your doctor will likely recommend surgery in any of these cases. And it’s typically covered by insurance.
- What’s not covered? Corrective surgery, such as LASIK, is generally not covered by health insurance.
- Why? It’s deemed by many insurance providers to be an elective or “cosmetic” surgery. But, there are some vision insurance plans and discount programs that will partly cover such elective procedures.
How much can you save with vision insurance?
It depends on the type of plan you get.
But here’s an example of how much it would cost to pay out-of-pocket for some basic vision services:3
National average out-of-pocket cost for vision care:
- Eye exam: $206
- Single lens: $114
- Frames: $242
If you paid out-of-pocket for these vision services without insurance, the total is $562.
How much would basic vision services cost with insurance?
Your vision insurance plan may only require a deductible Or your plan may give you discounted rates on vision services.
Here’s an example:
- Let’s say your vision insurance only costs $5 a month. And you get a 30% discount on services.
- You’d save over $100 on an exam, single lens and frames.
Over a year, vision insurance could save you hundreds of dollars or more, depending on the type of care you need.
Grin or grimace? Here’s why you need dental insurance
How much is it going to cost? When you visit the dentist for preventive care or your teeth need a little more attention, you probably want to know how much it’s going to cost.
Dental insurance helps offset the cost of dental care, depending on the service. Most dental insurance plans cover services based on three different levels of care:
- Preventive care: Dental insurance typically covers 100% of preventive care like routine exams and cleanings.
- Basic procedures: Dental insurance typically covers 80% of basic procedures like fillings.
- Advanced procedures: This includes services like crowns, bridges and other surgeries. Dental insurance typically covers 50% of advanced procedures.
7 types of services covered by dental insurance
If you have healthy teeth and gums, you might not need the most robust dental insurance plan available.
But if you do have tooth decay, poor oral health or need major dental work, choosing the right plan can save you a lot of money.
- Keep this in mind when you’re shopping for a dental plan: Insurance typically provides less coverage for more advanced dental care.
Here are 7 types of services covered by dental insurance:
- Preventive care. Routine dental exams and cleanings typically take place every 6 months. Most dental insurance policies cover 100% of these services.
- 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 can include new braces, retainers and care.
- Periodontics. Periodontics involves the treatment of gum disease, infections, and lesions.
- Prosthodontics. This can include dentures and bridges.
The cost of not having dental insurance
Vision and dental insurance have at least one thing in common: Paying out of pocket for vision and dental care can get expensive.
Vision and dental insurance can help you save money and keep your eyes and teeth healthier.
Think you might skip dental insurance for a while? You may want to think again:
In the U.S., an estimated 29% of adults don’t have dental insurance.4
If you don’t have dental insurance, here’s what you can expect to pay for common services:5
- Exams (including x-rays and cleaning) = $75 to $200
- Fillings (amalgam and composite) = $150 to $450
- Tooth extractions (non-surgical, gum-erupted) = $219 to $4,000
- Crowns (single resin) = $500 to $3,000
- Root canals (single, exposed) = $300 to $2,000
Vision and dental insurance: How to pick a plan
Ready to go shopping?
When you start shopping around for vision and dental insurance, chances are pretty good you’re going to have a lot of questions about things like:
- Waiting periods
- Preventive exams
- Co-pays, and more
Use this guide to help you pick the right vision and dental insurance for you or your family.
Vision and dental insurance: 2 types of plans
Dental and vision coverage can come in two different forms:
Here’s what you need to know:
This type of plan works a lot like a typical health plan with a:
- Fee for coverage: A monthly or annual premium
- Deductible: The amount you have to first pay out of pocket before the insurance starts kicking in.
· Copay or coinsurance: Your share of the doctor’s bill you’re responsible for.
- HMO (Health Maintenance Organization). You’ll have a primary care physician (PCP). You’ll also have access to an approved network of doctors, dentists, optometrists, and other health professionals.
- PPO (Preferred Provider Organization). You have more options to pick the doctors you want to manage your care and where you go, even if they’re outside the network in some cases.
- Indemnity plans. These types of vision and dental insurance plans reimburse you for approved medical services you get and pay for. You submit a claim with proof of service and payment. It gets reviewed. When it’s approved, you get paid.
An alternative to traditional dental or vision insurance is joining a discount program.
So instead of insurance, you’re paying discounted rates for approved services based on the plan.
Here’s how it works:
- Recurring fee. You pay a monthly or yearly fee, just like you do with health insurance.
- Discount offers. This fee grants you access to a pool of discount offers.
Note: Think of the fee as the cost of a “membership” to a club where all the members receive discounted dental or vision services.
- 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 clinics. But they will have to pay out-of-pocket instead of the discounted rate.
Getting familiar with these two types of vision and dental insurance options will help you choose which type of plan works best for you.
Where to get vision and dental insurance plans
You’ve done enough homework to recognize insurance to protect your eyes and teeth makes sense. So where do you find vision and dental insurance plans?
You can get vision and dental insurance in a couple different ways:
- Health plans: There are health insurance plans that include vision and/or dental benefits. These can be offered by an employer or purchased on your own.
- Supplemental plans. There are separate, standalone plans for vision or dental benefits. These plans 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.
- Medicaid. Medicaid provides vision and dental benefits for children in all states. In some states, Medicaid also provides coverage for adults.
- Medicare Advantage. Medicare Advantage plans include vision and dental benefits for seniors.
Vision and dental insurance at work
Under the Affordable Care Act, companies with at least 50 employees must provide group health insurance for their employees or face a penalty.
But, vision and dental insurance are not essential health benefits.6
- If your employer doesn’t offer vision and dental insurance, a licensed insurance agent can help you find a plan that works for you.
Vision and dental insurance for children
Good news. Vision and dental benefits for children are essential, according to the Affordable Care Act.
- 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.
Medicaid & Medicare vision and dental insurance
- Dental insurance. Just like the Affordable Care Act, federal Medicaid guidelines only require dental benefits to be made available to children.7
- 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 offer coverage of glaucoma testing and treatment and even cataract surgery.7
- Original Medicare (Part A and Part B) typically does not provide vision or dental benefits but many Medicare Advantage plans do.
Want to protect your vision and oral health?
Vision and dental insurance can help you get the care you need and save money on medical costs. Ready to get started?
Visit HealthMarkets or get in touch with a licensed insurance agent at (800) 827-9990, and we’ll help you find a plan that works for you.