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.
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.
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.
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
Pulling 2015 data from a leading provider of vision insurance, there is an average additional savings of $244 as opposed to not having 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
Supplemental 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 premiums, deductibles, 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.
Call us today and see how we can save you money on some great dental and vision plans! We will shop around for you and find the right fit that meets your needs while giving you the best band for your buck!