A Quick Guide to Dental and Vision Health Insurance Plans

A Guide to Dental and Vision Health Insurance Plans

When it comes to buying health insurance, there are many choices. 

As an individual or business owner, there are many options that can make buying a health insurance plan confusing.

As an employee, your employer may offer health insurance (or sometimes you may be able to get it through your spouse’s employer). If not, you can also buy insurance through an insurance agent or your state’s or federal health insurance marketplaces.

Employer-based plans – while most cost-effective – may not have very much flexibility. Individual health insurance policies purchased through an agent or in the health insurance marketplaces tend to offer much more flexibility in terms of the types of coverage.

With group health insurance offered by an employer, the costs are spread over the company and the number of participants covered. There are several types of group health insurance plans available, including HMO, PPO, etc.

 

Does Health Insurance Include Vision and Dental?

The landscape is even more confusing when it comes to additional cover for vision and dental care plans. Many people wonder if health insurance plans cover vision and dental, and the short answer is typically no.

Unfortunately, most health insurance plans do not cover dental or vision insurance unless otherwise stated in their terms. 

The majority of health plans will offer additional options for vision and dental but won’t necessarily include them as part of the base monthly premium.

However, the good news is that unlike health insurance plans, there’s no particular enrollment period for dental and vision (this may vary, of course, depending on certain insurance carriers).

 

What Dental Insurance Covers

Dental insurance, sometimes called supplemental dental insurance cover, can help pay for many services that range from basic care to advanced dental procedures. 

These dental services which are covered under dental insurance 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.

 

What are the Limitations of Dental Insurance Coverage?

Keep in mind that what amount is covered can vary wildly. The most basic dental care is widely covered by dental insurance, whereas the more advanced treatments are not as widely covered or may require a large deductible.

If you are aware you need major dental work, you should pay attention to your dental insurance plan’s maximum annual benefits. Typically annual maximums for dental plans run between $1,000 and $1,500 and won’t pay for much dental work. 

Some dental insurance plans can also have waiting periods as part of their policy. For example, you may have to wait 12 months or longer before you’ll be covered for more expensive treatment such as a crown.


What Vision Insurance Covers

Vision insurance, often called supplemental vision insurance coverage, can aid with the cost of examinations, treatments, prescriptions, surgical procedures, and equipment all related to your eyes and vision. 

Most vision insurance plans will typically include cover for:

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. 

Items tested 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 early detection of eye disease, any developing vision problems, or a need for corrective lenses. 

Glasses

Eyewear such as frames and lenses and contact lenses can be expensive but are often 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. 

Vision Surgery

Surgeries 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.


What are the Limitations of Vision Insurance Coverage?

Vision insurance will usually provide a specific dollar amount of coverage or offer discounts toward the products or services you buy. 

When you purchase, you will be provided with the figures as part of your plan information. Each specified product or service will come with its dollar amount or discount per year.

Also, when you purchase vision insurance, you will usually get access to a network of providers, such as optometrists and ophthalmologists, eyewear stores, and LASIK or PRK surgeons.

Even though finding the right vision and dental plan can be confusing, the good news is that there is a lot of information on each insurance plan today.

If you need help understanding which dental or vision insurance plans might be best suited for you or your business, please reach out to our team for assistance.

Jackson & Jackson Insurance Agents and Brokers offer commercial and business insurance with over 80 years of experience serving the San Dimas, Glendora, and LaVerne business communities.

We offer all lines of group health insurance that can provide you with a choice of health insurance providers based on your needs, to see what works best for your business.

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