A Guide to Vision and Dental Insurance | HealthMarkets

Dental and vision insurance is an important part of keeping you and your budget healthy.

The health of our eyes and mouth is no less important than that of the rest of our body. but dental and vision insurance are often excluded from traditional health insurance.

Reading: How much does medical dental and vision insurance cost

While a health insurance plan can help with the cost of a broken arm or skin infection, a chipped tooth or loss of vision is left to dental and vision insurance.

Dental and vision 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, stand-alone plans for dental or vision benefits that can be used in addition to a health insurance plan as a form of supplemental insurance. There are even dental and vision “bundles” that offer benefits for both.
3. Medicaid provides dental and vision benefits for children in every state. In some states, Medicaid also offers coverage for adults.
4. many medicare advantage plans include dental and vision benefits for seniors.

No matter how you buy it, dental and vision insurance can be essential in helping you keep your health and your medical costs low. But before you go shopping for plans, there are a lot of things you need to 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 yearly premium (the coverage fee), a deductible (the amount you must first pay out of pocket before the insurance kicks in), and copays or coinsurance (your share of the doctor’s bill).

These types of dental or vision insurance plans can function as HMOS, PPOS, or indemnity plans.

In an hmo, you will have a primary care physician (pcp) along with a network of doctors and medical or dental facilities approved by your insurance provider. You will receive dental or vision care at these offices as directed by your PCP.

With a ppo, you are not restricted by a pcp and have more freedom to visit doctors and facilities outside the network.

indemnity plans reimburse the client for services rendered once a claim is filed with the insurance provider.

alternative

An alternative to traditional dental or vision insurance is to join a discount program. this is how it works:

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

Those who do not have the discount plan can receive the same services from the same doctors and facilities, but will have to pay the “standard rate” for those services instead of the discounted rate enjoyed by members of the program.

vision insurance

People with vision insurance are twice as likely to schedule a routine eye exam as those without. and according to dr. burt dubow, a street. Cloud, an optometrist in Minnesota, “A very comprehensive eye exam will detect eye disease and uncover health problems you may not have known you had, such as high blood pressure, diabetes, and even brain tumors.”

what vision insurance covers

Just like health insurance, vision insurance can help with the cost of tests, 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 usually done once a year and involves a series of tests to measure the health of your eyes through several different parameters. Things that are tested during an eye exam can include the sharpness of your vision, color blindness, how well your eyes work together as a unit, the presence of glaucoma, your range of peripheral vision, and more. Eye exams can be critical in providing early detection of eye disease, any developing vision problems, or the need for corrective lenses.

glasses. Eyeglasses (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 eyeglasses purchased through your optometrist or an approved network vision center. sometimes even prescription sunglasses can be covered.

Lens coatings and enhancements. Some vision insurance plans may help with the cost of a lens coating. lenses can be coated with substances to reduce scratches, fog and moisture, reflections, and UV exposure.

surgery. Surgeries that are considered 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 many insurance providers consider it 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, 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

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$154

$15 (copay)

$139

glass frames

$159

$9

$150

eyeglass lenses

$86

$25 (copay)

$61

lens enhancements

$268

$170

$98

totals

$667

$423

$244

dental insurance

dental insurance often comes in the form of “100-80-50”. This means that the insurance provider pays 100 percent of the cost of preventive care (such as routine cleanings and 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 care (widely covered by dental insurance) to the most advanced (not as widely covered), include:

preventive care. Routine dental exams and cleanings are usually performed every six months and are covered in full by most dental insurance policies.

restorative care. Restorative care is any minor procedure to treat damaged or decayed teeth, such as fillings.

endodontics. more advanced damage or decay will require more complicated procedures, such as root canals.

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oral surgery. Common oral surgeries include tooth extraction, drainage of infections, and biopsies of gum tissue.

orthodontics. this includes the installation, maintenance and removal of braces and retainers.

periodontics. Periodontics involves the treatment of gum disease, infections and injuries.

prosthodontics. Denture and bridge adjustments and installations can be expensive, and you’ll need a quality insurance policy to help alleviate this cost.

the cost of not having dental insurance

Many people avoid going to 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 don’t have dental insurance, according to U.S. department of health and human services.

but those that do will incur many of the same out-of-pocket costs 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. dental extractions (non-surgical, erupted gums) = $75 to $300
4. crowns (plain resin) = $328
5. root canals (single, exposed) = $120

“When you go to the dentist, it will be much cheaper if you have dental insurance,” says dr. harold katz, founder of california breath clinics and author of the bad breath bible. “While many people forgo insurance because of the cost, dental insurance will generally save you money, especially if you have to have something other than a regular cleaning.”



workplace dental and vision insurance

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

As a result, dental and vision insurance benefits provided by an employer-sponsored plan are the exception, not the rule. In fact, only 53% of companies offering health insurance in 2014 provided any type of dental benefit, and only 35% of those companies offered vision insurance.

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

vision and dental insurance for children

While adult dental and vision insurance is not required under the Affordable Care Act, children’s dental and vision benefits are a required benefit offering in all plans that qualify as “essential coverage minimum”.

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 vision and dental care.

dental and vision insurance through medicaid

dental insurance. Like the Affordable Care Act, federal Medicaid guidelines only require that dental benefits be available to children. Some states have their own adult dental requirements under Medicaid, while others do not offer adult dental insurance at all.

vision insurance. Medicaid offers coverage for eye exams, frames and lenses for children under the age of 21, but it is up to each 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 for glaucoma testing and treatment and even cataract surgery.

original medicare (part a and part b) usually doesn’t provide dental or vision 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 dental and vision care

When you’re ready to take the next step in purchasing vision or dental insurance, let healthmarkets help. We have over 3,000 licensed agents ready to guide you to a dental, vision or other 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 more than 180 insurance providers nationwide. To date, we’ve sold over two million policies and earned an A+ rating from the Bureau of Better Business.

Contact one of our agents today to begin your journey to better vision, better oral health, and greater 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 newsletter. Jan 12 2011.ship, madeleine. “choosing vision insurance or a vision benefit plan. all about vision. oct. 2015. “Americans With Standalone Vision Plans Have Twice As Much…” 2010. “Vision Insurance Choice – Benefit Packages… – AARP”. 2012. hell, amy. “what is vision insurance?” all about vision. Oct 19 2015. “What is vision insurance and how much does it cost?”. 2006. “what do dental plans typically cover?” National Association of Dental Plans. 2014.

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