Coverage your health plan leaves out
Most adult health plans don't cover routine dental or vision care. Your medical plan will pay for an eye infection or a broken jaw. It won't pay for a cleaning or a new pair of glasses. That's what dental and vision insurance are for.
These plans cost far less than health insurance, and they're easy to understand once you know a few terms. Dobson Health Insurance Group helps you choose a plan that matches the care you'll actually use, so you aren't paying for coverage that sits idle.
Dental
Cleanings, exams, fillings, crowns, and more.
Vision
Yearly eye exams plus money toward glasses or contacts.
How dental insurance works
Most dental plans sort care into categories and pay a different share for each. Here is a common setup.
Cleanings and exams
Cleanings, exams, and routine imaging. Usually covered from day one.
Fillings and extractions
Fillings and simple extractions, often after a short waiting period.
Crowns and dentures
Crowns, bridges, and dentures, often after a longer waiting period.
Plans don't all sort procedures the same way. Root canals, for example, land in basic care on some plans and major care on others. We check that for you.
Three terms that show up on every dental plan
Deductible
What you pay before the plan starts sharing costs, often $50 to $100 a year. Most plans waive it for preventive care.
Annual maximum
The most the plan will pay in a year, commonly $1,000 to $2,000. Once you hit it, you pay the rest. It works the opposite way from health insurance, which caps what you pay.
Waiting period
Many individual plans make you wait six months before covering basic care and 12 months before covering major work. Preventive care is usually covered from day one.
Need work soon? If you already know you need a crown, look for a plan with no waiting period on major services. Some plans also waive the wait if you had dental coverage recently.
Dental PPO, dental HMO, or discount plan?
Dental PPO
Lets you see any dentist, but you pay less when you stay in network. It's the most popular choice because it gives you flexibility.
Dental HMO
Usually costs less. You pick a dentist from the plan's network and need a referral to see a specialist. Many have no annual maximum and no waiting periods, which can be a real advantage if you need major work.
Discount plan
You pay a membership fee and get lower prices at participating dentists. It can make sense if you need work right away and can't sit through a waiting period.
Dental and vision coverage for kids
Dental and vision care for children are both essential health benefits under the ACA. Some Marketplace health plans include children's dental. Others don't, and you buy a separate children's dental plan instead.
Adult dental and vision are not required on any ACA plan. That's why most adults buy them separately.
No double paying
We check which setup your health plan has so you don't pay for the same children's coverage twice.
How vision insurance works
Vision insurance covers routine eye care. That usually means a yearly eye exam for a small copay, plus an allowance toward frames or contact lenses. Many vision plans also offer discounts on LASIK.
Eye conditions like glaucoma or cataracts, and eye injuries, usually fall under your health insurance instead of your vision plan.
Every 12 or 24 months, with lenses covered after a copay
Is dental and vision insurance worth it?
Add up the dental and eye care you expect to use this year. Compare that to what the plan would cost you in premiums.
Dental usually pays off for
- Families with kids
- Anyone with a history of cavities or gum problems
- Anyone expecting major work in the next year or two
Vision usually pays off for
- Anyone who wears glasses or contacts
- Families who need yearly eye exams for the kids
If your eyesight is fine, paying for an exam out of pocket may cost less.
Two cleanings and exams can easily run a few hundred dollars without insurance. A pair of prescription glasses often costs $200 or more. If the plan would pay more for care you're going to get anyway than you'd pay in premiums, it's worth it.
Buying dental and vision together
Many carriers sell dental and vision as a bundle, sometimes at a discount. You can add them to a health plan we help you with, or buy them on their own.
No open enrollment needed
Dental and vision plans bought directly from a carrier generally aren't tied to open enrollment. You can usually sign up any month of the year.
Frequently asked questions
Can I buy dental insurance at any time of year?
Usually, yes. Most dental and vision plans sold directly by a carrier let you enroll any month. Plans bought through the Marketplace follow the Marketplace's enrollment dates.
Does dental insurance cover braces?
Some plans do. Orthodontic coverage is often limited to children, comes with its own lifetime maximum, and may have a waiting period of 12 months or longer. Adult braces coverage is less common.
Does dental insurance cover implants?
More plans cover implants than they used to, but many still don't. When a plan does cover them, implants usually count as major care, paid at around 50% after any waiting period.
Can I keep my current dentist?
With a dental PPO, you can see any dentist, though staying in network saves you money. With a dental HMO, your dentist has to be in the plan's network. Give us your dentist's name and we'll check before you enroll.
Is vision insurance the same as eye coverage on my health plan?
No. Health insurance covers medical eye problems. Vision insurance covers routine exams and eyewear. Some adult health plans include a yearly eye exam, but very few help pay for glasses or contacts.
Not sure which plan fits your family?
Call Dobson Health Insurance Group or request a free quote. We'll check your dentist and eye doctor before you pick a plan.
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