Dental and vision insurance can help make routine care more affordable, but understanding exactly what a plan covers isn’t always easy.
Some plans focus mainly on preventive care, while others provide benefits toward more expensive services such as crowns, dentures, glasses, or contact lenses.
Here’s a simple look at what you may find in a dental and vision plan.
What Does Dental Insurance Typically Cover?
Dental plans commonly divide services into different categories.
Preventive Care
Preventive services may include:
- Routine dental exams
- Cleanings
- X-rays
- Fluoride treatments
Many plans provide their highest level of coverage for preventive care because regular checkups can help catch problems before they become more serious.
Basic Dental Services
Depending on the plan, basic services may include:
- Fillings
- Simple tooth extractions
- Certain periodontal treatments
- Emergency dental services
You may be responsible for a portion of the cost through a copayment or coinsurance.
Major Dental Services
Some plans also provide benefits toward more expensive procedures, such as:
- Crowns
- Bridges
- Dentures
- Root canals
- Oral surgery
Coverage for dental implants varies considerably. If implants are important to you, make sure you specifically check whether they’re covered before choosing a plan.
What Does Vision Insurance Typically Cover?
Vision coverage is generally designed to help with routine eye care and corrective eyewear.
Depending on the plan, benefits may include:
- Routine eye exams
- Prescription eyeglasses
- Frames
- Prescription lenses
- Contact lenses
Some plans provide an allowance toward frames or contacts rather than covering the entire cost.
For example, if your plan provides a certain allowance for frames and you select a pair that costs more than that amount, you may be responsible for the difference.
Are Medical Eye Problems Covered by Vision Insurance?
There’s an important difference between routine vision care and medical eye care.
Vision insurance generally focuses on routine exams and eyewear. Medical conditions affecting the eyes may instead fall under your health insurance or Medicare coverage.
Medicare may cover certain eye exams, diagnostic testing, and treatment when medically necessary and when Medicare’s requirements are met.
Watch for Annual Maximums and Coverage Limits
Having dental insurance doesn’t necessarily mean every dental expense will be covered.
Many dental plans have an annual maximum, which is the most the plan will pay toward covered dental services during a benefit year.
Vision plans may also limit how frequently you can receive certain benefits. For example, a plan might provide an allowance for new frames or contacts only once within a specified period.
What About Waiting Periods?
Some dental plans have waiting periods before they’ll help pay for certain services, particularly major dental work.
This can be especially important if you already know you need a crown, bridge, dentures, or another costly procedure.
Before enrolling, ask:
- Is there a waiting period?
- What is the annual dental maximum?
- How much does the plan pay for major services?
- Are my dentist and eye doctor in the network?
- How often can I receive new glasses or contacts?
- Are there services the plan doesn’t cover?
Look Beyond the Monthly Premium
It’s tempting to choose the plan with the lowest monthly premium, but the least expensive plan isn’t always the best value.
A plan with a slightly higher premium could provide better benefits for the services you actually use. On the other hand, someone who only needs routine cleanings and an occasional eye exam may not need extensive coverage.
The goal is to find coverage that fits your needs and your budget.
Need Help Comparing Dental and Vision Coverage?
Dental and vision plans can vary in their benefits, provider networks, annual limits, and out-of-pocket costs.
Jordan Shanbrom can help you review available options and better understand what each plan covers before you make a decision.
Schedule an appointment to review your dental and vision coverage options and find a plan that fits your needs.