Choosing dental and vision coverage can feel simple at first. You find a plan with an affordable monthly premium and benefits that sound good but there are several important details to look at before enrolling.
The right plan isn’t necessarily the one with the most benefits. It’s the one that provides benefits you’ll actually use at a cost that makes sense for you.
Here are some things to consider when comparing your options.
1. Are My Dentist and Eye Doctor in the Network?
If you already have a dentist or eye doctor you like, start here.
Some dental and vision plans require you to use participating providers to receive the best benefits. Before enrolling, check whether your current providers participate in the plan’s network.
Don’t assume that because a provider accepts one insurance plan, they accept every plan offered by that insurance company.
2. What Does the Plan Actually Cover?
Look beyond the words “dental and vision included.”
For dental coverage, check for benefits such as:
- Exams and cleanings
- X-rays
- Fillings
- Extractions
- Crowns and bridges
- Dentures
- Root canals
- Other major dental services
For vision coverage, look for:
- Routine eye exams
- Frames
- Prescription lenses
- Contact lenses
Every plan is different, so make sure the benefits match the services you’re most likely to use.
3. How Much Will I Pay?
The monthly premium is only one part of the cost.
Depending on the plan, you may also have:
- Deductibles
- Copayments
- Coinsurance
- Costs above your benefit allowance
- Out-of-network expenses
A plan with a very low premium isn’t necessarily the least expensive option if it leaves you paying more when you actually need care.
4. Is There an Annual Dental Maximum?
Many dental insurance plans have an annual maximum, which is the most the insurance plan will pay toward covered dental services during a benefit year.
Once the plan reaches that amount, you may be responsible for additional covered dental expenses for the remainder of the benefit period.
If you expect to need significant dental work, the annual maximum can be especially important.
5. Are There Waiting Periods?
Some dental plans have waiting periods for certain services.
You may be able to receive preventive care immediately but have to wait before receiving benefits for services such as crowns, bridges, or dentures.
If you already know you need dental work, check the waiting-period rules carefully before enrolling.
6. How Does the Vision Allowance Work?
Vision benefits often provide a specific allowance toward frames or contact lenses.
Find out:
- How much is the allowance?
- How often can you use it?
- What happens if your glasses cost more than the allowance?
- Can you choose between glasses and contacts?
- Are there restrictions on where you purchase your eyewear?
Knowing these details can give you a better idea of what you’ll actually pay.
7. Are There Services That Aren’t Covered?
Exclusions are just as important as benefits.
For example, a dental plan may cover crowns and dentures but provide limited or no benefits for dental implants.
If there’s a particular procedure or service that’s important to you, verify its coverage before enrolling rather than assuming it’s included.
8. What Do I Actually Need?
Finally, think about your own situation.
Someone who needs routine cleanings and an annual eye exam may have very different needs from someone expecting major dental work or regularly purchasing prescription glasses.
Consider what you used last year and what you anticipate needing in the year ahead.
Don’t Choose Based on One Benefit
It’s easy to focus on a large eyewear allowance, low premium, or advertised dental benefit.
Instead, look at the whole plan.
Consider the providers, premiums, coverage limits, waiting periods, annual maximums, and your expected out-of-pocket costs together.
The goal isn’t simply to have dental and vision coverage. It’s to have coverage that provides value for the care you actually need.
Need Help Comparing Your Options?
Dental and vision plans can look very similar until you start comparing the details.
Jordan Shanbrom can help you review available dental and vision coverage, compare benefits and costs, and better understand what you’re getting before you enroll.
Schedule an appointment to review your options and find coverage that fits your healthcare needs and budget.
