Dental and Vision Insurance

What is Dental and Vision Insurance?

Dental and vision insurance are plans that offer coverage for treatment and procedures related to your oral or visual health. Typically only routine procedures are fully covered. These procedures include vision tests, corrective lenses, checkups, cleanings, and x-rays. Most dental plans follow the “100-80-50” rule.

This rule means that the insurance company pays for 100 percent of checkups and cleanings, 80 percent of fillings and root canals, and 50 percent of crowns, bridges, and other major procedures. Similar to health insurance, the higher premiums you pay for dental/vision insurance, the lower your co-payments and deductibles will be; conversely the lower your monthly premiums are, the more you’ll pay in co-payments and deductibles. 

Is it required by the ACA?

As an adult, neither dental nor vision insurance is required. There is no penalty levied to qualified businesses that don’t offer employees dental or vision coverage. Similarly, there is no penalty for those individuals who don’t buy vision or dental coverage.

The ACA does require health insurance plans to extend vision and dental coverage to children who are 18 and under. This requirement, called pediatric services, is covered as one of the ten essential health benefits of the ACA. It is important to note that the insurer is required to offer pediatric dental and vision coverage, but the family is not required to purchase it.

How can you Purchase Dental or Vision Insurance?

There are two ways to buy either dental or vision insurance.

1. Through your health insurance plan – Some health care policies include dental and vision insurance as part of the whole plan. If dental/vision coverage is included in your health care insurance, you will pay one monthly premium for everything.

If you purchase a dental/vision plan through your healthcare insurance, you must wait until the next open enrollment period to cancel or modify your plan. You may add or cancel your coverage, if offered through your health insurance, outside of the open enrollment period if you qualify for a special enrollment period.

2. As a stand-alone plan – In many cases, an individual or family will purchase dental/vision coverage as a stand-alone plan, separately from their healthcare insurance. It has been estimated that 98 percent of dental benefits are provided through stand-alone policies.

Under a stand-alone plan, you will pay one monthly premium for your health insurance, and a separate one for your dental/vision plan. Stand-alone plans also offer you greater flexibility, as you can cancel your plan anytime during the year.

You may purchase a stand-alone dental plan through the Marketplace but will have to buy a stand-alone vision plan through an agent, broker, or online. Additionally, you cannot purchase a stand-alone dental plan through the Marketplace unless you’re enrolling in a health plan at the same time.

Group vs. Individual Coverage

If it is offered, you can find group coverage through your employer. Your respective employer chooses a plan and offers it to all eligible employees, who can purchase this coverage, if they want, at a discounted group rate.

Your monthly premium is then automatically deducted from your paycheck. Group coverage is accessible, as you don’t have to do any comparisons or shopping, and usually, gives you a much-discounted rate on your premium.

An individual plan is a dental/vision plan that you would purchase for yourself or your family. Buying an individual plan means you will be paying the entire premium by yourself and without any group discount.

Individual plans offer you a greater amount of freedom to choose from multiple different insurers and plan types. This freedom allows you to choose what benefits your dental/vision plan will cover. 

What are the Main Types of Plans?

Insurance companies offer dental and vision plans through PPO and HMO plans, just like they would for health insurance. In addition to these, it is also common to have an indemnity dental/vision plan.

Indemnity plans allow you to choose which dental or vision provider you prefer. There are no networks you have to adhere to, the insurance company pays an agreed upon portion of any services you use with the provider you select.