What is dental insurance?
It doesn't just cover cavities and cleanings; it can lower your costs every time you visit the dentist. Dental insurance can also help ensure you don't end up with costly bills when you need more extensive dental work.
What is vision insurance?
It provides coverage for routine eye exams, as well as offering discounts on eyeglasses and contacts. These benefits are not typically covered under major medical plans and may not be included in your overall wellness checkups.
People often overlook oral and eye health – but they're essential to our overall wellbeing. Many serious conditions can be detected early by an eye exam, including diabetes, high cholesterol, and hypertension.1 Oral exams can be just as revealing: More than 90% of all common diseases have oral symptoms.2 And the importance of oral health goes beyond detection: Guardian studies3 – and other third-party research – show that good oral health can help adults avoid or better manage serious health-related issues:
- Diabetes Periodontal infections contribute to problems with glycemic control, which compromises the health of diabetic patients.
- Heart disease The inflammation associated with periodontal disease has a high potential to contribute to coronary artery disease. Good oral health can lower that risk.
- Pregnancy Studies have indicated that mothers with high levels of certain oral bacteria were found to have children with similarly high levels of bacteria, along with a higher risk of tooth decay.
- Self-esteem Research shows that healthy teeth and gums are important to a person's self-esteem and feelings about themselves.
It's hard to consider yourself a healthy and happy person when your eyesight is impaired, your mouth hurts, or you're worried about what's happening with your teeth. But affordable dental insurance and vision insurance can help you avoid all that!
Most dental care is preventive: checkups, cleanings, and simple procedures like X-rays and fillings that catch little problems before they become bigger problems. So dental coverage focuses on preventive and basic procedures – and one way to help lower the cost of coverage is by getting a plan that only offers those benefits. But if you or someone in your family needs more comprehensive services, "full coverage" dental insurance could be a better value. Full coverage plans typically cover more types of preventive and basic restorative procedures (such as fluoride treatments, extractions, and non-routine X-rays). These plans can also cover major restorative care, such as bridges, crowns, dentures, and the like. Have kids with crooked teeth? Plans with orthodontic coverage options are also available -- and they can help save you money by covering portion of the costs for braces and other types of teeth aligners.
Most plans have a provider network
Dental provider networks come in two basic varieties: Dental HMOs and Dental PPOs. In a DHMO, you have to see a network dentist – and because their networks are limited, you probably won't get to see your current dentist. The trade-off is generally lower costs and a simpler fee structure. A DPPO also has a network of dentists, but insurance companies typically let you go outside the plan. And if your coverage is from a large insurance company like Guardian, with a broad provider network, you may find that your current dentist is in the PPO.
Care costs less when you use a network dentist
In a DHMO, you're only covered when you see a network dentist. But what about a DPPO? Even though you go can outside of the network, it's almost always worth your while to see a network dentist because you'll get the PPO discount: insurance companies negotiate discounted fees on your behalf, and the savings can be substantial (the average Guardian discount is 36%). For example, if your dentist typically charges $100 for a particular treatment, with the discount, you may only be charged $60-$70.
How to lower out-of-pocket costs
The out-of-pocket cost you owe for a given treatment or service may vary widely depending on the insurer and specific plan you choose. Generally speaking, they will be lower in a DHMO plan than a DPPO plan, but look at the “Plan Summary” for a list of costs and complete details. Here are the different kinds of out-of-pocket expenses you can expect to see, with tips on how to help lower them:
In a DPPO plan, there's usually a deductible of about $50 for an individual or $150 for a family – it's the amount you have to pay before the plan starts to cover treatments other than checkups. To avoid that cost, choose a DHMO plan because they typically don't have deductibles.
This is the percentage of costs you owe for a visit or treatment once you've met your DPPO plan deductible. In a 80/60/40 plan, the insurance company pays 80% for preventive care, 60% for a basic procedure and 40% of the cost for a major procedure, and you are responsible for the rest. If you choose a 100/70/50 plan, your coinsurance will be that much lower. DHMO plans don't have coinsurance, but you will typically have a copay amount to pay for each service received.
- Annual maximums
DPPO plans usually cap the total amount they will cover for services in a given year, and you are responsible for anything over this maximum amount. If you think you'll need a lot of dental care, look for a plan with a higher annual maximum, or choose a DHMO because they typically don't have maximums.
Vision plans provide coverage for routine eye care exams not covered by most medical plans. But unlike dental insurance plans, they also provide discounts on the eyeglasses and contact lenses you need to correct vision problems. And you'll find that the plans are typically very affordable.
75% of us need vision correction4 – so even if you have 20/20 eyesight now, chances are you'll need correction at some point in your life. Adults and children alike should have an annual eye exam to test for such things as sharpness, color blindness, how the eyes work together, the presence of glaucoma, peripheral range, and more. For a few dollars a month, a vision plan can make annual eye exam services more affordable while also helping lower the expense of other types of eye care:
- Eyewear. Glasses (frames and lenses) and contact lenses can be expensive – but are often partially covered by vision insurance. Sometimes, even prescription sunglasses may be covered.
- Lens coatings and enhancements. Some plans can help with the cost of lens coatings that help decrease scratching, fog and moisture, reflections, and exposure to ultraviolet rays.
- Corrective surgery. Surgeries deemed medically necessary, such as a procedure to treat an eye disease, are typically covered by a medical plan and not by a vision plan. However, corrective surgery such as LASIK is generally not covered by a medical plan because it is deemed to be elective or "cosmetic" surgery. However, some vision plans will partially cover these procedures.
If you or your spouse have dental and/or vision benefits through work, that's almost always the way to go. The employer may pay the premium, or these plans may be offered as a voluntary benefit, which means the employee pays the entire premium. Either way, you'll may come out ahead since companies typically get low group rates, and voluntary benefits let you get coverage at significantly lower rates than individual dental coverage.
If that's not an option, you can easily see how much it can cost to buy dental and vision plans online direct from an insurance company. For example, Guardian offers both DHMO and DPPO plans, and with over 114,000 dentists in the Guardian PPO network, you may well be able to keep your current dentist through Guardian Direct®. We also offer VSP, one of the nation's largest vision network.
Finally, if you're a senior on Medicare, take a look at Medicare Advantage plans that offer dental and eye care benefits not covered by regular Medicare.
Who has the best dental and vision insurance?
It's hard to say who has the best dental insurance plan because no single plan is right for every person. For example, there is almost always a trade-off between cost and dentist choice. A DHMO plan will typically cost less, but with a limited number of dentists available, you probably won't get to stay with your current dentist. On the other hand, if you are comparing dental or eye care plans from two different insurance companies, you might want to go with the plan that offers a larger number of dentists and vision providers.
Does medical insurance cover vision and dental?
Health insurance coverage typically does not provide benefits for routine dental and eye care services, nor do they offer discounts for things like eyeglasses. However, medically necessary, non-cosmetic procedures to treat issues like eye disease will typically be covered in a health care plan. Also, Affordable Care Act (ACA) compliant health insurance plans purchased on an exchange must include dental and eye care benefits for children, but that is not required for adults.
Is dental and vision covered under the Affordable Care Act?
As noted, ACA-compliant health care plans on a health care exchange include pediatric dental benefits. You may find some medical plans that include dental benefits, and you may also be able to find a stand-alone dental plan on the exchange – but you have to purchase an exchange medical plan first.
Which is better, dental insurance or a dental discount plan?
A dental discount plan doesn't provide coverage for dental costs; it just makes certain discounts available if you use one of their dentists. By comparison, a quality Dental PPO plan will typically provide the same or better discounts when using in-network providers, but you may also get checkups and cleanings covered at 100%. A full-coverage DPPO will also help cover portions of major procedures such as crowns and bridges and may even cover orthodontic care.