Considering Adding an Individual Dental or Vision Insurance Plan?

Revised on January 31, 2023

Here Are Tips to Help You Evaluate Your Decision.

Are you considering adding coverage for dental and/or vision? If so, there are a few things to consider before deciding whether it’s worth it to enroll, and if so, which plan to enroll in. Let’s start with the basics of these kinds of plans which may help you evaluate your decision. 

Dental Insurance Basics

Dental insurance helps cover the cost of dental care, such as checkups, cleanings, x-rays, and other dental procedures. Like health insurance, in addition to a monthly premium, you’ll generally have some cost-sharing responsibility for services such as co-pays or co-insurance and deductibles. Many plans offer preventative care coverage (such as checkups and cleanings) with little or no out-of-pocket costs when using in-network providers. Dental plans typically have a maximum benefit amount that they will pay out annually. Many plans also have waiting periods or offer limited coverage in the first year for major dental work.

Vision Insurance Basics

Vision insurance is similar to dental insurance, but it helps cover the costs associated with routine vision care, such as eye exams, lenses, frames, contact lenses and more. Most vision plans also offer discounts on eyeglasses or contacts at certain retailers. Like dental plans, many vision plans also pay for preventative care with little or no out-of-pocket cost when using in-network providers and have an annual maximum benefit amount that they will pay out over the course of the year. Note that any medical eye problem, like an eye infection or glaucoma typically is covered under your medical insurance plan, and not a vision plan. 

Understanding Your Cost-Sharing Obligations

Both dental and vision plans typically contract with a network of providers. With HMO plans, you’ll need to use providers that are “in-network” for services to be covered. Keep in mind that cost-sharing may still apply for covered services. PPO plans include coverage for services for both in and out-of-network providers, but usually have higher cost-sharing for out-of-network providers.

It’s important to understand that although a plan’s summary of benefits may show it covers 100% for both in and out-of-network providers, it is actually covering 100% of the plan’s “allowed amount” for out-of-network providers and not necessarily 100% of the cost. For example, if an out-of-network provider charges $200 for a covered service, and the plan covers 100% of the “allowed amount”, which let’s say is $100 for this example, you’ll be responsible to pay the outstanding balance of $100. In-network providers agree with the plan to charge a pre-negotiated rate so if a service is covered at 100%, you can expect the full cost of the service to be covered, except for any annual deductible that may apply. 

Plans typically have a search function on their website where you can find a list of in-network providers for a specific plan within a specified search radius. It’s also a good idea to contact your preferred provider and confirm if they are in network with the plan prior to enrolling or obtaining services.

Understanding the Plan Benefits 

Be sure to review the plan’s summary of benefits and terms and conditions to understand cost-sharing and what the plan will and will not cover. While plans may appear similar, you’ll want to compare not only premium, cost-sharing, annual plan maximum and the list of covered services, but also the frequency the plan allows for certain services to be covered. Plans may apply waiting periods and/or increase coverage annually up to a maximum. 

Making a Decision

The security of having dental and/or vision insurance may be important to some, but others may prefer to pay for services out-of-pocket as needed. Both dental and vision plans can help reduce costs associated with care, but when it comes to choosing a plan, it’s important to consider what type of coverage you might need and what fits into your budget best. You can enroll in a stand-alone dental and/or vision insurance plan or in some cases, add it as an optional “buy-up” package with a Medicare insurance plan. 

Speak to a licensed insurance agent to learn more.