By Trish Pearson
Insure Your Future
Trish Pearson
As with most insurance plans, the answer to whether dental and vision plans are worth the cost is “it depends.” Factors to consider include your dental and vision needs, how many people need coverage and what kind of medical insurance you have.
Group dental insurance is much less expensive than individual plans because the risk is spread over all the company’s enrolled members. Medicare Advantage plans often include some dental and vision coverage at no additional cost.
Individual insurance plans do not include dental or vision coverage, but it can be purchased separately. Most dental plans cover preventative care at no additional cost. However, any other procedure is covered on a cost share basis. For instance fillings might be 60-80 percent covered and root canals or crowns at 50 percent. Also, all dental plans have an annual maximum coverage amount. This means once they have paid that specific amount, any additional out-of-pocket cost is the patient’s responsibility.
How often do you go to the dentist? If dental needs are limited to cleanings and preventive care twice a year, consider the cost of cleanings versus the premium. Most plans cover cleaning completely, but the annual premium could equal the cost of cleanings.
Does the dentist accept the plan? Not all dentists accept every insurance plan. Check to find out if he/she is in network or will process the claim for you. Also, check whether the dental plan is a PPO, which will allow for coverage out of network, or an HMO plan, which will not.
Many stand-alone dental plans have waiting periods. This means you must pay the premium for a specific number of months before they will cover expensive procedures such as root canals, crowns or extractions. The dental coverage that is part of Medicare Advantage plans does not have waiting periods.
Is the employer contributing to the premium or is it part of a voluntary benefit package? If covering a family, it is generally worth purchasing the group dental insurance, especially if there are dependents who need orthodontia care.
Eye exams are covered under most health insurance plans. Generally, it is considered a specialist visit with the corresponding copay. In some cases, the vision provider will also bill for specific items such as contact lens fitting or refraction (glasses prescription).
Stand-alone vision plans include some additional coverage for the annual exam, thereby reducing the net out-of-pocket cost. A vision plan will also cover a portion of the cost of glasses (lenses/frames) or contact lenses.
As with dental insurance, check to see if you need to go to a specific provider or vendor to purchase eyewear. Medicare Advantage plans generally offer a nominal amount toward the cost of frames/lenses either on a reimbursement basis or at the point of sale depending on the benefit plan.
While the premium for vision plans is generally nominal, it is a monthly expense, which when totaled up might equal the cost for a pair of glasses.
In both cases it is important to do the math before purchasing.