By Trish Pearson
Insuring Your Future
Trish Pearson
Many clients ask about dental and vision insurance when choosing an individual or senior insurance plan. Usually they have had one or both of these coverages through their employer or group health insurance. The cost under the group plans is relatively low, as the insurer’s risk is spread over a number of people, whereas in individual plans all the risk is concentrated on one person.
Here are some things to consider about individual dental plans. First, there are waiting periods before comprehensive treatments are covered such as fillings, root canals and crowns. Cleanings and x-rays are generally covered right away.
Second, the plans have an annual maximum for how much they will cover. The range generally is $1,000 to $3,500, but there is still a cost share for the insured. The plans generally cover 50 percent of the more expensive procedures and up to 80 percent for fillings.
Third, many plans have networks, which means the dentist must participate in order to use the insurance. Some plans will allow you to go out of network and get reimbursed, or the dentist can process the claim and then “balance bill” the patient if the negotiated amount is less than they charge for a given procedure.
Most Medicare Advantage plans include some dental coverage ranging from cleanings only to comprehensive services up to a certain amount. There is no additional cost. Some Medicare Advantage plans also offer a dental plan that can be added on to medical coverage for a nominal cost. There are also dental plans available through the Access Health CT – the state health exchange – which are not overly expensive and provide coverage for cleanings and x-rays as well as comprehensive services.
Remember, no plan covers all dental costs; there is generally a 50 percent cost share up to a specified maximum.
Vison plans are another benefit that many are used to having as part of their employer plan at a minimal cost. While individual plans are still relatively inexpensive, they are really savings plans. Medical insurance covers the visit to the optometrist or ophthalmologist just as any other specialist. Vision insurance provides some cost share for lenses and frames.
It is important to read the fine print on these plans as some require that the client go to specific providers and only cover certain brands of frames. Vision plans are cost-effective if there is a family with a variety of eyewear needs, such as prescription sunglasses, contacts, glasses and other prescription eyewear. Otherwise, consider the cost of a pair of glasses and how often you replace them. Vision insurance is actually a budgeting tool to protect you from a big expense at once. Alternatively, you can use funds in an HSA account to cover these expenses.
Before signing up for dental or vision insurance, consider how you would use the benefit based on your dental and eyewear needs as opposed to keeping the monthly premium and paying out of pocket if necessary.
Trish Pearson is a licensed independent insurance agent and certified long term care specialist. Contact her at 203-640-5969 or trishpearson281@gmail.com.