Lots of people find value in buying dental and vision insurance. These benefits can help reduce out-of-pocket costs for oral and vision care—and they may even increase the likelihood that you’ll seek such care.
Individuals with dental benefits are more likely to visit the dentist and have greater overall health, according to the National Association of Dental Plans. About two-thirds of Americans have private dental insurance, and many others access dental coverage through public programs such as Medicaid, the Children’s Health Insurance Program, Medicare Advantage, and Indian Health Services.
What else makes this coverage worthwhile for so many of us? How it works, what it costs, and who might need it can help explain.
Short term health insurance through Pivot Health offers you the option to add value-added dental insurance and vision coverage when you purchase a temporary health insurance plan, all at the time of application with no additional steps.
How dental insurance works
Dental insurance provides benefits that help lessen what you pay out of pocket for dental services. Benefits are commonly divided into three categories:
- Preventive, which includes things like cleanings, routine exams and X-rays.
- Basic, which includes things like fillings, root canals and simple extractions.
- Major, which includes things like crowns, implants, bridges and oral surgery.
Most dental plans cover preventive care at or near 100%, and then basic care is often covered at a higher percentage than major care. Typically, you can access preventive care benefits immediately—check your policy to confirm, of course. Some plans have a waiting period before benefits for other types of care will begin. (As you shop for insurance coverage, be looking for these details to help determine which plan will best meet your needs.)
When it comes to how they function logistically, dental insurance plans work much like like health insurance plans:
- You pay a premium to maintain coverage.
- Once you meet your policy deductible, your benefits will fully kick in.
- You will share costs with your insurer, paying coinsurance for services received or paying a copayment when you visit the dentist.
As with your health insurance plan, you will want to visit a provider who accepts your coverage. If your dental plan has a network (we’ll get to that soon), then you will want to visit an in-network provider to get the best rate.
When you arrive at your appointment, you’ll present your dental plan ID card. Your provider will submit the claim to your insurer; the insurer will pay the provider for the portion covered by your policy; and your provider will bill you for your share.
Dental plans have a benefit year or annual maximum—a cap on how much your policy will pay for covered services. If you need additional care after you meet this maximum, you will be billed for 100% of the cost.
What’s the average cost of dental insurance?
It’s tough to cite an exact amount when it comes to the national average monthly and annual dental premiums for individual dental plans.
There are individual plans on the market for less than $20 a month up to around $50 a month.
What you’ll personally pay for dental insurance depends on a number of factors including where you live, the insurance company you buy from, and the plan you choose. Generally speaking, the more insurance pays for covered services, the higher your premium and vice versa. In other words, you can expect to pay more for coverage that pays 60% coinsurance for fillings and less for coverage that pays 40%.
The best way to find out what dental insurance will cost you is to get a quote, which can be done online within a minute or two.
Dental insurance plans with and without networks
Some dental plans include provider networks — specific dentists who have contracted with a plan to provide care to its members. Others don’t. Some plans that include a network require you to seek in-network care. Others don’t.
Non-network plans — Commonly known as indemnity or fee-for-service plans, these will allow you to visit any provider. That means you can keep your preferred dentist. You are likely to pay a higher premium for this type of coverage.
Network plans — Dental plans with provider networks include dental HMOs and dental PPOs. As you’ve probably guessed, a network plan favors in-network care.
- With a dental PPO, benefits will be higher for in-network providers. You may still choose an out-of-network provider, but you will pay more for care.
- With a dental HMO, you will almost certainly be required to seek in-network care or pay 100% for out-of-network care.
Networks are an important consideration when you’re choosing a dental insurance plan.
If you already have a preferred dentist, you’ll want to see if that dentist is covered in-network for the plan you’re considering or find a plan without network restrictions. If you don’t have a preferred dentist, you may want to select a plan with a network because you may pay lower premiums and less for care.
Why dental insurance might be a good idea if your oral health isn’t stellar
When you’re someone who tends to visit the dentist for more than twice-annual cleanings, it’s probably wise to have dental insurance and maintain it over time.
For starters, the benefits can help reduce what you pay out of pocket for covered dental work once you meet your plan deductible (this may be around $50 for individual coverage—again, check plan details when shopping around). Otherwise, you’ll have to pay 100% for any dental services you receive—exams and cleanings as well as root canals, crowns, implants and more.
Additionally, you want to have access to benefits when you need them. Remember we mentioned waiting periods earlier? If you wait to buy for dental insurance after you begin experiencing symptoms of a dental problem, it could be too late. You probably don’t want to suffer through a six-month waiting period before you seek treatment.
Enroll in a dental insurance plan, and then stay enrolled year after year. That way you can put any requisite waiting periods behind you while your oral health is good. Then, when your tooth starts aching, you can schedule an appointment knowing you’ve got coverage in place and benefits that will kick in once you’ve paid your deductible.
Does Medicaid include dental insurance benefits?
Whether or not Medicaid includes dental benefits depends on how old you are and where you live. All states must provide dental benefits to children covered by Medicaid and the Children’s Health Insurance Program (CHIP). At a minimum, these programs must include coverage for children who need dental services for relief of pain and infection, restoration of teeth, and maintenance of dental health.
For adults age 21 and older, however, each state gets to decide what (if any) dental benefits for adults their Medicaid program will include. Most states include emergency dental services for adults, but less than half provide comprehensive dental coverage.
If you are an adult enrolled in Medicaid, you’ll need to check what dental benefits your state’s program includes. Otherwise, you may want to look into a private dental plan—gather a few online quotes to see what options are available and how much they’ll cost. Additional ways to access affordable dental care may include dental schools, clinical trials, or free or reduced-cost clinics through your state or local health department.
Do you need dental insurance if you are on Medicare?
Traditional Medicare excludes dental services, with the exception of certain dental services covered by Medicare Part A when you’re in a hospital.
And while some Medicare beneficiaries have access to dental coverage through Medicare Advantage plans and other sources, nearly two-thirds of the Medicare population have no dental coverage at all.
If you’re among those 37 million beneficiaries without dental coverage, you may want to look into group dental benefits for seniors or private dental insurance. There are many individual dental plans that will cover adults over 65, but some may not. You’ll want to gather a few online quotes and see what is available where you live.
Why vision insurance is also valuable
A vision plan can help lessen what you pay out of pocket for eye exams as well as corrective lenses and frames. Benefits and how they are covered will vary by plan, of course. Some may stick to the basics while others may extend to the treatment of eye diseases or surgery.
Furthermore, some vision plans utilize a network, while others don’t. If you already have an eye doctor and want to continue care through them, make sure they accept your vision plan. If you’re considering a vision plan with a network, be sure your preferred eye doctor part of it.
As with health and dental insurance premiums, vision insurance premiums will typically increase with the level of benefits. If you enroll in a more comprehensive plan, you can expect to pay more for coverage; whereas, if you enroll in a plan that helps with the basics, you can expect to pay less. You may also find dental and vision benefits bundled together, which could be financially beneficial. You’ll want to compare your options and crunch the numbers to see what makes the most sense.
Even if you don’t have vision problems that require correction right now, vision insurance can be helpful. In addition to helping cover the cost of an annual eye exam, it may encourage you to get one. In addition to catching vision problems, which tend to increase with age, an eye exam may help detect cataracts, glaucoma, age-related macular degeneration, and other conditions so they may be treated early.
Are dental and vision insurance worth it?
In addition to adults on Medicaid or Medicare, others who might consider individual dental and vision insurance beneficial include those who are:
- Self-employed.
- In between jobs.
- Without access to employer benefits.
- In college don’t have coverage through a parent or don’t have access to coverage with network providers where they attend school
Beyond life circumstances, it’s probably worthwhile to find a plan you like and enroll if:
- Paying for dental and vision benefits encourages you to stay on top of preventive care (e.g., routine exams, dental cleanings).
- You want to know you have coverage for more expensive services if you need them.
You can buy dental and vision coverage year-round, and there are lots of options available. If you need help comparing your options or deciding what best suits your needs, talk with a licensed health insurance agent.
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