Vision insurance is designed to help you cover and budget for ongoing vision care expenses like routine eye exams, prescription glasses and contact lenses.
Are you looking for vision insurance, or eye insurance? We have plans that feature:
Coverage for people of all ages
No waiting periods
Saving through a national network of vision service and eyewear providers
Freedom to go out of network and still get benefits if you pay the difference between your plan allowance and your final cost
The Two Types of Plans
Dental and vision coverage can come in two different forms.
The first is much like a traditional health insurance plan. You’ll have a monthly or annual premium (the fee for coverage), a deductible (the amount you have to first pay out of pocket before the insurance starts kicking in), and copayments or coinsurance (your share of a doctor’s bill).
These types of vision or dental insurance plans can operate as HMOs, PPOs, or indemnity plans.
In an HMO, you’ll have a primary care physician (PCP) along with a network of physicians and dental or medical facilities approved by your insurance provider. You’ll receive your dental or vision care from those offices as directed by your PCP.
With a PPO, you are not restricted by a PCP and have some more freedom to visit physicians and facilities outside of the network.
Indemnity plans reimburse the customer for services rendered once a claim is submitted to the insurance provider.
An alternative to traditional dental or vision insurance is joining a discount program. Here’s how it works:
You pay a monthly or yearly fee, just like you do with health insurance.
This fee grants you access to a pool of discount offers. Think of the fee as the cost of a “membership” to a club where all the members receive discounted dental or vision services.
Once you’re in the “club,” you can then choose from the selection of discounted services as needed.
Those without the discount plan can receive the same services from the same physicians and facilities, but will have to pay the “rack rate” for those services instead of the discounted rate enjoyed by the program members.
People with vision insurance are twice as likely to schedule a routine eye exam as those who do not. And according to Dr. Burt Dubow, a St. Cloud, Minnesota optometrist, “a very thorough eye exam will catch eye disease and discover health issues you may not have known you have, such as high blood pressure, diabetes, even brain tumors.”
What Vision Insurance Covers
Like health insurance, vision insurance can aid with the cost of examinations, treatments, prescriptions, surgical procedures, and equipment. Some of the things most commonly covered by vision insurance plans include:
Eye exams. This preventive care measure is generally performed once a year and involves a series of tests to gauge the health of your eyes across several different parameters. The things tested for during an eye exam can include the sharpness of your vision, color blindness, how your eyes work together as a unit, a presence of glaucoma, your range of peripheral vision, and more. Eye exams can be instrumental in providing an early detection of eye disease, any developing vision problems, or a need for corrective lenses.
Eyewear. Glasses (frames and lenses alike) and contact lenses can be expensive but are often at least partially covered by vision insurance. Some vision insurance plans may limit coverage to eyewear purchased through your optometrist or a network-approved vision center. Sometimes, even prescription sunglasses may be covered.
Lens coatings and enhancements. Some vision insurance plans can help with the cost of a lens coating. Lenses can be coated with substances to decrease scratching, fog and moisture, reflections, and exposure to ultraviolet rays.
Surgery. Surgeries that are deemed medically necessary, such as a procedure to treat an eye injury, infection, or disease, will often be covered by a health insurance plan. But corrective surgery, such as LASIK, is generally not covered by health insurance because it is deemed by many insurance providers to be an elective or “cosmetic” surgery. However, there are some vision insurance plans and discount programs that will partially cover such elective procedures.
Dental insurance often comes in the form of “100-80-50.” This means that the insurance provider pays for 100 percent of the cost of preventive care (such as cleanings and routine checkups), 80 percent of the cost of basic procedures (such as fillings or root canals), and 50 percent of the cost of more advanced procedures (such as bridges or crowns).
What Dental Insurance Covers
These services, in order from the most basic of care (widely covered by dental insurance) to the more advanced (not as widely covered) include:
Preventive care. Routine dental exams and cleanings typically take place every six months and are covered in full by most dental insurance policies.
Restorative care. Restorative care consists of any minor procedures to treat damaged or decayed teeth, such as fillings.
Endodontics. More advanced damage or decay will require more involved procedures like root canals.
Oral surgery. Common oral surgeries include teeth removal, the drainage of infections, and gum tissue biopsies.
Orthodontics. This includes the installation, maintenance, and removal of braces and retainers.
Periodontics. Periodontics involves the treatment of gum disease, infections, and lesions.
Prosthodontics. Fittings and installations of dentures and bridges can be expensive, and you will need a quality insurance policy to help alleviate this cost.
The Cost of Not Having Dental Insurance
Many people avoid the dentist simply because they don’t like going. Others stay away because they don’t enjoy the cost. In fact, some 108 million Americans do not have dental insurance, according to the U.S. Department of Health and Human Services.
But the ones that do will incur many of the same out-of-pocket expenses as regular health insurance, including premiums, deductibles, and copayments or coinsurance.
While this may seem like a burden, it can pale in comparison to the cost of some dental care services without insurance.
Listed below are some average shelf prices for common dental services.
Exams (including x-rays and cleaning) = $288
Fillings (single, silver-amalgram filling) = $50 to $150
Tooth extractions (non-surgical, gum-erupted) = $75 to $300
Crowns (single resin) = $328
Root canals (single, exposed) = $120
Vision and Dental Insurance in the Workplace
Under the Affordable Care Act, companies with at least 50 employees are required to provide group health insurance for their employees or face a penalty. However, vision and dental insurance are not required as part of this mandate.
As a result, vision and dental insurance benefits granted by an employer-sponsored plan are the exception, not the rule. In fact, only 53 percent of companies that offered health insurance in 2014 provided any sort of dental benefits, and only 35 percent of such companies offered vision insurance.
Meanwhile, according to a benefits trend study conducted by MetLife, the two most popular voluntary benefit programs for employees are vision and dental insurance.
Vision and Dental Insurance for Children
While vision and dental insurance for adults is not a requirement of the Affordable Care Act, vision and dental benefits for children is a required benefit offer under all plans that qualify as “minimum essential coverage.”
This means that all children under the age of 19 enrolled in individual, family, and small group health insurance plans must be offered basic and preventive care for vision and dental.
Vision and Dental Insurance Through Medicaid
Dental insurance. Just like the Affordable Care Act, federal Medicaid guidelines only require dental benefits be made available to children. Some states have their own dental requirements for adults under Medicaid, while others do not offer dental insurance to adults at all.
Vision insurance. Medicaid offers coverage of eye exams, frames, and lenses to children under 21, but it’s up to each individual state to determine how much—and how often—the coverage is offered.
Many state Medicaid programs offer similar coverage for adults and some states even provide coverage of glaucoma testing and treatment and even cataract surgery.
Original Medicare (Part A and Part B) typically does not provide vision or dental benefits but many Medicare Advantage plans do.
If this all seems complicated, contact us and we can help you understand your options today.
Where to Get Vision and Dental
Contact us today to get started on your way toward better vision, better oral health, and bigger savings.