Health Insurance

A Guide to Understanding Vision and Dental Insurance Plans

Without vision and dental insurance, exams and procedures may be costly, and reviewing your dental and vision options may help you save money if an emergency occurs.

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As with any medical emergency, you need insurance coverage to avoid paying out-of-pocket expenses and treatment. However, this applies to dental and vision coverage as well. Dental and vision services could cost tens of thousands of dollars without insurance. Alternatively, should you elect not to purchase insurance for vision and dental your quality of life could significantly suffer. Oral infections can be excruciating, while poor vision inhibits your ability to work and even causes migraines.

Unfortunately, even with health insurance, you must purchase vision and dental insurance separately from your health plan. Luckily, when it comes to vision and dental coverage, there are many options to fit your needs and budget. Read on to learn more.

Types of Vision and Dental Plans 

There are two different ways that you may get vision and dental plans. The first way is getting them traditionally through your HMO, PPO, or Indemnity plan. The second way, also known as an alternative, is signing up for a savings plan with your provider. 

Traditional

Traditional health insurance plans may have a monthly or annual premium, deductible, copays, or coinsurance. However, within that framework, several different options operate independently, differentiated mainly by the variety of healthcare professionals you have access to and the pricing model:

  • HMO Plan: With an HMO plan, you may only go to in-network medical and dental facilities with which your insurance provider works. 
  • PPO Plan: A PPO plan allows more freedom to choose your providers, regardless if a physician is out-of-network. However, it may be more expensive because of the variety. 
  • Indemnity Plan: This is a fee-for-service plan with your insurer covering a percentage of your service. An indemnity plan may cover up to 80% of the costs, leaving you paying the rest of the 20% of the cost. You may visit any doctor or physician you would like with this plan.

Alternative 

If you want an alternative to traditional health plans, consider joining a local health clinic’s dental or vision savings plan. To get reduced-price treatment, many need to pay a regular fee (monthly or annually). Those fees act as savings accounts to pay for vision or dental procedures from a local network of providers.

Compared to traditional insurance, the alternative option has no waiting period and no restrictions for individuals with preexisting conditions to receive care. 

How Does Vision Insurance Work? 

Vision insurance helps cover the cost of eye exams, cosmetic eye surgery, and glasses or contact lenses. You may purchase vision insurance through your employer or by yourself. This insurance is not as costly, as premiums range from $6 to $43.

Vision insurance often gives you an allowance to spend on glasses once or every other year. For example, if you see an in-network provider, your insurance may let you spend $120 on new glasses. If you go out-of-network, you may be reimbursed for what you paid to the provider. 

Depending on your selected plan, standard copays for vision insurance range from $10 to $20

What Does Vision Insurance Cover? 

Vision insurance provides coverage for:

  • Eyewear: Vision insurance covers eyewear, such as class, contacts, and occasionally prescription sunglasses.
  • Eye exams: Routine eye exams happen once a year to assess the health, sharpness, and range of your vision. 
  • Lens coating and enhancements: Depending on which vision plan you choose, you may be covered for lens coating. Lens coating decreases scratches, fogging, and exposure to ultraviolet rays. 
  • Surgery: Surgeries due to eye infection or injury are deemed medically necessary and may be covered by your health insurance. However, your health insurance may not cover a procedure labeled as corrective surgery, such as LASIK. In this situation, vision insurance may cover corrective or cosmetic surgery that pertains to the eye. 

What Does Vision Insurance Cost? 

In 2022, the average monthly premium for an individual with vision insurance could range between $6 to $14 and $20 to $43 for a family plan. Copays and deductibles may vary from plan to plan. To compare plans, you may click here and compare up to four plans of your choosing. 

Below is a table of 2022 costs with and without vision insurance for eye exams, glasses, contact lenses, and eye surgery.

ProcedureCost without insuranceCost with insuranceSavings
Routine Eye Exam$50 to $250$0 to $20 copay$30 and more
Eyeglass framesAverage of $187 in 2022.You pay up to $90$90 and more
Contact Lenses$35 to $80, depending on whether your contacts are daily disposables or yearly.You pay up to $100$100 and more
Medically Necessary Eye Surgery$3,500 to $7,000 per eyeThe cost depends on your health insurance plan.

How Does Dental Insurance Work? 

If you have a plan, you must pay the premium to the insurance company each month, usually deducted from your paycheck if provided by your employer. Like standard health insurance, you have a primary dentist that you may see for any oral problems. The primary dentist then refers you to specialists if needed. 

Also, like health standard insurance, you must reach your deductible before coverage begins. After meeting your deductible, you may only have to pay a fixed copayment or a percentage of the bill when you go in for a check-up or procedure. Annual deductibles may range from $50 to $100, and 50% coinsurance after meeting your deductible. 

What Does Dental Insurance Cover? 

Dental insurance covers: 

  • Preventative care: Routine dental exams and cleanings that happen every six months.
  • Restorative care: Minor procedures such as treating damaged or decayed teeth. 
  • Endodontics: Treating advanced damaged or decayed teeth, such as root canals. 
  • Oral Surgery: Surgeries such as teeth removal, gum tissue surgery, and treating infections. 
  • Periodontics: The treatment of lesions, gum disease, and infections.
  • Prosthodontics: Fittings and installations of dentures and bridges. 

What Does Dental Insurance Cost? 

In 2022, the average monthly premium for an individual with dental insurance could range between $21 to $60 and $58 to $180 for a family plan. Copays and deductibles may vary from plan to plan. You can compare up to four plans of your choice.

Below is a table of 2022 costs with and without dental insurance for dental exams, fillings, root canals, and denture installations.

ProcedureCost without insuranceCost with insuranceSavings
Routine Dental Exam$70 to $20050% coinsurance$35 and more
Filling$150 $2,000, depending on which filling you choose50% coinsurance$75 and more
Root Canal$700 to $2,10050% coinsurance$350 and more
Denture Installation$1,500 to $1,800$500 copayment 50% to 70% coinsurance$750 and more

Dental and Vision Costs Without Insurance 

You could pay $70 to $200 without insurance for a dental exam. While that may not seem like much initially, remember you should see a dentist every six months. Likewise, vision exams range from $50 to $250

For emergency dental services, you may have to pay between $150 and $2,000, depending on what you need complete. Vision insurance may cover surgeries considered cosmetic, such as LASIK. Your health insurance may cover medically necessary eye surgeries. However, you may have to pay $3,000 and more out-of-pocket if you do not have health insurance.

Depending on your glasses and contact lenses, your vision may change throughout the year, necessitating a new prescription. You may be able to find cheap prescription glasses and contacts; you will be paying out of pocket for them.

How To Get Vision and Dental Insurance 

There are different ways to get vision and dental insurance, often through your employer, online, or Medicare and Medicaid

Employer 

Your employer may offer dental and vision insurance to you and your family. An employer’s vision plans cover routine exams, glasses, and contact lenses.

For dental insurance, you may choose to have a basic plan or add more coverage. A basic plan covers cleaning, exams, fluoride treatment, and fillings. You may add more coverage to cover oral surgery, implants, and root canals. 

Individual 

You may enroll for dental and vision insurance by phone or online. If you search for a policy online, you can easily compare plans and premiums.

Medicare and Medicaid

Neither Original Medicare nor Medigap offer dental and vision insurance. If you have a Medigap plan, you may have to purchase dental and vision insurance separately. However, Medicare Advantage offers dental and vision coverage as part of their coverage.

Medicaid covers all dental services for those who are 21 and under. For those 21 and over, Medicare may limit what they may cover depending on which state you live in. For example, in Michigan, Medicare may only cover dental check-ups, teeth cleaning, x-rays, fillings, and dentures.