Ask any dentist, they'll tell you the first thing people notice about you is your smile. The same can probably be said about your eyes if you asked an optometrist. Keeping a photo-fresh smile and sharp eyes can help improve your overall wellness — including how healthy your wallet can be.
Going to a doctor may feel like a chore, and many people avoid checkups. Maybe it's because they don't feel like anything is wrong at that time. Or maybe it's because they're concerned about the costs of medical, dental or vision services. Whatever the reason, avoiding preventive care may have negative financial and physical impacts down the road.
How does dental insurance work?
Dental insurance plans can vary. Like health insurance, you have the same basic parts like premiums, benefits and out-of-pocket costs. With dental insurance, there are some differences. Let's focus on the main types of coverage options: Dental Health Maintenance Organizations (DHMO) and Dental Preferred Provider Organizations (DPPO).
DHMO plans typically use a dentist as a primary dental care provider in a network. They work as the quarterback for your care and would refer you to a specialist as needed. DHMO plans usually cover preventative care like cleanings and exams with no out-of-pocket costs and typically provide a set fee for non-preventive dental work. Plans may not require a deductible and may offer a low copayment for services. In some cases, the network of dentists can be limited, and coverage may not be available outside of your plan network.
DPPO plans offer more flexibility of dentists as you can choose the provider you want, whether it's for a routine need or if you want to go directly to a specialist. But if the dentist isn't in the plan network, you may pay a higher cost for care and possibly seek reimbursement from your coverage if your dentist doesn't accept your insurance. DPPO plans typically have a higher premium, require a deductible and may have a yearly cap on benefits your plan offers. The flexibility of who to receive care from and when may be appealing for people who choose a DPPO plan.
There are several other plans, such as indemnity plans, which give you a specific limited benefit amount for covered services like emergency care. Employers typically offer either the DHMO or DPPO variety of plans.
How does vision insurance work?
Vision insurance, like dental insurance, comes in different plan types. Vision benefits plans and vision discount plans are the most common types of coverage available. Vision benefit plans will typically offer coverage for preventative care, routine visits and exams and a series of discounts on contacts and glasses. Some costs associated with surgical procedures may be covered as part of these plans as well.
Vision discount plans offer the same scope of benefits, but the amount of coverage or the number of visits covered by the plan may be limited. Vision discount plans also may have a network of providers and may not be as flexible as the vision benefit plan variety.
Vision care is primarily for keeping healthy vision or correcting vision issues. Where medically needed surgeries or accidents that affect your eyes occur, it most likely will be something that would involve your medical insurance.
Where to get coverage
Dental and vision insurance are offered mostly through employer benefits or cafeteria plan arrangements as optional coverages.
Outside of employer-provided benefits, dental and vision insurance can be purchased directly through the health care exchange, private insurance companies or through different group associations. These could include a doctor's association or small business owner group.
Military dental and vision options
Active-duty military members receive dental and vision care through TRICARE. If you retired from the service, you recently went through a decision on where to get your dental and vision benefits. In 2018, TRICARE ended the TRICARE Retiree Dental Program and opened enrollment availability in the optional Federal Employees Dental and Vision Insurance Program, or FEDVIP.
FEDVIP offers dental and vision insurance plans as an enrollee-pay-all program, meaning you won't receive any subsidy or offset toward your plan's premium costs. Plans and benefits can vary. If you're shopping for dental and vision insurance, you'll need to ensure that you're eligible for FEDVIP benefits.
Most private dental and vision insurance plans offer continuous enrollment, although you may have a short waiting period before your plan benefits can be used.
Preventive dental and eye care benefits
Having dental and vision insurance may make it easier for some to take steps to be preventative with their health. But not all dental and vision plans work the same way.
Some plans work like traditional insurance where you pay a premium and cover costs up to a certain amount like your deductible or out-of-pocket limits. Your insurance then covers the rest.
Other plans may provide coverage for preventive services like checkups or cleanings. They then provide a limited benefit toward more critical things like dental work or more extensive vision treatments.
What are the costs?
Dental and vision plans are typically high use. If this describes your situation, then the cost of paying out of pocket far outweighs the cost of adding these plans. The average cost per month for a dental plan is about $40 for a 37-year-old male in Texas. If you self-insure and schedule the recommended number of visits to the dentist, your out-of-pocket costs may be about $400 a year just for maintenance. Tack on unexpected expenses, where your costs could be upward of $1,000, and it all makes sense.
It's the same with vision. You can expect a plan to cost about $20 a month, as opposed to nearly $600 for eyeglasses and an eye exam without insurance coverage.
If you have kids, signing up for these plans is an easy decision. The amount of people on your plan is going to increase the probability that you'll use the insurance.
With these plans, ask yourself a simple question: “Would I rather save the money each month and hope nothing happens, or be covered in case something does?” For most people, it's the latter.
Steps to getting coverage
1. Determine your needs and wants.
Whether you're looking for coverage for just you or for your family, it's important to consider what you need to have covered based on your health history or concerns, and how you want your plan to work. Consider the differences between DHMO and DPPO plans and how you want to receive care when needed.
2. Consider the total cost of your plan.
We naturally look for the best bargain, but it's important that you compare both costs and benefits during your search. Look at premiums, copays and benefit limits across any plans you're considering. Also, review specific benefits like allowances for frames or contact lenses as well as maximum annual limits allowed by your plan. Make sure you can budget for or have savings to help offset out-of-pocket costs.
3. Call your doctor's office or search for a provider.
If you have a dentist or eye doctor that you visit or know of a provider that you want to start seeing, ask them about what insurance provider options they work with or if they're networked with a plan that you're considering.
Explore your dental and vision coverage options.