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What Coverages Are Typically Included In A Dental and Vision Insurance Plan?

Dental and vision insurance is almost always considered separate from standard “health insurance.” That’s true even if you have an employer-supplied health insurance plan. In some cases, you can even opt-out of your dental and vision insurance to save money.

The separation between dental, vision, and “all the rest” can be very confusing. After all, there are many Floridians who have been visiting the eye doctor once a year or so since they were young. It truly is puzzling why your eyes or teeth are different from the rest of your health.

Luckily, it’s not that they matter less, but that the business behind them is different:

  • Millions of people never go to the dentist, due to dental anxiety or for other reasons.
  • Some lucky people won’t need to go to the eye doctor until they are in their 50s or 60s.

Separating the coverage types is a way of making it more convenient for everyone – those who have no interest in these insurance products don’t end up paying for them by accident. In fact, even if you get an ACA marketplace health insurance plan, you’ll still find this separation.

But there are lots of good reasons to get dental and vision insurance. Sometimes, people choose to get this insurance as a way of making certain that their children or spouse will be covered. Everyone’s needs are different, and those needs are sure to change over time.

So, even if you’ve never had dental and vision insurance before, it’s a wise idea to take a closer look from time to time and see if it might benefit you.

The first question most people ask is exactly what kind of coverage they can expect from these policies.

What Coverage Will You Get in a Standard Dental Insurance Plan?

Bear in mind that all insurance policies are a little bit different. Any two dental plans won’t necessarily cover the same things, even if you would pay a similar monthly premium. But there are some standards that many dental insurance products cover.

1. Access to Basic Preventive Care for Adults

In many dental insurance plans in Florida, you are covered for 100% of the costs of a standard dental exam, including the X-rays necessary to evaluate the health of your teeth. You can access this kind of coverage once a year. If you need more than one exam in a year, you will usually pay full price.

A dental cleaning is a usual follow-up to an exam. Everyone should get a dental cleaning done at least once a year, whether or not they have cavities or other dental problems. This is covered under most policies’ basic preventive care clause, and is usually 100% covered once a year.

100% coverage isn’t universal, however, and you might pay 50% or 25%.

If all you ever need is basic preventive care, you might have zero costs out of pocket for your dentistry. But what if you need more advanced treatment? By and large, any dental insurance policy you choose will cover more intensive treatments. Precisely how much they cover will differ.

For example, imagine that your dentist discovers you have gingivitis, an early form of gum disease. This is managed with a treatment called “planing and root scaling,” which can eliminate the infection. It is a minimally invasive procedure, but it takes specialized equipment and anywhere from one to three hours.

Many dental insurance plans will have a flat rate for the amount you pay out of pocket for “advanced” procedures, no matter whether they relate to your teeth or gums. So, in this example, you might find that the standard cost of planning and root scaling is $250, and end up paying $125 with insurance.

The same approach would apply to other procedures, like filings.

2. Access to Enhanced Dental Care for Kids

Children age 18 and under and covered by your dental insurance may be able to access services that are not provided to adults. In some cases, pediatric dentistry treatments may be covered at a reduced rate because early care will help prevent dental complications in the future. This usually takes the form of enhanced coverage for braces.

Limits to Standard Dental Insurance

1. Little or No Orthodontic Coverage

It’s vital to remember that orthodontics is separate from dentistry. If you have a dental insurance plan, it does not necessarily cover the cost of braces or alternatives such as Spark or Invisalign. You will usually be expected to pay fully out of pocket for treatments like these, though there may be exceptions.

2. In-Network Coverage Only

It’s also worth mentioning that, just like most health insurance plans, the majority of dental plans specify a set of in-network practitioners you can visit. All of the potential savings associated with your plan will require you to visit an in-network dentist. If you have to see a dentist outside your network, you will usually pay 100%. There may be provisions in some plans to partially cover emergency services.

3. Annual Coverage Limits

While some treatments can only be covered once a year, there is also a grand total of coverage that you cannot exceed for a given year. When you exceed the coverage limit, you will have to pay for additional dental care wholly out of pocket until the end of the calendar year.

What Coverage Will You Get in a Standard Vision Insurance Plan?

1. Basic Preventive Care

Just like with dental insurance, vision insurance is built around the idea of reduced-cost preventive care that virtually anyone will benefit from. This typically includes full coverage of one eye exam per year. It does not necessarily cover an eyeglass prescription – getting one may incur an extra fee.

If you do require glasses, one helpful part of vision insurance is that you will be able to access some frames at reduced costs. These tend to be more functional than stylish, and they can be covered up to 100% depending on the details of your plan.

More advanced treatments are minimally covered or not covered at all. For example, laser eye surgery is not considered medically necessary and would not be part of a standard vision insurance plan. Other eye surgeries required to protect or restore sight may be partially covered.

2. For Seniors, Enhanced Cataract Care

People aged 65 or older are at enhanced risk of developing cataracts, a cloudy film over the lens of the eye that inhibits vision. The lens of the eye can be removed and replaced with a clear alternative. This is an extremely common procedure often covered for seniors.

When you’re looking for personal insurance, a local health insurance broker is the best ally you can have. Whether it’s dental and vision insurance, whole life insurance, or anything else, a local health insurance broker is on your side – providing impartial advice to help you make the right decisions.

In Central Florida, you have options. Contact us today to find out more.