Dental and Vision
Dental and vision insurance are two types of insurance that cover specific areas of healthcare. While they are not typically included in traditional health insurance plans, they are important for maintaining overall health and wellbeing.
Dental Insurance
Dental insurance is designed to cover the costs associated with dental care, such as routine cleanings, fillings, and other dental procedures. It can also cover more complex procedures like orthodontics and dental surgery.
Typically, dental insurance plans follow a structure known as “100-80-50”. This indicates that the insurance company covers the entire cost of preventive care (such as regular cleanings and checkups), 80% of the cost of basic procedures (such as fillings or root canals), and 50% of the cost of more complex treatments (such as bridges or crowns).
average family dental premium in Oregon
What Dental Insurance Covers
Supplemental dental insurance can be beneficial in covering a wide range of services, from basic care to advanced surgical procedures. Dental insurance often follows the 100-80-50 model, where the insurance provider covers 100 percent of the cost of preventive care, 80 percent of the cost of basic procedures, and 50 percent of the cost of advanced procedures. The coverage you receive from your dental insurance plan depends on the level of procedure needed, with advanced procedures receiving less coverage.
Dental services range from the most basic, such as routine dental exams and cleanings, to the more advanced, such as root canals, extractions, and gum tissue biopsies.
- Preventive care, such as routine dental exams and cleanings, is usually covered in full by most dental insurance policies.
- Restorative care, such as fillings, is considered a minor procedure and falls under basic care.
- Endodontics, which involves root canals and other procedures for advanced damage or decay, requires more involved procedures.
- Oral surgery, including teeth removal, drainage of infections, and gum tissue biopsies, is another advanced procedure.
- Orthodontics, which covers the installation, maintenance, and removal of braces and retainers, also requires coverage. Periodontics, which involves the treatment of gum disease, infections, and lesions, and prosthodontics, which covers the fittings and installations of dentures and bridges, can be costly, and a quality insurance policy is needed to help alleviate this expense.
Vision Insurance
Vision insurance covers the cost of vision-related services, including eye exams, glasses, and contact lenses.
Vision insurance typically covers the cost of annual eye exams, as well as glasses and contact lenses. Some plans also include coverage for more complex procedures like LASIK and other refractive surgeries.
average family vision premium in Oregon
What Vision Insurance Covers
Similar to health insurance, vision insurance can help reduce the cost of eye-related services such as examinations, treatments, prescriptions, surgical procedures, and equipment. Vision insurance plans commonly cover the following services:
Eye exams: Vision insurance usually covers the cost of annual preventive eye exams, which include a series of tests to evaluate various aspects of eye health such as visual acuity, color blindness, peripheral vision, and more. These exams can be critical in detecting early signs of eye disease, vision problems, or the need for corrective lenses.
Eyewear: Prescription glasses (frames and lenses) and contact lenses can be costly, but vision insurance plans often provide partial coverage for these expenses. Some plans may restrict coverage to eyewear purchased from an optometrist or a network-approved vision center, while others may cover prescription sunglasses as well.
Lens coatings and enhancements: Certain vision insurance plans may help cover the cost of lens coatings that reduce scratches, fog, reflections, and UV exposure.
Surgery: Health insurance plans typically cover medically necessary surgeries for eye injuries, infections, or diseases. However, elective or cosmetic surgeries like LASIK are often not covered by health insurance. Some vision insurance plans or discount programs may provide partial coverage for such elective procedures.
The cost of vision insurance can vary depending on the provider, the type of plan, and the coverage options. According to data from a prominent vision insurance provider in 2015, a vision insurance plan with an annual premium of $204 may provide the following cost savings:
- Eye exam: $15 copay (savings of $45)
- Eyeglass frames: $25 copay (savings of $55)
- Single vision lenses: $0 copay (savings of $65)
- Bifocal lenses: $30 copay (savings of $70)
- Contact lenses: $150 allowance (savings of $150)
It’s important to note that these numbers may have changed since 2015, and costs may vary based on the specific plan and location. Overall, vision insurance can be a helpful investment for those who require regular eye care or corrective lenses.
The Two Types of Plans
Dental and vision insurance are available in two different forms: traditional and alternative.
The traditional form of dental and vision insurance operates much like a traditional health insurance plan. You will pay a monthly or annual premium for coverage, and you will also have a deductible that you must first pay out of pocket before the insurance starts to pay for your care. You will also have to pay copayments or coinsurance, which are a portion of the cost of the services you receive.
These types of insurance plans can be offered as HMOs, PPOs, or indemnity plans. With an HMO, you will have a primary care physician (PCP) and a network of approved physicians, dental or medical facilities. You will receive your dental or vision care from those offices as directed by your PCP. With a PPO, you have more freedom to visit physicians and facilities outside of the network. An indemnity plan reimburses the customer for services rendered once a claim is submitted to the insurance provider.
On the other hand, the alternative to traditional dental or vision insurance is joining a discount program. You will pay a monthly or yearly fee, which will grant you access to a pool of discounted offers for dental or vision services. It is like being a member of a club where all the members receive discounted services. Once you are a member, you can choose from the selection of discounted services as needed. Those who are not part of the discount plan can still receive the same services from the same physicians and facilities but will have to pay the regular rate for those services instead of the discounted rate enjoyed by the program members.
FAQS
Q: What does dental insurance typically cover? A: Most dental insurance plans cover preventive care such as cleanings and routine checkups, as well as basic and major procedures such as fillings and root canals.
Q: What does vision insurance typically cover? A: Vision insurance plans typically cover eye exams, eyeglasses or contact lenses, and sometimes other services like lens coatings and enhancements.
Q: What are traditional dental and vision insurance plans? A: Traditional dental and vision insurance plans operate similarly to traditional health insurance plans, with a monthly or annual premium, a deductible, and copayments or coinsurance.
Q: What are alternative dental and vision insurance options? A: An alternative to traditional dental or vision insurance is joining a discount program, which offers discounted rates for dental or vision services to members who pay a monthly or yearly fee.
The Bottom Line:
Dental and vision insurance can be a valuable investment for maintaining your overall health and well-being. With dental insurance, you can receive coverage for preventive care, restorative care, endodontics, oral surgery, orthodontics, periodontics, and prosthodontics. With vision insurance, you can receive coverage for eye exams, eyewear, lens coatings and enhancements, and sometimes corrective surgery. Whether you choose a traditional insurance plan or a discount program, dental and vision insurance can help you save money on these important health services.