Dental and Vision Insurance
Routine dental and vision care sits outside most medical plans, and outside Original Medicare entirely. A standalone plan is how that gap gets closed.
The gap these plans fill
Adult dental and vision care is usually not part of a medical plan. Cleanings, fillings, crowns, eye exams, glasses and contact lenses are generally paid out of pocket unless you buy separate coverage for them.
This surprises people most often at 65. Original Medicare, meaning Part A and Part B, does not cover routine dental care or routine vision care. It does not pay for cleanings, fillings, extractions, dentures, eyeglasses, or the exam that measures you for them.
Where the gap shows up
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Original Medicare does not cover routine dental or routine vision care. It pays for dental work only in narrow circumstances tied to another covered medical procedure.
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Some Medicare Advantage plans include a limited dental or vision benefit. The amount, the annual cap and the network vary a great deal from plan to plan, so read yours rather than assume it.
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Many employer medical plans cover children's dental and vision but not the adults on the plan.
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Individual medical plans generally include pediatric dental and vision as an essential health benefit, but adults are on their own.
Check your dentist before you check the price
Dental plans work best when your dentist is already in the network of the insurance company. Network dentists have agreed to lower negotiated fees, and that is what keeps the premium down.
So the order matters. Look your dentist up first, then look at plans. Carriers generally offer both kinds of plan, and the plan name tells you which is which. It is worth two minutes in the provider directory before you compare a single premium.
How to look your dentist up
This takes about two minutes and it decides which plans are worth pricing at all.
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Start on the carrier site. Ameritas find a dentist and Delta Dental find a dentist are the two we use most. Both open a provider search you can run yourself.
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On the Ameritas site, look to the lower right hand corner of the page and click Find a Dentist. That opens the network search.
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Type in your dentist's name and your area. If your dentist is listed, the network plans are open to you. If you do not have a regular dentist, or you are willing to change, use the same search to find one who is in the network.
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Do the same on the Delta Dental site before you decide. The two carriers have different networks, and a dentist who is out of network with one is often in network with the other.
The plan name rule
If your dentist is listed in the network, look for plan names with the word network in them. Those dentists have agreed to lower negotiated fees, which means the premium is less. It must actually say network in the plan name.
If your dentist is not listed in the network, look for dental plans without the word network in the name. These plans cover expenses for dentists who are not in the network, and they cost more because of it.
That single word in the plan name is the difference between the two kinds of plan, and it is the thing most people miss when they compare on price alone.
Then apply
Once you know which kind of plan you are looking for, the rest is short.
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Applying is quick and it is done online through the carrier's own system.
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You can pay by credit card, which for some people means earning travel mileage on the premium.
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You can apply for a vision plan through the same system at the same time. There is no need to start over somewhere else.
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If you would rather not do it alone, tell us who your dentist is and we will run the network checks and walk the application through with you.
How dental plans are usually built
Dental coverage follows much the same shape from carrier to carrier. Once you know the shape, comparing plans gets a great deal easier.
Preventive care
Exams, cleanings and routine x-rays. This is the tier plans cover most generously, often in full, and it is frequently exempt from any waiting period.
Basic services
Fillings, simple extractions and similar routine repair work. Plans usually cover a share of the cost and leave the rest to you.
Major services
Crowns, bridges, dentures, root canals and oral surgery. These are covered at the lowest share, and they are the services most likely to carry a waiting period before the benefit begins.
Two features that decide whether a plan is worth it
The annual maximum. Most dental plans cap what they will pay in a calendar year. Once you reach the cap, the rest of the year is yours to pay for. Compare caps, not only premiums.
Waiting periods. Many plans require you to hold the coverage for a set number of months before major work is covered. If you already know a crown is coming, this is the first thing to check.
Orthodontics is frequently excluded from adult plans altogether, or offered only as an add on with its own separate lifetime maximum.
What a vision plan usually covers
Vision plans are built around a benefit period rather than a percentage, so read them by the calendar as much as by the price.
The routine eye exam
A routine exam with a participating provider on a set schedule, usually for a small copay. This is the part that catches problems early, and it is the part Original Medicare does not cover.
Lenses and frames
Most plans cover lenses on a set schedule and give you an allowance toward frames, with anything above the allowance paid by you. Upgrades such as progressive lenses or anti glare coatings are usually offered at a set discount.
Contact lenses
Plans typically offer an allowance toward contacts instead of glasses in a given benefit period, along with the contact lens fitting. You generally choose one or the other, not both.
Medical eye care is not the same as routine vision care
If you are being treated for an eye condition such as glaucoma, cataracts or diabetic eye disease, that is medical care. It is generally handled by your health plan or by Medicare, not by a vision plan.
Medicare does cover cataract surgery, and it covers one pair of corrective lenses afterward. A vision plan is for the routine exam, the glasses and the contacts, which is exactly where Medicare stops.
Questions worth asking first
Ask us these, or ask the carrier. Either way, the answers are what separate two plans that look identical on price.
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Is my dentist, or my eye doctor, in this plan's network?
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What is the annual maximum the dental plan will pay?
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Is there a waiting period, and which services does it apply to?
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How are preventive, basic and major services covered, and at what share of the cost?
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Is there a deductible, and does it apply to preventive care?
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For vision, how often are exams, lenses and frames covered, and what is the frame allowance?
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If I already have a Medicare Advantage plan, what dental and vision does it include, and would a standalone plan overlap with it?
Which carriers we look at
If you are looking for an excellent dental plan, or a vision plan, we most often recommend Ameritas and Delta Dental . Both offer good coverage at reasonable prices and have broad dentist networks on the Central Coast.
That said, the right plan is the one your own dentist accepts. If the directory points you somewhere else, we will tell you so.
Want help picking a dental or vision plan?
Tell us who your dentist and eye doctor are, and we will check the networks before you compare a single premium.