Dental/Vision Plans

If you only have health coverage through Original Medicare, you may be concerned that your benefits do not include dental or vision coverage. To get such coverage, you will have to seek out and enroll in a qualified plan that offers the benefits you need. Dental and vision insurance are not required by the Affordable Care Act, therefore you don’t have to worry about facing penalties for not buying coverage.

What Are Dental and Vision Plans

Oral and eye health are often overlooked by consumers who are thinking about health insurance. Still, a dental or vision plan can offer extremely helpful coverage that helps you maintain your overall health. Here’s what you need to know about dental and vision insurance.

Why Do You Need Dental And Vision Insurance

Dental and vision insurance is often essential, especially as you grow older. Vision insurance is important because it allows you to receive eye care affordably. With routine eye exams, you may be able to detect a number of different serious medical conditions, including diabetes and hypertension. Likewise, oral exams and routine care can help you manage a wide range of different health conditions. For example, the inflammation caused by periodontal disease can contribute to cardiovascular disease down the road. By getting routine dental treatments, you can prevent periodontal disease and limit the strain on your body.

How Does Dental Insurance Work

In exchange for monthly premiums, dental insurance will provide you with coverage that helps you pay for dental services. There are two major categories of dental insurance; basic coverage and full coverage. Basic plans cover preventive care services, like cleanings, x-rays, and a few other basic procedures, like cavity fillings.

Full coverage, on the other hand, covers far more services and can significantly decrease your out-of-pocket costs for dental care. Though, full coverage typically has much higher premium costs than basic coverage. But the cost is usually worth it, because full coverage plans often cover a wider range of preventive dental treatments, including fluoride treatments and sealants.

With full dental coverage, you may have access to the following major benefits:

  • Basic restorative care – Coverage will help pay for fillings, extractions, and non-routine X-rays.
  • Major restorative care – Coverage will help pay for bridges, crowns, dentures, and other major procedures.
  • Orthodontic treatment – If you need teeth alignment procedures, these benefits will help pay for braces and other types of teeth aligners.

Provider Networks

When it comes to dental insurance, there are typically only two basic varieties being offered by insurance coverage. They are Dental HMOs and Dental PPOs. There is a third option, called Indemnity plans, but they are uncommon.

Dental HMOs are dental insurance plans that restrict policyholders to only seeing providers that are within their plan’s network. Most HMO networks are quite limited, so it is difficult to see the same dentist regularly, but in exchange, you typically face lower costs and the plans have simpler fee structures.

Dental PPOs also have a network of dentists, but they are far less restrictive than HMO plans. Your PPO plan will typically let you seek care outside of the network, but doing so may come at a higher cost. If you choose a larger insurer, you may be able to find a plan that includes your current dentist within their network as well.

If you have an HMO, you don’t really have the option to see out-of-network dentists, but if you have a PPO, the choice is yours. Though, we suggest you always try to see in-networks providers, because your insurer negotiates discounted fees on your behalf.

Cost of Dental Insurance

Dental insurance requires plan participants to pay a range of out-of-pocket costs, like coinsurance, deductibles, and premiums. Premium costs vary from plan to plan, but the average American pays approximately $360 a year for dental insurance. Averages may be different in different states. Most plans also have a maximum annual benefit, that marks the maximum amount you are allowed to receive per year. In most cases, this limit will range from $1,000 to $2,000. This limit can be met quite quickly, so be sure to prepare for additional out-of-pocket costs if you need a serious dental procedure.

How Does Vision Insurance Work

Vision insurance is another form of insurance that works just like any other type of insurance; you pay monthly premiums in exchange for access to essential benefits. There is a difference between the way vision insurance works and the way dental insurance works. Vision insurance will help you pay for routine exams that are not covered by most medical plans, and it also helps policyholders pay for glasses and contact lenses. Yet, serious procedures, like non-elective surgery to fix an eye injury, are not covered. Instead, you will have to leverage another form of coverage to pay for such treatments. Because of this difference, vision insurance is often incredibly affordable.

What Do Vision Plans Cover?

Overuse of digital devices can cause eye strain, so many Americans suffer from symptoms like poor eyesight. Chances are you’ll need vision correction at some point in your life, and vision coverage can help make vision correction affordable. With vision coverage, you can have the following products and procedures paid in part or in full.


Buying glasses without insurance can be expensive, because you need to purchase the frames and the lenses. If you opt to choose contact lenses, those may cost less upfront, but over time the costs compound. Insurance can help you make sure that you always have the eyewear you need to keep your vision protected. Some insurance plans also cover coatings that can be added to your eyewear, such as anti-scratch, fog and moisture, and reflective coatings.

Corrective Surgery

As stated before, medically necessary eye procedures are normally covered by health insurance plans. Corrective surgeries, like LASIK eye surgery, are not. Therefore, if you wish to receive a corrective surgery, your vision insurance plan may help pay for it. Keep in mind that only some plans include this benefit, so check with your provider before signing the contract.

Cost of Vision Insurance

Vision insurance is very inexpensive, with average costs ranging from $5 to $15 a month. Adding coverage for a family member may result in lower per-person costs. Each plan covers a different set of expenses, so check with your provider to determine what your monthly premiums pay for and whether you have to pay deductibles or coinsurance for services rendered.

Get Qualified Eye and Oral Insurance Coverage

There are countless vision and dental insurance policy options, so get help sifting through them. Trust the insurance professionals at Legacy Peace Of Mind, Inc to help you find the coverage you need. If you want to start collecting quotes on vision or dental insurance, get in touch with one of our agents.

If you have any additional questions related to Medicare, our team of Colorado Medicare experts is happy to help you. Contact us at 970-233-0063 today.