Dental & Vision Insurance
Dental Insurance for Individuals and Families
Dental Insurance is not just offered as an employee benefit through work. You might choose your own dental plan if…
if you are age 65 and over and covered by Medicare and supplemental insurance (Medicare and most supplemental plans do not cover dental)
If you are self-employed or a small business owner and must choose your own insurance coverages
If your employee benefits package through work does not include dental insurance
Three Details to Note When Considering Dental Insurance
What is the Annual Benefit Maximum?
The most important benefit of a dental insurance plan is the “annual benefit maximum” which is the most an insurer will pay toward your dental costs in a year. After the annual benefit maximum is met, you are paying for all dental costs until the year is up. A higher annual benefit maximum signals a more benefit-rich plan.
How are Endodontics (Root Canal) Covered?
Insurance companies decide how each dental service is covered in their plan. Look carefully at Endodontics (having a root canal). Most insurers place Endodontics in the Major services category, but others place Endodontics in the Basic services category, ensuring less cost for you!
Is Your Favorite Dentist In Network?
If the dentist you wish to visit is in-network there are many reasons this means the dental insurance plan will be more beneficial to you. Insurance companies do have searchable databases of their network at their corporate web site, so we can see which plans count your dentist as in-network.
We Offer Dental Insurance from Many Companies, Including…
These are just a few of the dental carriers we represent.
The Basics of Dental Insurance Benefits....
Insurance companies’ plans differ in the details, but most plans follow a model of grouping benefits into 3 categories; preventative, basic and major.
Preventative Services in Dental Insurance Plans….
usually include those “six month visits,” the dental exam, x-rays, and teeth cleaning. Preventative services can also include flouride treatments and sealants for children and teenagers. Though there are always exceptions, dental insurance covers preventative services at 100%.
Basic Services…
usually include extractions, fillings and stainless steel crowns. Basic services, depending on the dental insurance plan, are usually covered at either 60%, 70% or 80%, after any deductible on the plan is met.
Major Services…
usually include porcelain crowns, dentures, bridges, endodontics (root canals), oral surgery, inlays and onlays. These dental services are covered at 50% by a majority of dental insurance plans, after any deductible on the plan is met.
Annual Deductible
Some dental insurance plans contain an annual deductible you must pay before benefits begin. Note that this annual deductible does NOT apply to preventative services. But if you utilize basic or major services you would pay the dental costs up to the deductible amount (usually $50 or $75), then the insurer would begin to pay their percentage of benefit for ongoing dental services.
Annual Benefit Maximum
All dental insurance companies have an annual benefit maximum, which simply means the most benefit the dental insurer will pay towards your dental expenses in the year. The standard annual benefit maximum is $1,000 per covered person, though some plans feature higher amounts ($1,250 or $1,500). If you meet your annual benefit maximum in the plan year, the dental insurance company pays nothing more toward your dental expenses until the new plan year begins.
Understanding Dental Insurance Networks
Understanding how your dental insurance plan works with provider networks can help you maximize the benefit, meaning less out of pocket cost for you. First, understand that there are two main types of dental insurance plans in regards to networks:
Indemnity / PPO Plans
The majority of dental insurance plans allow you to visit any dentist you wish, and plan benefits will be valid and applied. There is still a network, and if your dentist is in network, they have agreed to lower costs when you visit
HMO / Network Specific Plans
There are dental insurance plans that are network specific, meaning that you must visit a dentist in network to receive any of the dental insurance plan’s benefits. If you visit a dentist out of network, no benefits apply.
We recommend and offer Indemnity / PPO plans. It is nice to know you can continue to utilize the dentist you feel comfortable with. When recommending dental plans to customers we research and figure out which plans count your dentist as “in network” so you can take that factor into consideration. Why is it so important that your dentist is in network?
If your dentist is in network:
the dentist will file your claims for you with your dental insurer, only expecting you to pay them your portion of the cost. Out of network dentists can ask for payment in full, with you having to file dental claims and wait for reimbursement via mail.
the dentist offers you, a member of the insurance plan, lower rates (than their posted regular, retail rates) on dental services the insurance company has negotiated. These lower rates for services saves both you and the insurance company money. An example, if your dental insurance plan pays 80% of the cost of a filling, and you pay 20%, it would benefit you to pay 20% of $165, the negotiated, lower rate of a filling performed by your dentist, rather than 20% of $225, the dentist’s regular charge for a filling.
Vision Insurance
Vision Insurance for Individuals and Families.
If you do not have access to vision insurance through your employer, no worries! You can choose your own vision insurance plan, And insurance companies have built their individual vision insurance plans with the same benefits and networks as vision insurance offered through work.
Why Do You Need Vision Insurance?
A Yearly Eye Exam is Good for Your Health
A yearly eye exam with an optometrist not only gauges your eyes’ health, but also helps look for signs of other conditions such as high blood pressure, diabetes, cancer, and other conditions. And since most health insurance plans no longer cover annual eye exams, vision insurance can help you cover the cost.
Our Eyes are Working Overtime Looking at all of Those Screens
We spend so much time with our phones, computers, and other screens. And that can cause digital strain and excess UV light exposure to even those of us with the best vision. An eye exam with a professional can help you protect your eyesight for years to come.
Glasses and Contacts Are Not Cheap
Have you recently bought a pair of glasses? Wanted a name brand pair of frames? Ray-Bans? Coach, Oakley, etc. They can be expensive! Vision insurance helps you cover the cost of needed glasses or contacts, and also offers discounts on other vision services such as LASIK vision correction and sunglasses.
Benefits of Vision Insurance
Each vision insurance plan’s benefits are slightly different, but each of the available plans follow a pattern of four main benefits:
Pays For An Annual Eye Exam (Once Per Year) After Your Copay
Each of us, whether or not we wear glasses or contacts, should have an eye exam each year. Vision insurance plans pay for this annual exam with you just paying a $15, $10 or even $0 copay (the plan we find we recommend the most has a $0 copay for eye exams). If you do not wear glasses or contacts, you can choose a lower priced plan that only covers eye exams.
Pays for a Majority of the Cost of Your Contacts
Vision insurance plans pay up to a certain allowance toward an annual supply of contact lenses (many plans set the allowance at $150), with you paying the remainder of the cost, if any (and at discounted costs if you can utilize an in-network provider).
Pays for a Majority of the Cost of Your Glasses (frames and lenses)
Vision insurance plans divide the cost of prescription glasses into two parts, the lenses and the frames. Vision insurance plans cover the cost of lenses, with you paying a copay based on the type of lens ($25 copays for many lens types). Frames are covered up to a certain dollar amount, many plans pay $150, with you paying the remainder, if any of the cost above that.
Offers Big Discounts on Other Vision Services
Though not directly covered by the plan other vision services you may need are offered to you at discounted prices by in-network providers and optical shops; including extra pairs of prescription glasses, or sunglasses, LASIK, and retinal imaging.
Vision Networks
Vision Insurance offers benefits whether or not your provider is in their network or not. But it really benefits you if your provider is in-network.
The good news is that vision insurers have built strong, expansive networks with plenty of independent and small town providers, and also the brand name providers like Target Optical, LensCrafters and Pearle.
If your vision provider or optical shop is out of network…
The insurance plan will still pay toward eye exams, glasses and contacts. The amount of benefit will just be less than if your provider was in network. It is also important to understand that the provider has not agreed to lower costs for their services, and may ask that you pay up front for the claim and be reimbursed by the insurer.
If your vision provider or optical shop is in network…
The insurance plan will pay the maximum amount toward your eye exam, glasses and contacts. Any part of the cost remaining for you to pay may be lower, as the in network provider has agreed to lower than their usual retail cost for services and vision hardware. The provider will file your claim.
Free Dental and or Vision Quote
Complete the form below and we will send you ideas of dental insurance to consider from a few insurance companies. We will compare the plans’ benefits and costs, and recommend what looks best based on your preferences.