As an experienced individual/family health insurance broker, throughout my career I have encountered a lot of misconceptions and confusion about dental and vision plans, what they cover and what value they provide. 

Frankly, unless a client insists on having a dental and/or vision plan, I do not recommend them. This may sound odd or counterintuitive for an insurance broker, but because I always strive to give honest and practical advice, I can’t make a case for individual dental and/or vision plans providing any real value to consumers. 

Let’s go over the basics of dental and vision plans and compare the coverage they provide with what they cost. As you’ll see, if we do some simple math, it becomes clear that they are not always what they seem. This information is simply intended to help you make a more informed decision about your healthcare-related expenses. 

What do Dental and Vision Plans Cover?

Many people incorrectly assume that dental and vision services are included in their health insurance plan. However, both dental and vision plans are their own standalone coverage that can be purchased at will even if you don’t have health insurance. 

While medical conditions relating to the eyes or mouth are included with health insurance in most cases, health plans expressly exclude coverage for routine dental work and vision services for corrective lenses. 

In general, dental plans will provide coverage for routine dental work and some additional services, but only up to the coverage limit. Vision plans offer savings for eye exams and glasses or contacts. Let’s go over the components of dental and vision plans to better understand the coverage they offer. 

Network – This is the network of dentists that participate in the plan’s network. If you want to see a dentist who’s not in the plan’s network, you may receive reduced coverage but most often no coverage at all. 

Deductible – This is what you must pay out-of-pocket before the plan covers anything. A typical deductible for a dental plan ranges from $50-$100.

Waiting Periods – Most dental plans require waiting periods when you are first enrolled. These waiting periods are generally between 6 months to a year depending on the service before the plan will cover anything. 

Coverage Limit – All dental plans will have a coverage limit, which is the maximum amount the plan will cover each year. A typical coverage limit for a dental plan is $1,000, with some plans offering up to a $2,000 limit.

Preventative Services – Preventative services such as the twice-yearly recommended cleaning/checkup are typically covered at 100% up to the coverage limit. X-rays, fluoride treatments, and other services may or may not be included in the preventative benefit depending on the plan. 

Basic Services – Basic services are things such as fillings, basic extractions, and denture adjustments. These services are covered by a percentage, such as 60% up to the coverage limit. 

Major Services – Major services include things such as services requiring anesthesia or sedation, crowns, oral surgery, periodontics, endodontics, etc. These services are typically covered at a small percentage, such as 15% up to the coverage limit. 

Due to the high costs of many dental services, even with a dental plan, there will still be a significant amount of expenses left after the plan coverage limit is reached. 

Vision plans are much more basic in what they cover. These plans only offer benefits for services related to corrective lenses. If you have perfect 20/20 vision or don’t need corrective lenses, there is no need for a vision plan. Below are the basic components of the average vision plan. 

Annual Eye Exam – With a vision plan, an annual eye exam is covered at 100% or by a small copay with in-network providers. 

Eyeglasses and Contact Lenses – Most vision plans offer a simple cash benefit to be used towards the cost of eyeglasses or contact lenses. This benefit typically ranges from $150-$200

How Much Do Dental and Vision Plans Typically Cost?

People who are offered dental and/or vision coverage through their employer, which is bundled with their health insurance will have nominal rates of as little as $3-$10 per month. This is not the case if you don’t get coverage through your job and have to find coverage on your own. Rates for individual/family dental and/or vision plans vary, but in general, the rates are fairly similar across different insurance companies for comparable coverage. 

A typical dental plan with a $1,000 coverage limit may be anywhere from $15-$40 per month for a single individual. For a vision plan, they are generally around $10 per month for a single individual. 

Rates are naturally higher the more family members are added to the plan, and if it has a higher coverage limit. 

So, Are Dental and Vision Plans Even Worth It?

When thinking about dental and vision coverage, it’s important to know they do not operate like traditional insurance, which operates on the principle of indemnification. They operate under more of a discount model. 

Indemnification is the principle that insurance uses to return a policyholder to their financial state before they experienced a catastrophic event that resulted in an insurance claim, thus mitigating a financial hardship. This is how health insurance works, as it can pay for thousands and thousands of dollars of medical expenses in the event of a major illness or injury. This is money that the average person simply would not be able to come up with on their own, which is why they purchased an insurance policy. 

In the case of dental and vision plans, they have very small coverage limits and due to the high cost of many dental services, there is still a big bill left over after the plan pays its share. 

For example, the average cost for a crown can be between $1,500-$2,000 per tooth depending on the type of material used. Tooth extractions can range anywhere from $250-$800. Root canals can range from $1,000-$1,500. It’s easy to see how quickly one could reach their coverage limit, and most services are only covered by a percentage with a dental plan. 

This goes to show the small coverage limits that dental plans provide don’t go a long way and at the same time, you’re unlikely to even be entitled to your limit. Now, let’s do some math. 

Let’s say a single individual has a dental plan with a $1,000 coverage limit and pays $20 per month for their plan. That’s $240 per year just to buy $1,000 of coverage. Is there some value in this? A little, but not much, especially considering you’ll likely never be able to access the full $1,000. What makes matters worse is you have to use a dentist that’s in-network, which isn’t always an easy task, especially if you have a dentist you already like and want to keep seeing. 

The same is true for vision plans. For $120 per year, you get an annual eye exam for free or for a small copay and a $150-$200 benefit for contacts or eyeglasses. Not much left to work with is there? Consider instead that I have seen eyewear companies and optometry offices advertise eye exams for as little as $60 with substantial discounts for eyeglasses and contacts if you shop with them. 

So, are dental and vision plans worth it? I say no, especially if you can save a little bit of cash and self-pay. If you can save $1,500-$2,000, you’ll have access to more money than any dental and vision plan would ever pay and you can see whatever dentist you want, go anywhere for an eye exam, and shop for eyeglasses and contacts anywhere. 

While most people can’t save hundreds of thousands of dollars to protect themselves from medical expenses in place of a health insurance plan, most people can save a couple thousand dollars in a relatively short amount of time. It’s very attainable to set aside some money to self-pay for dental and vision services. 

What Are the Benefits of Doing Self-Pay For Dental and Vision Services?

There are many benefits to doing self-pay, or “paying cash” for dental and vision services. In my opinion, as we have discussed, I believe it’s a more simple and cost-effective option than paying for a dental and vision plan. These benefits include:

Cutting out the middleman – you can pay your dentist or optometrist directly, which may give you access to significant cash discounts and better pricing. 

No network restrictions – If you self-pay instead of using a dental and vision plan, you won’t be restricted to the plan’s network, so you can see any dentist or optometrist you want. 

Dental and vision expenses are HSA eligible – If you have an HSA (Health Savings Account), dental and vision expenses are permitted to be paid for by your HSA. This allows you to use your tax-free HSA contributions towards your dental and vision expenses instead of paying for a plan.

No deductibles or coverage limits – Without a dental and vision plan, you can just use your own money that you’ve put aside instead of going through the hassle of submitting claims to your plan and having to overcome all of their restrictions. It’s a much more stress-free process to self-pay and it will save you more money in the long run. 

Conclusion

While you’re not risking much by opting to purchase a dental and vision plan, you should at least know they are not what they seem and don’t provide a substantial value. If you can put away a little bit of savings, you’re better off in many cases without being held to the plan’s many restrictions.

Unlike health insurance, dental and vision plans aren’t set up to indemnify policyholders with thousands of dollars in coverage. As we’ve discussed, you’ll be lucky to be entitled to $1,000 of coverage, which doesn’t go far with the costs of today’s dental services.

Keep this information in mind and do with it what you will. I think that you will find that dental and vision plans are not worth the trouble when you crunch a few numbers and understand what you’re getting and what you’re not.

This information is provided by HealthCare Advisors, a Cincinnati, Ohio-based individual health insurance broker dedicated to helping folks find the coverage thats right for them, for the right value. Our services are available for residents of OH, KY, IN, FL, GA, NC, MI, AZ, MO, SC, and TN. CLICK HERE to schedule a free, no-obligation phone consultation to learn more about your health insurance options.