Dental and Vision Insurance: Your Guide to Coverage

Dental and vision health are essential to our well-being. Having dental and vision insurance not only helps keep our eyes, teeth, and gums healthy — it also helps protect our quality of life, overall wellness, and finances too.

Read on to learn more about the benefits of dental and vision insurance, what these plans cover, how and when to enroll, and how to choose the right coverage for your needs.

What Is Dental and Vision Insurance

Health plans under the Affordable Care Act (ACA) offer a comprehensive set of items and services that are covered, but dental and vision care for adults are typically purchased separately. These supplemental plans help ensure you get the preventive care you need while providing peace of mind for the unexpected—like sudden vision changes or a root canal.

Dental and Vision Insurance Benefits

Caring for your teeth, gums and eyes is essential, but it can be costly — especially if things go wrong. Dental and vision insurance plans help cover the cost of professional care, from preventive care to emergency care, when problems arise. Here are some key benefits of dental and vision insurance for both your health and your wallet.

Benefits of Dental Insurance

Having dental insurance is about more than protecting your smile. It can help prevent tooth and gum problems before they start, lower the risk of serious disease, and more. Consider these powerful benefits of dental insurance:

• Get the preventive care you need. The American Dental Association recommends seeing your dentist for a cleaning at least every six months. People with dental insurance are more likely to get this necessary preventive care, helping avert problems like cavities, gum disease, and tooth loss. Insurance typically covers two of these preventive dental care visits a year, which can cost as much as $200 each if you pay out-of-pocket.

• Diagnose issues early. Beyond getting a thorough cleaning, regular visits to the dentist can help diagnose issues early. This can be filling a cavity before it requires a root canal or identifying early signs of oral cancer. In both cases, the earlier you get treatment the better.

• Improve overall health. Did you know oral health is linked to overall health? For instance, gum disease is connected to a number of conditions, including diabetes, heart disease, and Alzheimer’s disease. Giving your mouth the care it needs helps support a healthier you.

• Protect your finances. A root canal can run you up to $1,500 without insurance. Crowns can cost as much as $3,000 if you pay out of pocket.

Benefits of Vision Insurance

Vision insurance helps make eye care more affordable and accessible. From covering the cost of preventive treatments to ensuring you're able to correct your vision as needed, the advantages of vision insurance extend far beyond your eyes. Consider these benefits for staying covered:

• Get preventive care. The American Optometric Association recommends healthy adults get a comprehensive eye exam at least every one to two years. If you have risk factors for eye disease, you might need more frequent exams. Having vision insurance makes you more likely to stay on schedule. While an exam is on average $184 out of pocket, vision insurance will often cover the bulk of this cost.

• Identify issues early. During an eye exam, an optometrist looks for eye conditions like glaucoma or retinal disease. Your eye doctor can also be the front line for identifying other diseases like diabetes, brain tumors, and heart disease.

• Protect your overall health. Vision that goes uncorrected can lead to cognitive issues, depression, and more.

• Correct your vision as needed. If you need glasses or contact lenses, vision insurance can help pay for them

What’s Covered in Dental and Vision Plans?

Dental plans focus on covering the care for your teeth and gums. This generally includes preventive care, nonsurgical procedures (like filling a cavity), and more extensive care, such as crowns. Likewise, vision insurance covers eye exams and corrective lenses. In both cases, plans may vary in terms of coverage and how they help with treatment costs. Read on for what to expect from a typical plan.

Dental Plan Coverage

Dental insurance is for care of your oral health. Coverage can be broken down into three different types of care. Plans may cover:

• Preventive dental care. Most dental plans cover 100 percent of the cost of preventive care like teeth cleanings, routine exams, dental X-rays, fluoride treatments, and sealants.

• Basic dental care. Plans may charge a copay or pay a percentage of the cost of restorative, nonsurgical procedures. Think fillings, nonimpacted extractions, root canals, and gingivectomies (removal of gum tissue).

• Major dental care. More invasive procedures like crowns and complete extractions may also be covered at different rates for copays and coinsurance.

Vision Plan Coverage

Vision insurance is for vision-related care, correction, and treatment. Keep in mind, health plans cover issues involving eye care for medical reasons, including diabetes complications and eye infections. Most vision plans help pay for the following:

• Preventive vision care. Most vision plans cover routine, preventive eye exams performed by an optometrist after a copay. These exams check your vision and look for any health issues present in the eyes.

• Corrective lenses. Plans cover part of the price of lenses for eyeglasses or contacts to correct your vision.

• Additional discounts. Your plan may also provide a discount on frames and corrective surgery like LASIK.

How to Get Dental and Vision Insurance

You can get dental and vision insurance in a few different ways. Your employer may provide dental and vision benefits, or you can purchase these plans directly from insurance companies. One way to get dental insurance is through Covered California.

Covered California is a free service from the state that helps people get affordable health insurance. When you enroll in a health plan through Covered California, it’s easy to add dental insurance. Keep in mind, you do need to sign up for a health plan to add a dental plan. Vision insurance is not available through Covered California, but you’ll find links to trusted providers on our website, where you can explore vision plans and sign up for coverage.

Here’s how to compare dental and vision plans for adults and children to find a great solution for you and anyone else in your family who might need coverage.

Comparing Dental Insurance Plans

Dental plans can differ in the monthly cost, the deductible (the amount you pay before the insurance kicks in), and more. Your options will depend on where you get your insurance. When choosing dental insurance through Covered California, you can pick between two types of plans:

DHMO Dental Plans have no deductible or annual benefit limit. No matter how much care you need throughout the year, your DHMO plan continues to help you pay for it. This type of plan has free preventive care and set fees for different procedures like fillings, root canals, and crowns. There’s no waiting period for major services, but you have to see a dentist within your provider network (except for emergencies).

DDPO Dental Plans charge a deductible, and there’s a limit to how much the plan pays for treatments each year. Preventive care is also free with DDPO plans. Instead of a flat fee, DDPO plans cover a percentage of the cost for different treatments. There’s a six-month waiting period for major services for adults. You can see both in-network and out-of-network dentists, however costs can vary.

Check here to get a side-by-side look at how these types of plans compare.

Comparing Vision Insurance Plans

Vision plans also have different monthly costs, copay amounts, and spending limits. Again, your options depend on where you get your insurance. You can enroll in vision insurance through one of the three companies selected by Covered California here.

Vision plans may cover comprehensive eye exams with a copay. Benefits come in the form of discounts and allowances, but for plans with lower monthly premiums, you typically pay more for glasses, contact lenses, and vision correction surgery. Different plans also cover different types of enhancements like polycarbonate or scratch-resistant lenses. Consider your needs as you explore available plans.

Dental and Vision Plans for Children

ACA-compliant health plans include dental and vision coverage for children under the age of 19. That goes for all health plans offered through Covered California.

As part of their health plan through Covered California, children get free eye exams and one free pair of glasses or contacts each year. They also get free preventive dental care, including cleanings and exams. For basic and major dental care, the cost is shared between you and your insurance company. You will not pay more than $350 total per child — that’s the out-of-pocket maximum. Families with more than 2 children may benefit by purchasing a supplemental dental plan as that out-of-pocket maximum is capped at $700 total for all children.

When to Buy Health, Dental, and Vision Insurance

When you can enroll in coverage depends on where you get your insurance plans. You can enroll in health and dental insurance through Covered California during open enrollment from November 1 to January 31.

If you miss the open enrollment window, you can still get covered when you experience a major life event that qualifies you for special enrollment. Major life events include adding a new child to your family, getting married, losing your job and your employer-sponsored health insurance, and more. In most cases, your special enrollment period lasts 60 days after the life event, so don’t wait to enroll.

Enrollment in vision insurance plans found on CoveredCA.com is available year-round.

Get Covered

Sign up for coverage through Covered California to keep yourself protected and healthy from head to toe. During open enrollment and special enrollment, you can get started here — or get expert help to understand your options at any time.