Individual Dental and Vision Insurance

• Dental insurance helps pay for dental care such as exams, cleanings, X-rays, fillings and other treatments. Depending on the plan, it may also provide benefits for major services such as crowns, bridges, dentures and root canals. Coverage levels, deductibles and annual maximums vary by plan.

• Yes. Common types include dental PPO, HMO or managed-care plans, and indemnity plans. PPO plans generally provide access to a network of dentists while allowing you to receive care outside the network, usually at a higher out-of-pocket cost. Plan types and availability vary by location.

A missing tooth clause is a provision found in some dental plans that may limit or exclude benefits for replacing a tooth that was already missing before your coverage began. Not every plan has this restriction, so check the policy details if you need a bridge, denture or dental implant.

It depends on the plan. A dental PPO may allow you to visit both in-network and out-of-network dentists, although using an in-network dentist can reduce your out-of-pocket costs. Other dental plans may require you to use participating providers.

Usually, no. Some health plans may include limited dental benefits or offer dental coverage as an additional benefit. Individual dental insurance can be purchased separately when dental coverage is not included in your medical plan.

Most dental insurance plans do not cover procedures performed solely for cosmetic reasons, such as teeth whitening. However, a procedure that has both restorative and cosmetic purposes may qualify for some benefits depending on the plan. Always check the plan’s coverage before treatment.

Review your plan’s benefits and exclusions or contact the insurance carrier before receiving treatment. For more expensive procedures, your dentist can often submit a pre-treatment estimate so you can better understand what the plan may pay and what your estimated out-of-pocket cost could be.

An annual maximum is the most a dental insurance plan will pay toward covered dental services during a benefit year.

After the maximum is reached, you generally pay the remaining cost of dental care for that period. Preventive services and other benefits may be treated differently depending on the plan.

Yes. Individual dental and vision plans are available to many adults, including people enrolled in Medicare.
Original Medicare generally does not cover routine dental care, routine eye exams for eyeglasses, or eyeglasses in most circumstances.
Medicare does, however, cover certain medically necessary dental and eye services under specific conditions.
Those who have a Medicare supplement plan, should enroll in a separate dental and vision plan.

Often, yes. However, coverage for existing dental problems can depend on the plan’s exclusions, waiting periods and other provisions. For example, some plans may limit benefits for replacing teeth that were missing before the policy became effective.

Vision insurance commonly helps with routine eye exams and may provide allowances or discounts for prescription eyeglasses, frames, lenses and contact lenses. Benefits, copays, allowances and frequency limits vary by plan.

Many vision plans provide benefits toward prescription glasses or contact lenses. The amount covered and how often you can use the benefit varies by plan. Some plans may provide an allowance, with the member paying any amount above that allowance.