:max_bytes(150000):strip_icc()/optometrist-6e0f5f556ac049e6820228a3152ff016.jpg "Why Are Vision and Dental Insurance Separate?")
Insurers bundle many health care services under a more comprehensive health plan, but vision and dental insurance are typically sold separately. That may seem odd, but the history of healthcare and current regulations and economics help explain why. Let’s look in more detail at why vision and dental are separate.
- Health insurance companies do not offer vision and dental as a core plan benefit.
- The Affordable Care Act (ACA) excludes adult vision and dental as one of the 10 essential health benefits that health plans must provide.
- Excluding vision and dental helps health insurance companies keep premiums low.
- With separate vision and dental plans, you have more flexibility when choosing plans.
Reason 1: Medical, Vision, and Dental Care are Separate Fields
Dental and vision care have always been separate from medical care. Going back in history, barbers, not doctors, took care of teeth extractions. They were similar to general practitioners, often mending broken bones and performing bloodletting and wound care. Only in the 18th Century did a barber’s role become more exclusive to hair.
When the first dental schools were created in the mid-19th century, the distinct training and separation of dentistry as a discipline further divided oral care from other medical fields.
The story for vision care is similar. Glasses were historically created and sold by craftsmen rather than physicians, creating a distinction between vision and healthcare.
The separation of dental and vision care from the rest of medicine was further cemented when “unions negotiated with employers to provide eye and oral health plans as supplemental benefits beyond what existing medical insurance offered,” Samuel Greenes, founder and CEO of BLUE Insurance, told Investopedia in an email.
“This supplementary coverage approach, based on periodic rather than emergency care needs, persists in benefit plan divisions today,” Greenes said.
Note
Health insurance may only cover dental work when the procedure is serious enough to warrant hospitalization or emergency room treatment because of an injury or accident.
Vision insurance
Regarding the eyes, health insurance typically only covers issues and eye exams stemming from medical reasons, such as infections, diabetes complications, vision loss, and floaters. Your medical insurance can also cover any prescriptions you’re given by your vision professional.
Glasses, contacts, and routine eye exams are generally the only benefits vision insurance provides. Not all vision insurance covers annual contact lens evaluations.
Reason 2: Vision and Dental Insurance Are Specific to Vision and Dental Carriers
Your health insurance plan often includes a network of medical professionals it has contracts with. This gives you more comprehensive coverage at a lower price than without insurance. It’s also why you often pay more out of pocket when going with an out-of-network doctor.
Health insurance networks are comprised of physicians, specialists, hospitals, and other providers, but they usually don’t include oral and vision health professionals.
Dental insurers and vision insurers have their own network of professionals they’ve developed relationships with them to bring you cost-effective and comprehensive coverage. Dental insurance networks are comprised of oral health professionals like dentists and orthodontists, while vision insurance networks include specialists like ophthalmologists and optometrists.
Make sure your vision specialist is in-network for both your health and vision insurance plan. If you go in for a routine eye exam and the doctor discovers your new vision issues are due to developing glaucoma, they would bill your health insurance for the visit.
Reason 3: Vision and Dental Are Considered Supplemental
“Insurers classify vision, dental, and pharmacy plans as supplemental given lower per-service costs than broader hospital/physician medical insurance,” Greenes said. “Separate but integrated networks allow specialized administration.”
However, Greenes said there is growing interest around bundling ancillary benefits with medical plans to simplify consumer options.
Vision and dental discount plans, which give you discounted rates on services, are not the same as vision and dental insurance, which are policies fully covering diagnostic and preventative care and partially covering other services (like root canals, crowns, and fillings).
You can’t use both a dental discount plan and dental insurance for the same procedure.
For now, it’s unlikely that vision and dental will be unified with general health insurance.
“Unlike the required minimum health insurance plan essential benefit inclusion of pediatric dental/vision coverage, adult dental and vision benefits remain classified as non-essential optional supplementary offerings under the [Affordable Care Act (ACA)],” Greenes said.
As a result, insurers with dental or vision plans typically sell policies separate from their health insurance ones to keep plan costs lower and give consumers more flexibility in choosing the services they want and need.
Can I Get Vision and Dental Coverage Through the Health Insurance Marketplace?
Yes, you can get vision and dental coverage through the health insurance market place. Although not all providers offer dental or vision coverage because they are not considered one of the 10 essential health benefits that ACA-compliant plans must provide.
What Is the Federal Employee Dental and Vision Insurance Program (FEDVIP)?
The FEDVIP makes vision and dental insurance available to Federal and Postal employees, retirees, their eligible family members, and certain other groups of people. Premiums aren’t subsidized, so those eligible for the program pay the full insurance cost.
Based on our research, individual dental and vision plans average about $35 per month for dental preferred provider organization (PPO) plans and about $14 per month for vision plans. Dental and vision programs under FEDVIP have no pre-existing condition limitations and are usually competitively priced because of group discounts. Premiums are also taken from salaries using pre-tax dollars.
Which Type of Dental Plan Is the Most Common?
Preferred provider organization, or PPO, dental plans are the most common. These plans usually have a bigger network of providers than health maintenance organization (HMO) plans, so it’s more likely your preferred dentist is in-network. You can still go outside your network if needed, though you’ll have to pay more out-of-pocket.
What Is the Most Popular Vision Insurance?
VSP is the largest vision insurance company in the country. It has over 80 million members and a network of more than 36,000 eye doctors.
Can I Bundle Dental and Vision Insurance?
Whether you’re buying a plan on the Marketplace, privately, or through your employer, you may be able to bundle your dental and vision insurance so that it’s under one company. You’ll have to check if your provider offers this, but many of the best health insurance companies do, such as MetLife, UnitedHealthcare, and Blue Cross Blue Shield.
The Bottom Line
Dental and vision care have historically been separate from care for other body parts. The separate education and training of these doctors from general medicine have kept these fields divided, as have recent regulations like the Affordable Care Act. Insurance companies also aren’t interested in integrating vision and dental services into their policies to keep premiums lower and give customers more choices in a la carte services.