Why Dental and Vision Aren't Included
Despite being essential parts of overall health, dental and vision care are not considered "essential health benefits" for adults under the ACA. This means most marketplace health plans don't include them, and you'll need separate coverage.
Dental Insurance Options
Standalone dental plans typically come in two types:
- DHMO plans: Lower premiums, require a primary dentist, and referrals for specialists
- DPPO plans: Higher premiums but freedom to see any dentist, with lower costs for in-network providers
What Dental Plans Cover
Most dental plans cover 100% of preventive care (cleanings, exams, X-rays), 80% of basic procedures (fillings, extractions), and 50% of major procedures (crowns, root canals, bridges). There's usually an annual maximum benefit of $1,000-$2,000.
Vision Insurance Options
Vision plans are generally affordable, with premiums of $10-$25 per month. They typically cover an annual eye exam, plus allowances for glasses or contact lenses.
What Vision Plans Cover
- Annual comprehensive eye exam
- Allowance for frames (usually $100-$200)
- Allowance for lenses or contact lenses
- Discounts on LASIK and other procedures
Bundled vs. Standalone Plans
Some Medicare Advantage and employer plans bundle dental and vision with medical coverage. If you're on the ACA marketplace, you'll typically need standalone plans. Many marketplace websites let you shop for dental plans alongside medical plans.
Is It Worth It?
For families with children (pediatric dental is required under ACA) and anyone who wears glasses or contacts, dental and vision plans almost always save money compared to paying out of pocket. For adults with good oral health and no vision needs, a dental discount plan might be a cheaper alternative.
