Consumer IQ

Are Vision & Dental Plans Worth It?

It’s open enrollment season, and that means you may be deciding whether to change or add to the insurance coverage you currently have. And while most people recognize that medical coverage is necessary, dental and vision plans might seem less essential. In many ways they are: healthy people can go without a dentist or optomologist for a few years. But in the long term, the benefits of a dental or vision plan may pay off. This is especially true if you are covering family members.

First of all, let’s get clear on what these plans cover:

Dental Plans

Dental plans can come in many forms: HMOs, PPOs, and indemnity plans. Dental HMOs work well for people who only need basic preventive care. They usually cover routine care 100%, but have big cost shares for more complex care. You are also required to stay within a network of dentists.

PPOs offer more coverage and allow you to see any dentist, but they will pay more when you see an in-network dentist. For example, a PPO plan may pay 80% for an in-network dentist, but only 50% on an out-of-network dentist.

Finally, indemnity plans offer the most freedom: you can see any dentist you want, but the premium and co-insurance is usually higher. Indemnity plans are ususally only offered through employer group plans are are not available for individuals to purchase. The average dental plan can range from $15 to $75 per month, depending on the type.

Vision Plans

Vision plans offered through employers are often just discounts–not true insurance. They are only designed to cover vision exams and glasses or contacts. For pretty much anything that is a real health issue (such as cataracts, detached retinas, or injuries to the eye), you should turn to your medical insurance. Still, your vision plan should cover basic eye health such as screening for eye disorders, glaucoma tests, and tests for your eyes’ ability to change focus or focus at different distances.

Individual vision plans are more rare. You can find them if you shop around, but if you are only planning to purchase frames or lenses and already have a current prescription, the plan may not be worth the benefits.

Here’s how to decide if these plans might be right for you:

Review the Benefits

As with any insurance product, make sure you know what you’re buying. For a dental plan, the exams, x-rays, basic care, and which dentists you can see are most important. If you have children, you may also want to consider orthodontic benefits. For a vision plan, how frequently exams are covered and how much is allowed for glasses or contact lenses is key.

Compare Other Out-of-Pocket Costs

Don’t forget to consider the deductible, co-pays, and coinsurance in the plan. After all, it’s not really a health plan if you’re still paying on your own. Watch out for plans that have a deductible for preventive care, because you will most likely be paying out-of-pocket for the very services you intended to have the plan cover. A good cost-comparison method can be to look back and see how much you actually used these services in the past (which a site like Simplee or Cake Health can help with).

Consider your Timeframe

Will your health insurance situation will be changing in the future? Are you pretty much caught up on your dental exams and vision prescription? If so, you might decide that you can go without dental and vision benefits for the moment. Remember, they are meant to provide routine, preventive care and basic eyewear. For medical issues, you have your health plan. However, putting this routine care off for too long could result in more expensive cavities or eye diseases later. If in doubt, check with your doctor. How long is too long?

The bottom line? If your employer offers dental or vision, odds are, it’s a good benefit for a small cost.  My company, Simplee, recently took a look at the dental expenses of our members for 2011 and found that a typical family of four saved about 60% with their dental plan, including premiums:

 

But, as always, read the details and understand your own history to make sure you’re getting your money’s worth.

Tomer Shoval is the CEO and Co-Founder of Simplee, a free online personal health care expense management tool. Connect with him on twitterfacebook or email.