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Sep, 27 2016

Wading through dental or vision insurance decisions? Let's admit, an actual root canal might be less painful.

For those who get insurance through an employer, it’s open enrollment time. You’re being handed the health insurance menu of options. For those who purchase your own insurance – you have more options, but fewer good ones. 

Whichever scenario fits you, the key is to evaluate value. In other words, consider what you’re getting versus what you’re paying. Americans are paying more than ever before for medical insurance and healthcare. It’s worth considering whether you’re getting the bang for your buck with dental and vision insurance. We know you still need to keep your pearly-whites pearly (and white) and those bright blues sparkling (or browns, or greens). But, you can be smart about how you're spending your hard-earned money.

Here are 3 questions to help you figure out the dental insurance question!

1. What are my options?

If you have dental insurance options through your employer, it’s usually better coverage at a better price than you’ll find if you’re purchasing as an individual. Pricing is better through an employer because of volume and it might be subsidized by the employer. If you are a high dental-user family, this might be a good value for you.

If you purchase individual insurance or don’t have an offering from your employer, options are limited. Individual insurance tends to be very expensive with less coverage.  It may also require you to be on the plan for a year before covering major dental work. These are usually only worthwhile if you’re planning on some major work in the future and are willing to wait. Do the math to understand the pricing of your major work versus the cost of a dental insurance plan for multiple years. And look at some unique options such as an indemnity style plan or consider a dental savings plan.

2. What are my family’s dental needs in a year? 

Think over the past couple years – are you getting your standard two cleanings a year and an X-ray every other year? Or maybe you’re having more “work” done: multiple fillings, reconstruction, braces, etc. Then, consider the next couple of years. Is there a risk of big expenses or needs coming your way?

If you foresee just needing the basics, look at the monthly insurance premium. You might be paying more for dental insurance than you actually get out of it. For instance, a family of 3 might pay $100 a month for dental insurance ($1200 a year), but only use it for the basics at about $600 a year. If your family is in constant need of fillings, crowns, root canals, etc., then you’ll get the most use out of an insurance plan.

If braces, teeth whitening or caps are on the list, they often aren’t covered by Individual insurance. Read your policy or ask your broker. If you need these, the best thing might be a dental savings plan which can translate to big savings on these expensive treatments.

Under the Affordable Care Act, many health insurance plans will include some amount of dental coverage for kids under the age of 19. So, if you're buying a dental plan for your family, you might only need it for mom and dad. 


Dental Savings

3. What's the worst-case scenario? 

By definition, insurance is meant to protect us from the chance of something very bad or very expensive. This makes sense with home and auto insurance. But how bad a situation do we face with dental care? A root canal, a cavity, a crown, braces? Sure, these things might cost hundreds or even thousands of dollars. But, you aren’t likely to lose your home to pay for it. Another thing to remember is that all dental insurance plans have a maximum payout each year (maybe $1,000 to $2,000), so all charges over that amount are paid by you.  

Bottom line: Compare dental insurance premium costs to the expected work to be done and ask “is the benefit worth the cost and risk for my family?”

But is it the same story for vision insurance?

Here’s 4 questions to ask yourself to make it easier to choose a plan of action for your family.

1. What’s included in a typical vision insurance plan?  

Review your offering, but these are typical:

  • An eye exam – partial or 100% paid for  
  • Glasses – a pair every year (or every 2 years) or there’s a pool of money you can spend
  • Contacts – usually a pool of money you can spend

Major eye issues, surgery, disease aren’t covered in a vision insurance plan, these would fall under medical insurance. And, there is a maximum payout in every vision plan, so know what that is. Finally, be sure to look at the coverage. Will insurance pay for those expensive designer frames? In the end, getting your money out of a vision insurance plan requires that you have a yearly exam and use glasses/contacts. 

2. What are my family’s vision needs in a year?

Look at everyone in your family (pun intended!).

  • How many get an annual eye exam?
  • How many wear glasses or contacts?
  • Any divas that consider designer frames a must-have (“or I’ll just die, Mom”)?
  • How many may start to need eyewear this year? Is anyone planning LASIK surgery?

Now, add up your family’s expected costs and compare that to the annual cost of the insurance and the insurance payout. Is your payout worth the cost of the insurance?    

Let’s assume a typical vision insurance plan costs about $10-$35/month for your family and an eye exam is around $100. If annual eye exams are all you need, you don’t need to pay for insurance.

If you’re considering LASIK, recognize most insurance plans don’t cover it. But you should be able to get the cost cut almost in half with a vision savings plan (which might be your best approach). And getting surgery would take away your need for new glasses – so the need for insurance might go away. 

Under Obamacare (the Affordable Care Act), many health insurance plans include some amount of vision coverage for kids under the age of 19. So, if you're buying a vision plan for your family, you may only need it for mom and dad.

Vision Savings

3. What are my options?

  • Employers used to pay for vision insurance plans for employees and their families. Today, less than 20% do. If you’re not in this lucky group, you probably have the option to purchase a vision insurance plan through your employer (cost range is approximately $6 - $25/month).  
  • If your employer doesn’t offer it, you could choose to buy an individual vision insurance plan. Unlike buying through an employer where the risk is spread across many, the only people who purchase these plans are heavy vision users. As a result, these insurance plans cost more and/or don’t cover as much (cost range is approximately $15 - $35/month).
  • If you have some vision expenses, but insurance isn’t a great value for your family, consider a good vision savings benefit. While exams and product aren’t “covered,” a vision savings means you don’t have to pay full retail price. These are relatively inexpensive (cost range is approximately $5 - $15/month). It could save you a few dollars on an annual exam with much bigger savings on contacts and glasses. A tip for finding a good vision savings: make sure there are providers near you (LensCrafters, Eyemasters, Pearle, JCPenney, Target, etc.) and look for an average discount of 30% or better on eyewear. 

4. What’s the worst-case scenario?

Remember, we buy insurance for unpredictable high-risk situations. Eyewear isn’t very unpredictable. And the biggest value you get out of vision insurance is probably a few hundred dollars (more with a whole family). While it’s something, it’s not an unbearable cost – considering you’ll spend hundreds of dollars each year for the insurance. 

Bottom line: Compare the insurance premium costs to your family’s expected vision needs and ask “is the benefit worth the cost and risk for my family?” If the insurance doesn’t appear to be a good value, it probably isn’t.

Now it's your turn! Have you determined dental or vision insurance is worth it for your family? Or how did you determine a savings plan is your best option? Comment below or email me at


Reid has a passion for helping brokers & employers strategize fresh approaches to benefit plans that contain costs and increase access to care - helping employers & employees control their healthcare dime, time, and peace of mind. He writes & speaks around the country and is the Co-Founder & CEO of freshbenies.

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