As Texans push to the December 15th close of Open Enrollment, those that do not have access to an employer based health insurance plan are considering their options. Over the last week, many questions have to come our office about both Dental and Vision Insurance, and one of the most frequent is around whether or not their Affordable Care Act Exchange Health Insurance policy can include dental and vision insurance.
What Is Dental and Vision Insurance?
As workers in companies across Texas complete their annual enrollment for benefits, it often includes coverage for dental insurance and vision insurance. But what do they really cover and how do they work?
Dental Insurance
- Typically Coverage Offered
- Preventive services like cleanings, x-rays, and check-ups
- Basic services like extractions, fillings, and crowns
- Major services like bridges, dentures, and inlays and can often be optional
- Orthodontics is covered by some plans, but definitely not all
- Plan Types
- Indemnity plans will provide a defined dollars amount for specified services
- If your costs exceed the amount that they pay, you pick up the difference
- Often don't have deductibles or network requirements
- PPO Insurance will cover a percentage of services offered in network
- Benefits are typically reduced if you are out of network
- Subject to deductibles and/or copays
- Gotchas
- The big gotcha is that many plans come with a waiting period of anywhere from three months to a year to received benefits
- Orthodontics may not be covered in adults
Vision Insurance
- Typically Coverage Offered
- Annual Exams/Check-ups
- Coverage for Glasses including single vision, bifocals, trifocals
- Coverage for Contacts
- Can include coverage or discounts on things like LASIK
- Plan Types
- Indemnity plans will provide a defined dollars amount for specified services
- If your costs exceed the amount that they pay, you pick up the difference
- Often don't have deductibles or network requirements
- PPO Insurance will cover a percentage of services offered in network
- Benefits are typically reduced if you are out of network
- Subject to deductibles and/or copays
- Gotchas
- Many times coverage for glasses is limited to once every 24 months
- Contact lens coverage can be reduced if it is elective rather than medically necessary
- Common items like polycarbonate lenses may not be covered at a high level
Is It Included In My Exchange Policy?
The question about is it included always comes back around. Some of the exchange policies do include dental coverage for minor dependents on those policies purchased on the ACA exchange. However, for most adults you will be required to purchase Dental and Vision policies separate from your Texas health insurance. With that being the case, what should you consider when purchasing either one of both types of policies?
- Will you need to use them immediately? Wait periods can create problems.
- If a network is required to receive the benefits, is your local network robust?
- If you need a specific type of service (orthodontics/contacts), are there restrictions on using them?
If you are looking for a dental or vision policy, speaking with an agent at Insurance For Texans can help you understand your options and how to move ahead. Schedule a consultation today.
