Dental and vision benefits often get overlooked during enrollment because they seem simple compared to medical insurance. But understanding what’s covered (and what’s not) can help you get more value from these plans and avoid unexpected bills.
Most dental plans cover services in three tiers: preventive, basic, and major. Preventive care (like cleanings, exams, and X-rays) is typically covered at 100%, usually for two visits per year. Basic procedures like fillings and simple extractions are often covered at around 80%. Major procedures like crowns, bridges, and root canals may be covered at 50%. Most plans have an annual maximum, the most the plan will pay in a year, which commonly ranges from $1,000 to $2,000.
Orthodontia coverage varies widely. Some plans include it, some offer it as a separate rider, and some don’t cover it at all. If braces are on your radar for yourself or a dependent, check the specifics carefully.
Vision plans typically cover an annual eye exam and provide an allowance for glasses or contact lenses. The exam is usually covered at low or no cost to you, while the frames and lenses allowance might be something like $150 to $200 per year. If you want premium frames or progressive lenses, expect to pay the difference out of pocket.
One tip: if you have an FSA or HSA, you can use those pre-tax dollars for dental and vision expenses that your insurance doesn’t fully cover. This includes copays, the portion of major dental work you’re responsible for, and the cost of glasses or contacts beyond your plan’s allowance.
Taking full advantage of your preventive dental and vision benefits (the cleanings, exams, and check-ups that are covered at 100%) is one of the easiest ways to protect your health and catch potential issues early.