California Dental & Vision Health Plans Explained

You’ve got your health insurance and you’re ready for whatever life throws at you (in terms of health), right? Wrong! Most health insurance plans do not include cover for dental and vision care. Both of these are expensive, and paying for them out of your pocket can really eat into your finances. If your job doesn’t offer you dental and vision insurance, you need to purchase your own cover.

Sources of Dental and Vision Plans

You can get these plans from different sources such as:

• · Some individual and group insurance plans which also include dental or vision benefits (or both).
• · You can get a separate plan for dental and vision in addition to your main insurance. Some insurance companies offer combined vision and dental packages as standalone insurance.
• · A number of Medicare Advantage (Part C) plans have dental and vision benefits for senior citizens.
• · Medicaid provides dental and vision benefits for children, and in some states, this is also available for adults.

Types of Dental and Vision Plans

Dental and Vision Plans come in two main forms: Traditional health insurance and Alternative insurance.

1. Traditional Insurance

This is the typical insurance plan. You pay a monthly or yearly premium, a deductible, co-payments, and co-insurance. In California, these plans are classified as indemnity or managed-care plans.

Indemnity Plans
The insurance company pays for services only after you present them with the medical bill. This means that you have to pay for services upfront, after which you get a refund from your insurer.

Managed-care Plans
With these plans, the insurance company has a network of healthcare providers you can go to when you need dental or vision care. They charge you pre-negotiated fees and hand in your claim to the insurance company on your behalf. That way, you have lower medical expenses and less paperwork to do. You also have a wider selection of dental and eye specialists to choose from than with the indemnity plan. Managed-care plans can also be a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO):

• · With an HMO Plan, you have a primary care physician (PCP) in addition to other healthcare providers in a network provided by your insurer. Your PCP will refer you to the vision and dental care specialists approved by your insurance.
• · In the PPO Plan, you are not bound to a PCP and you can choose to visit physicians outside the network provided, though you pay more for those services.

2. Alternative Insurance

An alternative to the traditional insurance plans is to join a discount program. Without the discount, you could still get the services, but at a higher rate.
It works like this:

• · Similar to health insurance, you pay a monthly or yearly premium.
• · With this fee, you have access to a number of discounted dental and vision care services.
• · You choose the services you need to form the available selection.

What Dental Plans Cover

Dental insurance plans usually pay for 100% of the cost of preventive care, 80% of basic dental procedures, and 50% of the cost of advanced procedures.

• · Preventive care includes regular dental checkups and cleaning of teeth.
• · Basic procedures include doing fillings, root canals, and oral surgery to repair damaged teeth.
• · Advanced procedures include installation of crowns and bridges and fixing and removal of retainers and braces.

What Vision Plans Cover

Vision plans cover a number of preventive and necessary services such as:

Eye exams
This is preventive care and is usually carried out once a year. It involves tests like color blindness, vision sharpness, glaucoma and other tests. Preventive care is important as vision problems are detected early enough before they become worse and raise your healthcare costs.

Corrective eyewear
Vision care partially covers corrective spectacles (both frames and lenses) and contact lenses as well. Some vision plans limit where you can get eyewear- you would have to obtain them from optometrists in the network. In some cases, a vision care plan may also cover prescription sunglasses.

Surgery
A number of vision plans cover medically necessary eye surgeries such as treatment of an eye infection or injury. Surgeries deemed cosmetic, such as LASIK, are generally not covered, although some plans may offer a partial cover.

Frequently Asked Questions

Is my employer required to provide dental and vision insurance?
No. Although employers with at least 50 workers are required by law to provide their employees with group health insurance, this doesn’t include vision and dental insurance. Some companies do it, however.

Are vision and dental plans available for children?
Yes. Under the Affordable Care Act, insurance companies are required to include them for persons under 19 years of age.

Does Original Medicare (Part A and B) offer dental and vision plans?
No, it doesn’t. Some Medicare Advantage plans, however, offer dental and vision benefits.

Can I retain my eye doctor and dentist?
If you want to retain your dentist or eye doctor, look for a plan that already includes them in their network. If you choose to see a doctor who is outside the network, you will have to pay the entire cost of their services, or a higher portion, depending on your insurance plan.

Will I get a penalty if I don’t have dental coverage?
No. Dental insurance is optional do you don’t get penalized if you don’t have it.

Who are in-network and out-of-network providers?
In-network providers are healthcare providers contracted by the insurance company to offer services to members of a plan at pre-negotiated prices. An out-of-network provider is a healthcare provider who is not in the category of contracted providers.

Do dental plans have a waiting period?
Yes, they do. The period is put in place to discourage people from applying for a policy just to cover an impending procedure, and so the company can make a profit from the new policyholder. A typical waiting period for a standard procedure could be between 6 to 12 months. Waiting periods for major procedures tend to be longer- up to 2 years.

Now that you have the basic information about the dental and vision insurance plans, you can give us a call and get signed up for one of these. Use the information covered here as a guide, and we’ll get you started!