Do you need dental or vision benefits?
Signing on for the medical insurance your employer offers is usually
pretty much a no-brainer. But many companies also offer dental insurance
and vision insurance, and the choices there aren't quite so obvious.
For one thing, employees frequently have to pay for it. Also, the
coverage is often quite limited. So, is it worth it?
Do you have good teeth? Bad teeth? No teeth? No matter what state
your mouth is in, you should seriously consider dental insurance.
For those of you with excellent choppers, the preventive care feature
of a dental plan pays 100 percent of your routine dental visits
to keep those pearly whites sparkling. But even if you haven't seen
a dentist since your canines were pups, routine restorative care
or major restorative care features can help cover the cost of getting
you a healthy smile again.
If your employer offers a dental plan, it will probably have categories
of coverage for preventive care, routine restorative care and major
restorative care. If you are really lucky, you might get to choose
between two dental plans or more. If that's the case, here are some
guidelines to help you compare them.
According to Thomas D. Musco, director of research
and statistics at the Health Insurance Association of America, you
should consider the following when deciding which dental plan best
meets your needs:
There should not be a deductible for preventive care. It should
be covered at 100 percent. However, dental plans usually have deductibles
of $25 or $50 for routine restorative or major restorative care.
The lower the deductible, the better for your wallet.
Compare the maximum annual benefits
Once you've paid your deductible, dental coverage kicks in.
But there are limits to what the insurance company will pay. If
you know you have some major mouth work to be done, you need to
pay special attention to your plan's maximum annual benefit. Usually
these maximums run between $1,000 and $1,500.
"Work with your dentist to schedule procedures to use benefits
most efficiently and use the preventive care benefit to avoid major
problems in the future," said Musco.
Depending on what you need done and what it will cost,
you may want to have the work done over the span of a few years
to maximize the amount that the insurance company will cover for
you. Get the most immediate dental needs taken care of in the first
year, and then have additional work done in subsequent years.
Does the plan offer an orthodontia benefit?
Compare lifetime maximums. This is especially important for
families with young children. If your little princess needs braces,
you want help in covering the cost. Compare the lifetime maximums
to determine which plan offers you the most. Generally, a $1,500
lifetime maximum is standard.
Compare the categories of coverage and the percentages
Preventive care, such as your annual check-up and annual X-rays,
is almost always covered at 100 percent. Normal or routine care
such as fillings, root canals and periodontal care are usually covered
at 80 percent. Major restorative care, which includes fun things
like bridgework and crowns, is generally covered at 50 percent.
Ask about new features
"Dental plans haven't changed much over time," says
Musco, "but there are some new features to look for. Ask questions
about implant procedures. These are relatively new in the last 10
years or so and some plans will cover them at major restorative
Consider the overall plan cost
So what should the average consumer expect to pay for dental
"The William M. Mercer National Survey of Employer-Sponsored
Health Plans 2000 cites a cost of about $470 per employee. This
is an average of single and family costs together, but some of the
cost may be covered by an employer," explains Musco.
"Compare this cost with the $4,600 average cost of health
insurance and you see how affordable it is. Especially on the group
side, if an employer picks up part of the cost it's probably a real
bargain," says Musco.
However, what if your employer isn't paying a dime and it's all
out of your pocket? Is it still worth it then?
"There have been several studies that link oral
health with medical health -- heart disease as a result of poor
dentition, for example -- and employees should definitely consider
dental coverage. It's worth it," Mucso says.
If you have dental problems that need to be fixed, paying for dental
insurance should save you money in the long run. And if you have
excellent dental health, the preventive benefits of dental insurance
will help make sure it stays that way.
If you're looking for dental coverage on your own, check with the
company or agent providing your medical coverage. If that company
doesn't offer it, check the Internet for providers in your area.
You may be able to save some money by getting a multi-line discount.
What about vision coverage?
Vision coverage is a little different. Typically, an employer
will offer vision coverage as a discount program.
"Usually an employer negotiates with local ophthalmologists
or vision centers to obtain discounts in services for referring
their employees," said Musco.
Costs for vision coverage will vary by employer but should provide
you with at least a 10 percent discount.
What does it cover?
Vision coverage is meant to cover only predictable costs such
as comprehensive annual or bi-annual exams, lenses, frames and contact
lenses. The American Optometric Association recommends the following
for a comprehensive eye exam:
- A check of internal and external eye health for signs of possible
disorders such as cataracts or problems with your retina
- An evaluation of your current prescription (glasses or contact
- A visual acuity test to check your ability to see clearly at
- A refraction test to determine your eyes' ability to focus light
rays on the retina at all distances
- A glaucoma test of your eyes' internal pressure
- A visual coordination test for muscle control
- A test of your eyes' ability to change focus.
While an eye exam may reveal eye problems, the purpose of vision
coverage is not to replace your medical coverage.
"Most likely if a tumor or cyst is discovered during a routine
exam, treatment for it would then be covered under the individual's
medical plan," said Musco.
You can compare vision plans by checking to see whether exams are
covered each year or only once every other year. Another way to
compare vision coverage is to check how often lenses, frames or
contacts are covered and in what amount.
Who needs it?
You do, if you wear contacts or glasses, or have family members
that do. Getting a discount on services and corrective lenses you
need anyway is an obvious plus.
It is not often considered as an individual benefit,
but if you're looking for a plan on your own, shop around a bit.
Check with professional groups or organizations to which you belong
to see if they offer it as an association benefit at association
rates. You may be able to save yourself some money. And that benefit
is clear, no matter what your prescription.
-- Posted: May 20, 2004