It's open enrollment season, and that means you may be deciding whether to change or add to the insurance coverage you currently have. While most people recognize that medical coverage is necessary, dental and vision plans might seem less essential. In many ways they are, healthy people can go without a dentist or optometrist for a few years. But in the long term, the benefits of a dental or vision plan may pay off. This is especially true if you are covering family members. (To help you determine the best combination of benefits for you, check out Selecting The Right Mix Of Insurance Benefits.)
TUTORIAL: Intro to Insurance
First of all, let's get clear on what these plans cover:
Dental plans can come in many forms: health maintenance organization (HMO), preferred provider organization (PPO) and indemnity plans. Dental HMOs work well for people who only need basic preventive care. They usually cover 100% of routine care, but have big cost shares for more complex care. You are also required to stay within a network of dentists.
PPOs offer more coverage and allow you to see any dentist, but they will pay more when you see an in-network dentist. For example, a PPO plan may pay 80% for an in-network dentist, but only 50% for an out-of-network dentist.
Finally, indemnity plans offer the most freedom. You can see any dentist you want, but the premium and co-insurance are usually higher. Indemnity plans are usually only offered through employer group plans, and are not available for individuals to purchase. The average dental plan can range from $15 to $75 per month, depending on the type.
Vision plans offered through employers are often just discounts – not true insurance. They are only designed to cover vision exams, glasses and contacts. For anything that is a real health issue (such as cataracts, detached retinas or injuries to the eye), you should turn to your medical insurance. Still, your vision plan should cover basic eye health such as screening for eye disorders, glaucoma, the ability of your eyes to change focus and depth perception.
Individual vision plans are rarer. You can find them if you shop around, but if you are only planning to purchase frames or lenses and already have a current prescription, the plan may not be worth the benefits.
Here's how to decide if these plans might be right for you:
Review the Benefits
As with any insurance product, make sure you know what you're buying. For a dental plan, the exams, x-rays, basic care and which dentist you can see are most important. If you have children, you may also want to consider orthodontic benefits. For a vision plan, how frequently exams are covered and how much is allowed for glasses or contact lenses are important.
Compare Other Out-of-Pocket Costs
Don't forget to consider the deductible, co-pays and co-insurance in the plan. After all, it's not really a health plan if you're still paying on your own. Watch out for plans that have a deductible for preventive care, because you will most likely be paying out-of-pocket for the very services you intended to have the plan cover. A good cost-comparison method can be to look back and see how much you actually used these services in the past.
Consider Your Timeframe
Will your health insurance situation be changing in the future? Are you pretty much caught up on your dental exams and vision prescription? If so, you might decide that you can go without dental and vision benefits for the moment. Remember, they are meant to provide routine, preventive care and basic eyewear. For medical issues, you have your health plan. However, putting this routine care off for too long could result in more expensive cavities or eye diseases later on. If in doubt, check with your doctor to determine how long is too long?
The Bottom Line
If your employer offers dental or vision, odds are it's a good benefit for a small cost. As always, read the details and understand your own history to make sure you're getting your money's worth.
Tomer Shoval is the CEO and Co-Founder of Simplee, a free online personal health care expense management tool. Connect with him on twitter, facebook or email.