Are Dental and Vision Included in That?
Clients often ask if the health insurance they are considering includes dental and vision
coverage. There exists a limited choice of plans that include light coverage with limited
networks for dental and vision, available on various state and federal health insurance
marketplaces. However, the answer is usually “no” for anyone over the age of 19. For those
under 19, Affordable Care Act-compliant health insurance plans are mandated to offer pediatric
dental. In New Jersey, some carriers have disclaimers about the need for pediatric dental and
vision as it is offered as an “extra’ with some of the off-exchange options.
The best place to start when considering Dental Insurance is by asking your dentist 1. which
insurance plans they accept and 2. what specific dental networks they participate in. This can at
times be two different answers. A dentist being “in network” for a plan they accept will result
in the best pricing as being “in network” means the dentist has agreed to the network’s
negotiated rate. Be aware that dentists drop out of networks all the time, so please stay in
contact regarding this issue before your next appointment. If the dentist says they don’t accept
any insurance, only take PPOs, or will process your expenditure by sending it to the insurer, it
typically means they are not in network for that insurance, and balance billing issues may arise.
More on balance billing later. For now, let’s dive into the dental options we currently work with.
Additionally, it is worth noting that certain carriers provide comprehensive dental, vision, and
combination plans that are worth considering. While these plans are primarily targeted to
individuals on Medicare, they are available for most age groups.
Our primary quoting tool, which serves as a catch-all for Dental Insurance, can be found on
our page:
This tool offers a shopping and enrollment experience for many supported companies. It’s
important to note that this blog post serves as an ongoing resource, not an exhaustive list of all
the options we work with. Our goal is to guide clients and shoppers towards a wide range of
available choices and provide a comprehensive discussion where necessary. We aim to create
an informative, user-friendly resource that helps you understand the various options easily.
Delta Dental is one of the most prominent dental insurance carriers. Our primary tool includes
Delta Dental, but for your convenience, here is the direct link to our official Delta Dental store.
You can explore Delta plans specifically tailored to your region. By enrolling through this link,
we will serve as your dedicated broker, providing year-round assistance and support.
Morgan White‘s “Dental For Everyone” offers a range of dental and vision products. Here, you
will discover exclusive Delta Dental options that are distinct to Morgan White and not available
through the Delta Dental link.
The hottest dental option that has been buzzing recently is NCD, which utilizes MetLife‘s robust
dental network and offers options with yearly maximums of up to $10,000! This is unusual, as
the average dental plan has a yearly maximum of under $2,000 per person.
United Healthcare ranks among the top five health insurance companies in terms of financial
strength. Their suite of plans is worth considering if your dentist accepts their network. In the
Medicare space, their Medicare Supplements, featuring the “wellness extras” tag, usually offer
a built-in dental discount. However, to benefit from this, you must seek treatment from a
dentist who accepts the UHC Dental network. Otherwise, there will be no advantage. Most of
UHC’s individual plans operate on PPO networks and include out-of-network benefits.
Waiting Periods and the Plans that Waive Them
Waiting periods are a significant aspect of individual dental insurance options, especially for
major procedures. However, most insurance providers that claim to have no waiting period
offer limited coverage in the first year, typically only 5% or 10%, or slightly more at best. As of
the time of writing, there are a few carriers known to waive the waiting period for major work if
there is evidence of at least 12 months of prior dental insurance coverage, with no gap of more
than two months since that coverage ended. Certain services, like implants, may still be subject
to a waiting period, as is the case with the Cigna plans we currently work with. Here are the
carriers we are aware of that waive the waiting period with proof of prior coverage:
Cigna Supplemental using Carrington’s dental network
Even More Dental Plans
Additionally, we have a few alternative choices available from companies that do not currently
offer us an e-store or enrollment link. These options include:
Aetna Dental: If you’re interested in Aetna Dental options, feel free to email us for a
personalized quote. Please include your date of birth, zip code, and email address.
Independence Blue Cross offers dental options using the Dominion Dental Network. Email us
to receive a quote and please provide your date of birth, zip code, and email address.
Other Blue Cross Blue Shield options are also available. Please email us and provide your date
of birth, zip code, and email address.
More On Balance Billing
Returning to the topic of balance billing, this is a critical concept to understand when dealing
with dental insurance. Balance billing occurs when your dentist charges more than your
insurance plan’s “allowed amount” for their services. The “balance” – the remaining amount
after the insurance coverage has been applied – is then billed to you, the patient. This can often
result in unexpected out-of-pocket expenses.
To further illustrate, let’s consider an example. Suppose the usual and customary (U & C) fee for
a dental procedure is $500, but your dentist wants to charge $700. In this case, if your
insurance plan covers 80% of the U & C fee, they will pay $400, leaving a balance of $300. This
$300 is what you would be responsible for, resulting in a balance bill.
However, if you choose a dentist within your insurance provider’s network, they typically agree
not to balance bill patients, thereby potentially saving you from these additional costs. It’s
important to check with your dentist and insurance provider to understand their balance billing
practices, as well as the usual and customary fees for different procedures.
Group Plans?
If you have a small business and need information about dental plans for your company, there
are several reasons to consider them. One major advantage is that these plans usually don’t
have long waiting periods for major services. However, there is an exception if employees try to
join the plan outside of the policy’s renewal period, when those who originally waived the
coverage become eligible to join. Employees with valid reasons, such as loss of coverage, are
typically exempt from any waiting period.
Typically, dental plans work best when at least three employees enroll. Unlike medical plans,
dental insurance options don’t impose the same mandates on employers to offer coverage or
contribute financially. Companies can choose to cover the entire cost (employer paid),
split it with employees (contributory plans), or pass the expenses entirely
to the employee (voluntary plans). Pricing and participation requirements often reflect these decisions.
If you would like us to explore dental options for you, simply email us a census of your
employees, including their first names, home zip codes, and any dependents they wish to cover.
You can also fill out our group insurance form here to get into contact with us.
Vision Options
Typically vision plans do not have waiting periods and like most dental plans can be purchased
year-round. While we have already shared several links that offer additional vision options,
here are a few noteworthy ones we’d like to emphasize!
When it comes to Vision, United Healthcare‘s “Plan B” (B for both) still seems to be the only
individual vision option on the market, at least that we are aware of that will cover BOTH
glasses and contact lenses in the same year!
Morgan White offers stand-alone vision options in collaboration with leading companies like
VSP and Davis.
Humana also offers vision coverage –
In addition, many of the Blue Cross and Blue Shield companies out there offer stand alone
Vision plans, email us for additional options.
AARP members are encouraged to take advantage of the included vision discounts that come
with their membership. Be sure to check your membership portal for more details and
information!