Affordable Care Act

For Dental and Vision Benefits, Choice Is Still an Option

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Americans love having choices, even if they have only two options. This is true for employees reviewing insurance plans: they want to compare several benefit selections. Under the Affordable Care Act (ACA), some states or exchange marketplaces may have limited options and plan features. However, with stand-alone dental and vision benefits, choice is still an option!


One Size Doesn’t Fit All
Over the years, many Americans have recognized that the one-size-fits-all dental and vision plans are a misnomer. A plan designed “one size” (with preventive care and a few other limited option) rarely “fits all” the dental and vision health requirements of family members. Although consumers recognize the value of preventive care, they are interested in other services that help them maintain and improve their oral and vision health throughout each stage of life.

Understanding Stand-Alone Dental and Vision Coverage
Stand-alone dental and vision plans typically are offered by carriers that are experts in these benefits, which means the premium costs are accurate, benefits can be customized, customer service and claims processing systems are designed specifically for these products, and some also have a nationwide, credentialed provider network.

Satisfying the Pediatric Component of the ACA
The ACA has focused on the dental and vision needs of pediatric family members, with the requirement of Essential Health Benefit (EHB) packages. As of Jan. 1, 2014, medical insurers are required to offer EHB to individuals and employers of fewer than 50 eligible employees who choose to provide benefits. EHB includes pediatric dental and vision, typically up to age 19. Larger employers offering benefits to employees have until 2015 to meet the ACA employer-mandated insurance obligation.

Recognizing All Family Members’ Needs
Medical carriers that offer EHB likely will cover only pediatric family members. Adults will need to purchase dental and vision plans separately for themselves and their dependents age 19 and older. This means that within a family, there could be different insurance carriers to deal with, and the different plans may not meet the family’s dental and vision care needs:

  • Dependents age 19 and older may have special vision or dental needs, such as LASIK, the option of purchasing new eyeglasses each year, or coverage for major dental procedures , including root canals and crowns, in addition to routine dental and vision exams.
  • Adults may notice changes in their oral and vision health as they age, which may require services beyond preventive care, to help them enjoy good overall health in their senior years.
  • Children may need additional dental coverage for special needs, including orthodontia, because EHBs may cover only medically necessary orthodontia, such as cleft-palate conditions.

Bottom line, families need flexible dental and vision coverage that can be customized to their specific needs. Benefit surveys show that people with dental and vision coverage tend to use their benefits, but without this coverage people may not go at all.

Consumers’ Dental and Vision Needs Remain Constant
Some people may consider deferring the purchase of dental and vision coverage in order to save money on monthly premium expenses. Health professionals are concerned that with the requirement for pediatric EHB, parents will purchase dental and vision coverage for their children, but not for themselves. By doing so, these adults may face increased risks of developing serious health conditions and incurring significant bills for medical services on themselves.

There have been many changes to dental and vision coverage over the last few decades, but it is important to remember that the dental and vision needs of Americans have not changed.

To learn more, read this ameritasinsight blog post, “Dental and Vision Benefits Within the Affordable Care Act.”