Dental and vision: do the arithmetic before you buy

Dental and vision are separate policies in the United States. Your medical plan does not cover your teeth or your eyes, and adult coverage has to be bought on purpose.

They are also the two policies people most often buy without checking anything, because the premiums are small enough not to feel like a decision. That is exactly why the details are worth ten minutes.

For dental, three numbers decide everything

Not the premium. These:

Annual maximum. The ceiling on what the plan pays for you in a calendar year — commonly $1,000 to $2,000. Everything above it is yours. This is the opposite of how medical insurance works, and it catches people out: here the cap protects the insurer, not you.

Deductible. What you pay before the plan starts sharing costs, typically $50 to $100 a year. Preventive visits are usually exempt.

Waiting period. How long you must hold the policy before major work is covered — commonly six to twelve months for crowns, root canals and dentures. Some plans waive it if you are switching from previous dental coverage without a gap, which is worth asking about before you sign.

Two plans with the same monthly premium can differ by more than a thousand dollars a year on these three lines alone.

How dental plans usually split costs

Most follow a familiar pattern: preventive care covered at or near 100%, basic procedures like fillings around 80%, and major work — crowns, root canals, dentures — around 50%. Orthodontics, when included at all, usually has its own separate lifetime maximum and its own waiting period.

That last point matters for families. If braces are on the horizon for a child, the orthodontic maximum is the number to design the plan around, and it needs to be set up well in advance.

For vision, the money goes to four places

• The eye exam — a full annual exam for a modest copay, usually $10 to $25. Without a plan the same exam commonly runs $100 to $200.
• Frame allowance — a fixed sum toward frames each year or every other year, often $130 to $200. Anything above it you pay, usually with a discount on the difference.
• Lenses — standard single-vision lenses are typically covered in full after a small copay. Progressives, anti-glare and thinner high-index lenses are upgrades, priced differently by every plan.
• Contacts instead of glasses — most plans let you take a contact-lens allowance instead of the frame benefit in a given year, not both.

Routine vision is not the same as an eye problem

This distinction decides which card you hand over at the front desk, and it confuses almost everyone.

Routine care — the annual refraction, your prescription, glasses, contacts — is what vision insurance is for. A medical problem with the eye — an infection, an injury, glaucoma, cataracts, diabetic retinopathy — goes through your health insurance, because that is treatment rather than eyewear.

The same doctor may handle both, billed to two different policies. Which is exactly why one does not replace the other.

The arithmetic, done honestly

For vision the sum is simple. Add the annual exam you would pay for anyway, plus the frame and lens allowance you would use. If that exceeds twelve months of premiums — and for anyone who wears glasses it usually does — the plan pays for itself.

For dental it depends on what kind of year you have. Two cleanings and an exam already cover a large part of most premiums. The plan earns its keep in the year you need a filling, and earns it many times over in the year you need a crown.

The one case where a plan genuinely may not be worth it: if you never go, and would not go even with coverage. That is a real answer, and I will tell you so rather than sell you something.

Both are usually bought alongside a health plan, so the whole package gets designed at once. Tell me who your dentist is and I will check which plans have them in network — that check is free and takes a few minutes.