Why Doesn't Health Insurance Cover Vision and Dental?

by Team eLocal
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Even though your eyes and teeth are part of your body, health insurance tends to treat them as separate entities.

Dental and vision insurance are not automatically included in health care plans, but this type of care is essential for a healthy body. The reason why they're kept separate may not seem logical, but knowing can help you understand your health insurance choices.

Why Doesn’t Health Insurance Cover Vision and Dental?

You can find many explanations as to why vision and dental insurance aren’t covered by general health insurance, but it generally comes down to two things: history and the nature of insurance.

Historical Explanations

In the past, vision and dental care were seen as something different from other medical care. Barbers often acted as dentists, pulling teeth after providing a haircut or shave. People providing eye care were dismissed as craftsmen creating glasses rather than professionals providing medical care. This meant that when health insurance first appeared in the United States, it excluded vision and dental care, and this has continued until today.

The Nature of Insurance

One reason this historical anomaly has continued is because of the nature of insurance. Health insurance relies on a large pool of people putting money in just in case something catastrophic happens. Insurance companies make money because most people in the pool don’t experience a catastrophic event.

However, dental and vision care tends to be preventative. It can be predicted and is paid out regularly, and the costs are rarely catastrophic. This has led to some people describing dental and vision insurance as closer to a discount program rather than true insurance. As the regular payout for dental and vision would mean increasing premiums, most health insurance companies keep it as an add-on or separate policy, rather than offering it through their regular policies.

Why Is Dental and Vision Coverage So Important?

Vision and dental care are important in their own right. Without proper eye care, you may not be able to see clearly. Teeth problems can cause considerable pain. Additionally, missing teeth can lower self-esteem and may even impact your earnings.

However, vision and dental care can also help keep the rest of your body healthy. The CDC states that poor oral health is associated with conditions like heart disease and diabetes. Abscessed teeth can also lead to hospital stays and severe infections.

Ophthalmologists, on the other hand, can gain great insight into a person’s health by looking at their eyes. Eyes show signs of many conditions, including:

  • Diabetes
  • Multiple sclerosis
  • Hypertension
  • Certain types of cancer
  • Lupus

Regular eye exams can help people get timely treatment for other medical issues that can save lives, as well as decrease the cost of care.

Do Health Care Plans Cover Dental and Vision?

Under the Affordable Care Act, health insurance plans must cover certain categories of care that are known as essential health benefits. Dental and vision care are essential benefits for children and must be included in plans covering people aged under 18. However, these types of care are optional for adult plans.

Despite this, you can find plans that include dental and vision. Alternatively, you can purchase separate plans to ensure you have the coverage you need or pay for care out of pocket. All health care plans are different, so it’s important to check your policy for your specific benefits.

Covered Vision Care

While optometry isn’t generally covered by health insurance, ophthalmology often is. Ophthalmology is a medical specialty that looks at eye diseases and conditions, such as glaucoma and retina issues. They can also perform eye surgery to correct these conditions.

Do Medicare and Medicaid Cover Dental and Vision?

Medicare and Medicaid are government-provided health insurance programs. Much like with private health insurance, dental and vision coverage is not the norm in these programs.

Medicare

Original Medicare, known as Part A and B, doesn’t cover preventative dental or vision insurance. However, Medicare recipients who choose a Medicare Advantage (Part C) plan, may be able to find one with dental or vision included as an added benefit.

Despite this, some emergency treatments are included. For example, if you need to have an operation, but you have a loose tooth, the tooth extraction may be covered. Additionally, Medicare covers tests for high-risk eye conditions such as glaucoma, as well as any related surgery and medical care.

Medicaid

Vision and dental care for children are both covered in all states; however, coverage for adults is not mandatory. In some states, dental and vision care is provided, but it can be cut when states have budget concerns. It can also be hard for people with Medicaid to get appointments, as many dentists and optometrists don’t accept Medicaid payments or have limited appointment spaces for Medicaid beneficiaries.

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