Dental and vision plans are small, separate, and run on different logic than your medical plan. Once you see the pattern, they're simple.
Dental: it's backwards from medical
Medical insurance protects you from big bills. Dental insurance does the opposite — it pays well for small, routine things and caps out on big ones.
- The 100/80/50 pattern. Most plans pay about 100% for preventive (cleanings, exams, X-rays), 80% for basic work (fillings, simple extractions), and 50% for major work (crowns, bridges, root canals, dentures).
- The annual maximum. The plan stops paying once it's spent a set amount on you per year — commonly $1,000–$2,000. After that, you pay everything. This is the number that surprises people mid-crown.
- Waiting periods. New enrollees often wait 6–12 months before major work is covered.
- Frequency limits. Two cleanings a year, X-rays every so many months, one crown per tooth per five years, and so on.
- Orthodontics is usually a separate lifetime maximum, often only for children.
Practical move
Big dental work coming? Ask the dentist for a
pre-treatment estimate submitted to the plan. It tells you what's covered and what the maximum leaves. And if the work spans two plan years, you get two annual maximums.
Vision: a fixed allowance
- Typically: one eye exam per year for a small copay, plus an allowance toward frames or contacts (often $130–$200) once a year or every other year.
- Lenses are usually covered with a copay; upgrades (anti-glare, progressives, thinner lenses) cost extra.
- Out-of-network is often allowed but reimbursed at a lower flat rate.
- LASIK is generally a discount, not coverage.
The eye exam itself is a real benefit — it catches things beyond your prescription. The frames allowance is a modest discount; don't overthink it.
Where medical, dental, and vision overlap
- An eye injury or eye disease (glaucoma, cataracts, retinal problems) is generally medical, not vision. Use your medical plan and the medical ID card.
- Jaw surgery, some oral surgery, and facial trauma are often medical, not dental.
- FSA and HSA money can pay for dental and vision costs the plans don't — including glasses and orthodontics.