Don’t miss out! Enroll in the next 3 days to use your benefits in under a week Get Started
Richard Lee
02/07/2019 12:00 am

Finding Individual Vision and Dental Insurance When You’re Self-Employed

Being self-employed means that you’re accustomed to organizing a lot yourself. You probably enjoy the added freedom and flexibility of working independent of others, but sometimes that also leads to tougher decisions and added responsibility. Don’t make the choice between vision and dental insurance ‘either/or’, instead learn how to make both plans, well, a part of your own.

Choosing an individual dental insurance plan

A typical dental insurance plan is structured as a 100-80-50 plan.

     - 100% of the costs associated with preventative procedures will be covered. Normally, that includes regular check-ups, cleanings, and x-rays.

     - 80% of the costs of basic procedures like fillings and root canals are covered.

     - Finally, 50% of advanced procedures like crowns and bridges are also covered by the provider. 

Naturally, if you elect a plan with lower monthly or yearly costs, then the coverage in this structure might be reduced or not apply at all. Read the plan details carefully to be sure. 

As an individual, you will have the option of choosing between four different types of plans for you and your dependents (family members): 

HMOs (Dental Health Maintenance Organizations)—provide you access to a specific network of dentists and facilities. You pay a monthly premium and have to stay in network. 

PPOs (Dental Preferred Provider Organizations)—include more flexibility to see dentists outside of the contracted network. Coverage may be reduced outside of the network, but if you are enrolled in a PPO, you will generally receive discounts on normal fees associated with your dental coverage. 

Indemnity plans—don’t have a defined network. You choose your dentist freely and you do not require referrals for most procedures. Your provider pays a percentage of the costs after a service has been provided, only after you have paid the preset deductible. 

Discount programs—require a membership fee monthly or annually to receive discounts on a variety of dental services. There are no copays, deductibles, or reimbursements, but rather reduced prices on the services you choose. 

Choosing individual vision insurance plans

Very similarly, individual insurance plans are split up into HMOs, PPOs, indemnity plans, and discount programs. Many of the same principles mentioned above apply, but it’s very important to read through the details and benefits of each plan before deciding which one is right for you. For example, not every individual vision plan provides coverage for both contact lenses and eyeglass frames, but rather one or the other. The plans that provide coverage for both might be slightly more expensive, but will save you money in the long run if you require both on a regular basis. 

Comparing the costs: insured versus uninsured

Below are the estimated costs you would expect to pay for the most common services provided by optometrists and dentists respectively. 

Vision

 

Service

Cost without insurance

Cost with insurance

Eye exam

 

$154

$15 (copay)

Eyeglass frames

$159

$9

Eyeglass lenses

$86

$25 (copay)

Dental

 

Service

Cost without insurance

Cost with insurance

Exam with cleaning

$288

$10-15

Fillings and root canals

$50-150

$10-30

Crowns/tooth removal

$75-330

$38-165

Ultimately, it’s up to you to decide what’s best for you and your family. Shop around and see what’s available to you. If your typical dental and vision requirements are far and few between, then joining a discount program might be enough to meet your needs. But if you find yourself visiting the dentist often, or you have young children at home with vision problems, then a more robust PPO plan might be your best option. It comes down to a simple cost-benefit analysis; something, as a self-employed individual, that you’ve mastered long ago.