Pediatric Dental and Vision Benefits: What Parents Should Know
If your child is enrolled in an Affordable Care Act (ACA) health plan, you may not realize that dental and vision benefits are included for children under the age of 19. These benefits do not incur any additional costs and can be used alone or in conjunction with other dental and vision insurance plans.
The pediatric dental and vision plans are not as comprehensive as traditional à la carte insurances, but since they are included at no additional cost, every bit of coverage helps. Here’s a breakdown of what’s covered, who it may work best for, and when it might make sense to look into adding separate dental and vision coverage for your child.
Pediatric Dental Coverage
The included pediatric dental benefits are subject to your medical deductible, meaning the carrier will not pay for the services unless your deductible has already been met. In many cases then, it will go towards the deductible only. Many families do not reach their deductibles or have very high deductibles, which means the dental plan does not help them. The pro is that it's already included in your plan at no additional cost, so it’s worthwhile to use either way.
If your child only needs routine care, you’ll likely pay out of pocket because benefits don’t apply until after you meet your deductible. Cons include a limited dental network that accepts these plans, due to the low reimbursement rate. Orthodontic coverage is minimal, only covering braces when medically necessary.
Check out the chart below for an example of coverage on a BCBS pediatric dental plan.
When it comes to pediatric dental care, if your child only needs cleanings and you won’t meet your deductible, you likely won’t have a chance to access any paid-for benefits. However, the plan can offer some value if your child requires more than routine care, and if your plan's deductible is low enough that coverage will kick in.
Pediatric Vision Coverage
ACA pediatric vision benefits provide more substantial benefits. Even if your child does not need glasses, it can be worthwhile to use them for routine eye exams.
This benefit includes fixed-cost services for eye exams as well as basic lenses and frames every 12 months. While prices vary, these benefits often offer better value than standalone vision policies. During a recent visit to the eye doctor, one of our team members observed that the kids' vision policy provided a better price than their additional paid-for vision insurance plan. You may also be able to access discounts on lens coatings, specialty frames, and contact lenses using the ACA pediatric vision coverage. It’s a low-cost and fairly comprehensive option, so if you’ve got this benefit, use it.
Check out the chart below for more details on a BCBS pediatric policy:
Both pediatric dental and vision are built into your ACA plan, so it is always worthwhile to use these benefits. If you have any questions about your policy or are interested in supplemental coverage, get in touch with us today!
