Why are vision and dental insurance separate from medical insurance?

If I have a problem with my ears, I don’t need to worry about having “hearing insurance”. My medical insurance covers the problem. Why do the eyes and teeth have separate insurance. I would think that the health of my teeth and eyes would effect my general health. So why do I have different insurance for those two body parts/functions and not any others?

There are certainly other kinds of specialist that would be covered under my health insurance. I would use the same insurance for a podiatrist that I would use for an ENT. Why are dentists and optometrists different?

Perhaps it’s because, at least in the US, optometrists and dentists are not normally board-certified Medical Doctors with the MD degree, but have separate degrees/qualifications and licensures? When you get measured for glasses, you normally see a DO, not an MD, and dental work is done by a DDS (though I do believe that an MD Opthamologist can give you a glasses prescription).

This might not be the full story, as wouldn’t health insurance normally cover a visit to a MA or PhD Psychologist?

The basic answer is that they are two distinct health professions that aren’t all that closely aligned and they operate under separate systems from both a health and economical model. In others words, it is that way because it has been that way for a long time.

It is a good question though. Dentists used to have a reputation for being the ones that couldn’t hack medical school so they became dentists instead. That isn’t true anymore for the ones that I see. My dentist’s office is right across the hall from my primary care doctor’s office and she is a cutting edge medical professional who runs a tight ship. There isn’t any difference in the way the two offices run except that my main doctor takes care of 95% of my body and I get sent across the hall to a whole different system if the problem involves the mouth. The insurance is vastly different however even when she does surgery which doesn’t make a lot of sense as you say.

There are ENT’s and oral surgeons that work in the mouth area that are doctors just like there are opthamologists that will do some of the same things that an optometrist can but the insurance plans are different. The medical professions aren’t always laid out in clean-cut divisions between roles and the insurance schemes add more complication to that. It doesn’t make much sense. I can see an acupuncturist or a chiropractor under my medical insurance but they won’t pay if I see dentist for anything even if the problem could result in general infection, jaw damage or heart problems later.

We have threads on the reasoning (or non-reasoning) of this before. I will see if I can find one.

Here is a related thread with some insight although the pure logic isn’t sound if you had to rebuild the system from the ground up IMHO:

The real reason is it costs too much.

In the 80s and even as late as 1994, my MEDICAL insurance would pay for a root canal. Now I don’t know of any medical insurance that will do that.

Now explain that. You can’t. Did a root canal suddenly cease to be a medical procedure and become a dental problem. No it didn’t. It got too expensive and insurers dropped it.

Medical insurance pays for cheap things. This is why they often cover things like Christian Scientist Practitioners. Because it’s a lot cheaper to pay for them, then an actual medical treatment.

You can go into justifications and rationalizations on why teeth are different, but there is no REAL reason for it, other than costs. You can bet if a root canal was $100 that medical insurance would cover it.

And of course people will argue the point, but it really comes down to this, “it’s like that 'cause they can get away with it.”


I should point out that the existence of different doctoral practitioners argument doesn’t really hold water at the present time, as both optometrists and ophthalmologists can accept vision and medical insurance depending on what is wrong with your eyes. A diagnosis of nearsightedness is charged to the vision plan and a diagnosis of cataracts is charged to the medical plan.

Not at all sure about dental, but as far as vision insurance goes, the yearly vision-insurance eye exam is almost like a “checkup” for your eyes. Once you have a non-refractive problem (that is, something not hyperopia, myopia, or presbyopia) it is charged under ones medical insurance, not vision.

Health insurance here comes with the option of buying “extras” cover, that includes dental and optical expenses.

When I go to the doctor’s office, I often see a Nurse Practitioner and not an MD. The insurance still covers it.

I don’t understand this. I am sure that I have cost insurance companies significantly more money medically than dentally. I have had a lot of dental work in my life, but I know that three trips to the ER blow all that out of the water.

I also wear glasses and have since I was eight. They are not that expensive, as health related things go, so why wouldn’t health insurance cover it? In fact, it seems that when things start the get expensive, that is when the health insurance takes over.

Furthermore, my dental insurance has a yearly maximum that isn’t that high. I assume that this is because a lot of individual treatments wouldn’t reach that maximum.

Am I being short-sighted in my understanding of health insurance costs? I suppose “because that’s how it has always been done” is about what I expected, but you say that your health insurance used to cover the cost of a dental procedure and now does not. I didn’t realize they could do this (although I am not terribly surprised).

This just confuses me even more.

I guess I just don’t see a huge difference between an optometrist check-up and a medical one. Mental health treatments are often covered by health insurance. This is true, even for non-prescription mental health treatment. A stay at a rehabilitation facility, for example, is often covered. That seems like a hugely different professional model which is covered.
I really appreciate everyone’s responses. “That’s just the way it is” seems to be what I am gathering here.

What state on you in? It’s quite rare to have health insurance that covers hearng aids and audilogical exams. Most insurances only cover coachlear implants or Bone Anchored Hearing Aids.
I think in the cases where expensive technology is covered it’s b/c only a small percentage of people will opt for it. So the insurance companies don’t go broke.

I live in California. Whenever I have had an audiological exam, it has been covered by my insurance. I have never needed a hearing aid, so I don’t know about that.

there is also the reason that not everybody perceives the need for eye and dental insurance. some people have great teeth and vision and wouldn’t see a positive benefit from the added cost of insurance coverage for either. damage to teeth and vision caused by accidents are somethimes covered by general health insurance (although this might be much rarer in the current environment). for a similar case, single men may pay less for insurance because they don’t need maternity related benefits. i’m not advocating for this system, but along with the other reasons mentioned in this thread, it seems reasonable that this is how our traditional private insurance system would work.

I have good skin and would like to not have to pay for dermatologist coverage, but I don’t get that option. It is included in my health insurance. How is that different? (I am not trying to be argumentative, I am just trying to more clearly understand your point.)

A DO is a Doctor of Osteopathic Medicine. An eye doctor is an OD, Doctor of Optometry.

Not so quick. When I finally broke down and had my hearing checked, my insurance paid for the exam. However, the $3,000 hearing aid that was absolutely necessary? Insurance covered exactly $0.

actually, a lot of dermatology services are not covered by general insurance and considered cosmetic (as are many dental services), but most necessary care performed by dermatologists, such as excising a pre-cancerous mole could be done by any licensed physician or surgeon. the services provided by dentists, and optical practitioners are much more specialized. also, the term ‘good skin’ doesn’t really address your overall health needs, it sounds generally cosmetic.

I would say that anything covered by most dental insurance is not cosmetic. Any dental insurance I have had won’t cover cosmetic procedures. On the flip side, my sister has had insurance cover acne treatments. I would say a root canal is less cosmetic then that. The visit to the dermatologist was completely covered with a co-pay on the medication.

I guess hearing aids aren’t covered by some insurance, but you still can’t buy separate hearing insurance that would cover it (unless you count a more inclusive plan).

ok, i didn’t clearly make my point initially. traditionally, dental and vision care were not seen as core medical issues relating to overall health, and that contributed to the structure in question as a marketing consideration. that was my only point.

Markxxx hit it the closest…it costs to much. Not necessarily on an individual basis, because a heart transplant on an individual will certainly costs more than eyeglasses or a tooth filling. But in the group of insureds as a whole, including coverage for normal dental procedures with your medical procedures would be one of the most costly items covered…because normal dental work is a routine service that almost everyone needs regularly throughout their life. Open heart surgery…much more rare.

The best way to handle it is to separate it and insure it stand-alone.

if you look at the cost of necessary dental care, cleaning, filling cavity, and the occasional extraction, insurance may cost more than those procedures. i don’t have the statistics, but most dental insurance seems to cover more non-essentials than most general health insurance. you usually don’t need root canals, an extraction will do. for most of your teeth, the extraction will cost less than the root canal.

as far as optical care, most of that cost goes to corrective lenses, which i consider a major rip-off. i see that most corrective lenses, spectacles and contacts, inflate the cost of the raw materials about 10000%. these are almost all made by pretty simple machines now, and i can’t find a justification for this, unless you count outrageous profit taking only possible due to corrupt legislation a justification. now that i’m almost 100 years old, i use reading glasses occasionally. i can buy a pair of those for under $5. why should standard prescription eyeglasses cost hundreds of dollars? (yes this is off topic, but i said it anyway)

They shouldn’t. Zennioptical and others put out cheap eyeglasses. Last time I bought from Walmart they were expensive. I haven’t been paying attention too much, but it seems brick and mortar stores are getting cheaper, perhaps because of online competition.

Not everyone needs vision also, which might make it more “optional.”