Dental and Vision Coverage After You Retire: What Changes and What to Ask

For many people, dental and vision coverage simply came with the job. Cleanings twice a year, an eye exam, a new pair of glasses every so often, and most of it ran through payroll without much thought. Then retirement comes, the group plan ends, and the first bill for a crown or a pair of progressive lenses can be a surprise.

If you're retiring around Mooresville, Lake Norman or anywhere in Iredell County, or you've just moved here and need to find a new dentist and eye doctor, here's a clear look at what usually changes and the questions worth asking before you pick a plan.

What usually changes when work coverage ends

Dental and vision plans through an employer are group benefits. When you leave the job, that coverage generally ends too, often at the end of the month you leave, though the exact timing depends on the plan.

You may have a few ways to keep it for a while:

• COBRA. If your employer is covered by federal COBRA rules, you may be able to continue the same group dental and vision coverage for a limited time, usually up to 18 months. You typically pay the full premium plus a small administrative fee, so it can cost more than you paid while working.
• Retiree benefits. Some employers offer dental or vision to retirees. Many don't, and those that do can change the terms over time.
• A spouse's plan. If your spouse is still working, you may be able to join their coverage.

Your HR or benefits department can tell you which of these apply to you, and what the deadlines are.

What Original Medicare generally covers (and doesn't)

This catches a lot of people off guard. Original Medicare (Part A and Part B) generally does not cover routine dental care, such as cleanings, fillings, extractions or dentures. It also generally doesn't cover routine eye exams for glasses or contacts, or the glasses themselves. There are limited exceptions, such as certain dental services tied to a covered medical treatment and one pair of eyeglasses or contact lenses after cataract surgery with an implanted lens.

Medicare does cover some eye care related to medical conditions, such as certain screenings and treatment for eye diseases. Check Medicare.gov or ask your doctor's office how a specific service would be billed.

If you're on a Medicare Advantage plan, look at what dental and vision your plan already includes before adding anything. Benefits vary by plan, and some plans have limits, networks or yearly maximums that are worth understanding. The Medicare section of our site has more on how Medicare works.

Your options for dental and vision on your own

Standalone dental insurance

Individual dental plans usually group care into tiers. Preventive care, such as cleanings, exams and X-rays, is often covered at the highest level. Basic work like fillings comes next. Major work, such as crowns, bridges and dentures, is usually covered at a lower level and may have a waiting period before benefits start. Most plans also have an annual maximum, which is the most the plan will pay in a year.

Standalone vision insurance

Vision plans typically help with a routine eye exam and give you an allowance toward frames and lenses or contacts, often on a set schedule such as once every 12 or 24 months. Plans differ on the allowance amounts and which eye doctors and retailers are in network.

Dental discount plans

A discount plan is not insurance. You pay a membership fee and get reduced prices at participating dentists. It can make sense for some people, but it works differently than a plan that pays part of the bill.

Questions to ask before you choose

1. Is my current dentist or eye doctor in the plan's network, and what happens if I go out of network?
2. Is there a waiting period for basic or major dental work?
3. What is the annual maximum, and is there a deductible?
4. How often does the vision plan cover an exam, and how much is the frame and lens allowance?
5. Do I already have some dental or vision benefits through another plan, so I'm not paying twice?
6. If I know I'll need a crown, implant or dentures soon, how would this plan actually handle that work?

The last question matters most. Two plans can look alike on paper and pay very differently for the work you actually need.

For a quick overview of the coverage itself, see our dental and vision insurance page. You can also browse other supplemental health options, such as hospital indemnity insurance.

Talk it through with a local broker

I'm Matt MacMillan, an independent insurance broker in Mooresville. I can look at what you have now, whether that's COBRA, a retiree plan or Medicare, and compare standalone dental and vision plans from the companies I represent so you can see what each one would pay. If what you already have covers your needs, I'll tell you. There's no fee for my help, and we can meet in person, by phone or by video.

Call me at (704) 802-2523 or request a call below, and we'll go over it at your pace.

This article is general information, not legal, tax or financial advice. Coverage, rules, features and availability may vary by insurance company and state, and every policy is subject to the insurer's underwriting and eligibility rules.