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  • Diabetes, Your Eyes, and Your Teeth: Using Your Coverage

    Diabetes, Your Eyes, and Your Teeth: Using Your Coverage

    November is National Diabetes Month, and most of the attention goes to blood sugar, diet, and medication. But diabetes can also affect two parts of the body that are easy to overlook: your eyes and your gums. Regular eye and dental care are part of managing diabetes well — and your dental and vision coverage, along with your health plan, can help you keep up with both.

    Why Your Eyes Need an Annual Check

    Over time, high blood sugar can damage the small blood vessels in the back of the eye. Diabetic eye disease often has no early symptoms, so it can progress before you notice a change in your vision.

    That is why diabetes organizations recommend that adults with diabetes have a dilated eye exam at least once a year, or as often as their eye doctor advises. During a dilated exam, the eye doctor widens the pupils to look at the retina directly, which is how early changes are found.

    Why Your Gums Matter Too

    People with diabetes are more likely to develop gum disease, also called periodontal disease. The link appears to work in both directions: diabetes can make gum infections harder to fight, and serious gum disease may make blood sugar harder to control.

    Gum disease is often painless in its early stages. Regular dental visits — commonly every six months, or as your dentist recommends — give your dentist a chance to catch problems early. Be sure your dentist knows you have diabetes.

    Which Plan Pays for What

    This is where many people get confused, because more than one plan can be involved.

    Eye exams. A vision plan typically covers a routine eye exam for checking your prescription, plus an allowance for glasses or contacts. An eye exam to monitor a medical condition such as diabetes is often billed to your medical plan instead, under your health plan’s specialist or office visit benefits. Which plan applies depends on why the exam is done and how your eye doctor bills it, so ask the office before your visit.

    Dental care. Dental plans typically cover preventive cleanings and exams at a high level, often twice a year. Treatment for gum disease, such as a deep cleaning, usually falls under basic or major services, with a deductible and coinsurance. Some dental plans offer additional cleanings for members with diabetes; check your plan documents or call the carrier to find out whether yours does.

    Getting the Most From Your Coverage

    • Schedule your dilated eye exam and dental visits now, before your plan year resets
    • Ask your eye doctor’s office which plan they will bill — vision or medical
    • Ask your dental plan whether it offers extra cleanings for members with diabetes
    • If you don’t have dental or vision coverage, consider whether adding it makes sense for next year

    A Familiar Scenario

    David, who has type 2 diabetes, went in for what he thought was his yearly vision plan exam. Because the visit included a dilated exam to check for diabetic eye disease, the office billed his medical plan. A quick question at check-in would have helped him know what to expect — and confirmed he still had his vision allowance for new glasses.

    We’re Here To Help!

    If you are not sure what your dental and vision plans cover, or you are considering adding coverage for next year, we can walk through your options with you. Individual and group dental and vision plans are both available. Call us at 818-253-1736 or use the contact form on our website.

    This article is general information and is not medical advice. Talk with your doctor, eye doctor, or dentist about the care that is right for you. Coverage, frequency limits, and billing vary by plan; check your plan documents or contact your carrier for details.

  • Dental and Vision Benefits: Use What You Have Before They Reset

    Dental and Vision Benefits: Use What You Have Before They Reset

    Dental and vision benefits work differently from most health coverage. Many of them are built around a yearly allowance, and when the plan year ends, whatever you did not use is generally gone.

    For plans that run on the calendar year, that means the last few months of the year are the time to check what you still have.

    How the Dental Annual Maximum Works

    Most dental plans have an annual maximum — the most the plan will pay toward your care in a plan year. Once the plan has paid that amount, you are generally responsible for the rest of that year’s costs.

    When the plan year resets, the annual maximum resets with it. Any portion you did not use generally does not carry over. A few plans do include a rollover feature that carries some unused benefit forward, but it is the exception, and it usually comes with conditions.

    Check your plan documents or call your carrier to find out how much of this year’s maximum remains.

    Deductibles Reset Too

    Many dental plans also have a deductible that must be met before the plan starts paying for certain services. Like the annual maximum, it generally resets at the start of each plan year.

    If you have already met this year’s deductible, care completed before the reset may cost you less out of pocket than the same care scheduled after it.

    Preventive Care Is Usually the Easy Win

    Many dental plans cover routine cleanings and exams at a high level, often with no deductible. If you have not had your cleanings this year, scheduling them before the plan year ends is often the simplest way to use benefits you are already paying for.

    Dental offices tend to book up toward year end, so it helps to call early.

    Planning Larger Dental Work

    For crowns, bridges, and other major work, ask your dentist to submit a pre-treatment estimate to your plan. It shows what the plan expects to pay before the work is done.

    When a treatment plan is large enough to exceed one year’s annual maximum, some patients and dentists arrange the work so that part falls in one plan year and part in the next, drawing on two annual maximums. Whether that makes sense depends on the treatment and your dentist’s clinical judgment — it is worth asking about.

    Vision Allowances and Benefit Periods

    Vision plans commonly provide allowances for eye exams, frames, and lenses or contacts. Unlike dental, these are not always yearly. Many vision benefits run on a 12-month or 24-month cycle, and exams and eyewear can be on different cycles within the same plan.

    Check when you last used each benefit and when it becomes available again. An unused frame allowance may be close to expiring — or you may not be eligible again until next year.

    A Familiar Scenario

    Someone learns in October that they need a crown. The plan has most of its annual maximum left and the deductible has been met, but work gets scheduled for January to avoid the holiday rush. In January, the deductible applies again and the treatment draws on a fresh maximum that could have been saved for other care.

    Nothing was lost on purpose. The reset date simply was not part of the decision.

    We’re Here To Help!

    If you are not sure when your dental or vision plan year resets, or how much of your benefit remains, reach out and we will help you find out. A quick check now leaves time to schedule before the reset.

    This article is general information about how dental and vision benefits commonly work. Plan years, annual maximums, deductibles, frequency limits, and allowances vary by plan; confirm the details of your coverage with your carrier or plan documents. Treatment decisions should be made with your dentist or eye care provider.