When most people think about health insurance through the Affordable Care Act (ACA) Marketplace, they think about medical coverage—doctor visits, hospital stays, and prescriptions. But what about dental and vision insurance?
These two types of care are often essential, especially for families with kids or adults with ongoing oral or eye care needs. However, dental and vision benefits work differently than regular health plans on the Marketplace. They aren’t always included, and they come with their own set of rules.
This guide explains how dental and vision coverage fits into ACA plans, who should consider it, and how to make smart choices when shopping during open enrollment or qualifying life events.
How Dental and Vision Fit Into ACA Plans
Unlike medical coverage, dental and vision insurance aren’t automatically included in every Marketplace plan. The ACA requires health plans to offer certain essential health benefits, but adult dental and vision care aren’t part of that list. The only exception is for children under age 19, where dental (and sometimes vision) is a required benefit.
That means if you’re an adult looking for coverage for cleanings, fillings, glasses, or contacts, you’ll likely need to purchase separate dental or vision coverage, or choose a health plan that bundles those services in.
There are generally two ways to get dental and vision insurance through the Marketplace:
As part of a health plan that includes dental or vision benefits
As a standalone plan added during enrollment
The option available to you depends on your state’s Marketplace and the insurance companies offering plans in your area.
Who Might Benefit from Adding Dental and Vision Plans
Not everyone needs dental and vision insurance through the ACA Marketplace, especially if they already get these benefits elsewhere (like through an employer, a spouse’s plan, or a private insurer). But for many people, skipping out on dental or vision coverage can lead to high out-of-pocket costs down the line.
You might benefit from standalone plans if:
You have children under 19: Pediatric dental is required in all ACA plans, but the cost-sharing and provider networks may differ by plan. You’ll want to compare the specifics before choosing.
You have a history of dental work: People who frequently need fillings, crowns, or gum treatment often save money with a dental plan, even after paying monthly premiums.
You wear glasses or contacts: Vision plans typically cover annual exams, lenses, frames, or contact lenses—services that can cost hundreds annually without insurance.
You’re self-employed or retired early: If you don’t have access to employer-sponsored benefits, buying dental and vision plans alongside your Marketplace plan might be your only affordable option.
Think about your recent medical history: Did you get a root canal last year? Break your glasses? If so, bundling in dental and vision coverage during enrollment might be worth it.
What Dental Coverage Looks Like on the Marketplace
Dental insurance offered through the Marketplace usually comes in one of two forms: bundled with a health plan, or standalone. Here’s how to tell the difference and compare your options:
Bundled plans: Some health plans on the Marketplace include dental coverage as part of the plan. You’ll see these listed when shopping for health insurance. While convenient, these plans might not offer the flexibility or comprehensive coverage of standalone dental plans. You can’t remove the dental portion or change it separately.
Standalone plans: These are purchased in addition to your health insurance. After you choose your medical plan, you’ll have the option to browse available dental plans in your area.
Dental plans on the Marketplace typically come in two categories:
High coverage: Higher monthly premiums, lower deductibles, and more services covered (including major procedures like crowns and root canals).
Low coverage: Lower monthly premiums, but higher costs when you get care and fewer services included (often limited to preventive care).
You’ll need to decide based on your current oral health needs and budget.
Importantly, you can only purchase a standalone dental plan through the Marketplace if you’re also enrolling in a health plan. This is one of the quirks of ACA enrollment—dental-only coverage is not available unless it’s part of a full Marketplace health insurance package.
What Vision Coverage Looks Like—and Where It’s Lacking
Unlike dental insurance, vision coverage for adults is even less commonly bundled with ACA health plans. While pediatric vision care (like eye exams and glasses) is an essential benefit for children, adult vision is typically left out.
Here’s what to know:
Most ACA health plans don’t include adult vision benefits
Vision plans are not sold directly on the federal Marketplace (HealthCare.gov)
Some state-based Marketplaces (like California’s Covered California or New York State of Health) partner with vision providers to offer optional add-ons
In most states, you’ll need to buy adult vision coverage directly through a private insurer or broker
Standalone vision plans are relatively affordable—often ranging from $10 to $20 per month—and cover routine exams, glasses, lenses, and sometimes contacts or discounts on LASIK. Companies like VSP and EyeMed are major providers that sell directly to consumers and sometimes offer enrollment discounts during ACA open enrollment.
If you’re planning to add vision coverage, do your research outside the Marketplace—unless your state provides specific vision add-on options.
How to Add Dental (and Sometimes Vision) During Enrollment
Adding dental coverage on the ACA Marketplace depends on your timing and your state.
During Open Enrollment (typically November 1 to January 15):
Log in to your Marketplace account
Choose your health plan first
Then browse available dental plans (only if you selected a health plan)
Select and enroll in both before submitting your application
During a Special Enrollment Period (SEP):
If you qualify for a SEP (due to a life event like losing coverage, getting married, or having a baby), the process is similar
You’ll have a 60-day window to enroll in both a medical plan and add dental
It’s important to remember:
You can’t go back and add dental later if you don’t select it during your enrollment window
If your health plan includes embedded dental benefits, you won’t see standalone dental options unless you choose a medical plan without embedded dental
For vision, unless your state has specific add-on options, you’ll need to enroll separately through a private insurance website. You can do this anytime—vision insurance isn’t bound to ACA enrollment periods.
Tips for Comparing Dental and Vision Add-ons
Not all dental or vision plans are created equal. Just like health insurance, you’ll want to compare more than just the monthly premium.
Look for:
Waiting periods: Some plans have 6–12 month waiting periods for major procedures. If you need work done soon, look for no-wait plans.
Annual maximums: Many dental plans cap coverage at $1,000–$2,000 per year.
Networks: Make sure your dentist or optometrist is in-network to avoid surprise costs.
Coverage types: Preventive services (cleanings, x-rays) are often 100% covered, while fillings, extractions, and crowns are typically partially covered.
Copays and deductibles: Know how much you’ll pay out-of-pocket before the plan starts covering costs.
Also, weigh whether you’ll actually use the benefits. If you get an annual dental cleaning and nothing else, a low-premium, preventive-only plan may make more sense than a high-coverage plan with a high monthly cost.
What If You Already Have Dental or Vision Coverage?
If you’re already getting dental or vision benefits from another source—such as through an employer, a family member’s plan, or a standalone policy—you don’t need to buy coverage through the Marketplace. In fact, you can keep your existing coverage and still purchase a Marketplace health plan.
But if your current benefits are ending, or you’re losing employer-sponsored insurance, adding dental and vision through the Marketplace can help you stay covered—without needing to shop around too much outside of open enrollment.
Final Thoughts: Don’t Overlook These Benefits
Dental and vision insurance often take a backseat during ACA enrollment, especially when people are focused on premiums, deductibles, and medical provider networks. But skipping over these optional add-ons can lead to high out-of-pocket costs later.
Whether you have children who need braces or just want to avoid paying $400 for new glasses next year, it’s worth taking the time during open enrollment to explore your options. A little planning now can help you protect both your health and your wallet.
