ACA marketplace plans don't include adult dental or vision coverage. Medicare doesn't either. And the out-of-pocket cost of skipping both — a single crown, a broken frame, an annual exam — adds up faster than a year of combined premiums. Here's what's available in Arizona and how to choose the right plan.
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Adult dental coverage is explicitly excluded from ACA essential health benefits. Medicare Part A and B cover no routine dental whatsoever. The result: tens of millions of Americans are covered for hospitalizations and specialist visits but completely exposed on a crown, a root canal, or even an extraction.
Vision is similarly excluded from standard ACA and Medicare coverage. Most adults don't think about it until they're sitting in an optometrist's chair looking at a $500+ bill for frames and lenses. At $10–$15/month, vision insurance has one of the fastest payback periods of any insurance product available.
Three Types of Dental Plans
Not all dental plans work the same way. The right choice depends on whether you have preferred dentists, how much dental work you anticipate, and whether you want true insurance or a discount arrangement.
The most familiar dental plan structure. Works like your health insurance — annual deductible, coinsurance percentages by service category, and an annual maximum benefit. Use any licensed dentist (in-network costs less, out-of-network covered at reduced rate). Waiting periods typically apply for major work.
Pays a fixed dollar amount per procedure — regardless of what the dentist charges. You pay the difference between the fee schedule benefit and the actual bill. No networks, no referrals. See any licensed dentist anywhere. Benefits are predictable but may not fully cover high-cost procedures at premium practices.
Not insurance. A membership that provides pre-negotiated discounts at participating dentists — typically 20–50% off procedures. No annual maximum, no waiting periods, no claims. You pay the discounted rate directly at the time of service. Best for healthy individuals who need regular preventive care and want to avoid premiums.
PPO Coverage Breakdown
Coverage percentages shown are typical in-network rates. Out-of-network coverage is reduced — often by 20–30 percentage points.
| Service Category | Typical Coverage | Common Procedures | Arizona Out-of-Pocket Without Insurance |
|---|---|---|---|
| Preventive | 100% | Exams, cleanings (2/yr), X-rays | $150–$350 per visit |
| Basic Restorative | 70–80% | Fillings, simple extractions | $150–$400 per filling |
| Major Restorative | 50% | Crowns, root canals, bridges, inlays | $1,200–$2,500+ per crown |
| Oral Surgery | 50–80% | Wisdom teeth, complex extractions | $300–$1,000+ per extraction |
| Periodontics | 50–80% | Deep cleaning, gum surgery | $200–$400 per quadrant |
| Orthodontics | 50% (if included) | Braces, clear aligners | $3,000–$8,000+ |
| Annual Deductible | Typically $50–$150 individual / $150–$450 family | Applies to basic and major categories | |
| Annual Maximum | Typically $1,000–$2,500 — plan pays no more than this per year | Consider supplementing if major work anticipated | |
One of the most common major dental procedures. Here's what it costs with and without a PPO dental plan.
Most PPO dental plans impose waiting periods before major services are covered — typically 6 to 12 months from the effective date of your policy. Preventive care (cleanings, exams) is usually available immediately. Basic restorative work may have a 3–6 month wait. Major restorative services — crowns, root canals, bridges — often require 12 months of continuous enrollment before the plan will pay benefits. Enrolling in January and expecting crown coverage in February is not how these plans work. A broker helps you understand the waiting period schedule on any plan before you enroll, and can identify no-waiting-period or reduced-waiting-period options where available — including indemnity plans and discount plans that have no waiting periods at all.
For Arizona residents on ACA marketplace plans, the dental situation is a straightforward gap: your health plan doesn't cover it, and it needs to be sourced separately. The good news is that individual dental plans in Arizona are genuinely affordable — a comprehensive PPO plan for an individual typically runs $35–$50/month — and the financial case for enrollment is easy to make once you understand what a single major procedure costs without it.
The most common question a broker fields on dental is whether to buy a PPO plan or a discount plan. For most people, the answer depends on anticipated use. If you're generally healthy, visit the dentist twice a year for preventive care, and haven't had major dental work in several years, a discount plan at $10–$20/month may cover your realistic usage at lower total cost. If you know you have work coming — a crown that's been postponed, a filling that needs replacing, an extraction your dentist has flagged — a PPO plan provides actual insurance coverage, even accounting for waiting periods.
The annual maximum limitation on PPO dental plans is worth understanding clearly. Most plans cap benefits at $1,000–$2,500 per year. If you need $6,000 in dental work in a single year, your plan pays no more than its annual maximum — you pay the rest. For patients facing extensive restorative work, some brokers recommend enrolling in dental coverage, doing the highest-priority work within the annual maximum in year one, and continuing coverage into year two to reset the annual maximum for remaining work. This approach requires planning and patience, but it systematically reduces total out-of-pocket cost over time.
Issue-age pricing applies to most standalone dental plans. Just as with accident and critical illness coverage, locking in dental coverage while you're younger produces lower long-term premiums than waiting. A healthy 35-year-old who enrolls in a dental plan today will pay less over the next 20 years than a 45-year-old who enrolls at that age — assuming similar benefit structures. Dental needs generally increase with age, making early enrollment the financially sound approach.
If you're on an ACA plan, recently lost employer dental coverage, or are on Medicare and haven't had dental coverage in years — enroll now. The waiting period clock starts on your effective date. Every month you delay is a month added to the wait before major services are covered.
Choose PPO if: You have or anticipate major dental work, want genuine insurance coverage, or have family members with active dental needs.
Choose Discount if: You're healthy, primarily need preventive care, want the lowest possible monthly cost, and have no major work pending.
Most PPO dental plans cap annual benefits at $1,000–$2,500. If you need major work that exceeds the annual max, plan for a multi-year approach: prioritize the highest-cost procedures first, let the annual max reset, and continue coverage for remaining work in subsequent years.
Original Medicare (Parts A & B) covers no routine dental. Some Medicare Advantage plans include limited dental benefits — but "limited" often means preventive only, with sub-$1,000 annual maximums. A standalone dental plan alongside Medicare Advantage or a Medigap plan provides significantly more comprehensive coverage for most retirees.
Vision Coverage in Arizona
Vision insurance is typically the simplest supplemental product to evaluate. For most Arizona adults who wear corrective lenses, a standalone vision plan pays for itself within a single year's exam and eyewear purchase.
Vision insurance is straightforward by design — and that simplicity is part of its appeal. Most standalone vision plans follow a predictable structure: a covered annual eye exam, an annual allowance for frames or contact lenses, and optional discounts on upgrades like anti-glare coatings, photochromic lenses, or LASIK procedures through network providers.
For Arizona residents on ACA marketplace plans, vision — like dental — is explicitly excluded from adult essential health benefits coverage. A 40-year-old with a comprehensive ACA plan that covers hospitalizations, specialist visits, and prescription drugs has zero coverage for the eye exam they need every one to two years and the glasses or contacts they need to function daily. That gap costs $300–$700+ per year for a person who wears glasses — and a vision plan at $10–$15/month eliminates most of it.
The network question matters more for vision than for dental. Vision plan networks vary significantly by carrier — some plans give you access to independent optometrists and ophthalmologists across Arizona, while others are more restricted to large chains like LensCrafters, Target Optical, or Visionworks. If you have a preferred eye doctor, a broker confirms network participation before recommending enrollment. If you don't have a preference, a plan anchored in a large retail chain network often means convenient access and competitive pricing on frames.
Contact lens wearers should pay particular attention to how the annual allowance is applied. Most plans give you the option to use the allowance for either frames or contact lenses — but not both in the same plan year. If you wear contacts primarily but occasionally want a pair of glasses, understanding how your plan handles this split is important. Some plans offer a reduced contacts allowance alongside a glasses benefit; others require you to choose one per year. A broker clarifies this before you enroll.
For those considering LASIK or refractive surgery, many vision plans include a discount benefit — typically 15–20% off the standard procedure price at participating providers. This isn't coverage for the surgery itself, but on a $2,000–$4,000 procedure, a 15% discount represents real savings. If LASIK is on your near-term agenda, confirming that your vision plan includes a laser surgery discount benefit is worth the two-minute check with a broker.
Typical costs for common vision services in Arizona, 2026
Most plans provide an annual frame allowance of $130–$200. Frames within the allowance cost you nothing; frames above the allowance mean you pay the difference. A broker identifies plans with the highest frame allowances relative to premium — this is where meaningful variation between carriers exists.
Most vision plans give you the annual allowance for either contacts or frames — not both. If you wear contacts daily but want glasses as a backup, confirm whether your plan allows a partial contacts benefit alongside a reduced frames allowance, or requires you to choose one exclusively per year.
For families where two or more members wear corrective lenses, a family vision plan is one of the highest-value supplemental products available. Two annual exams, two frame allowances, and contacts coverage across a family quickly exceed the annual family premium of $30–$50/month.
Most Arizona residents who need dental coverage also need vision coverage. Buying both from the same broker — and sometimes from the same carrier — simplifies billing, ensures there are no coverage gaps between the two, and often produces better combined pricing than sourcing each independently. Here's what a typical combined individual dental + vision budget looks like.
The math below illustrates why the combined spend is easy to justify. A single dental cleaning visit plus an annual eye exam with a basic pair of glasses — two completely routine annual events — exceeds the annual premium for both plans combined at most age brackets. Any dental or vision work beyond the routine further increases the ROI.
Get Combined Dental + Vision Quotes →Actual premiums vary by carrier, age, zip code, and plan design. Cost estimates for services are representative of Arizona market rates. A broker provides exact quotes for your specific situation.
Common Questions
A licensed Arizona broker will compare available dental and vision plans for your zip code, confirm your preferred providers are in-network, and get you enrolled — completely free.
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