The Ultimate Guide to Dental and Vision Insurance for Adults: What ACA Plans Cover and What You Should Know

Brought to you by XactInsure — making health coverage smart, simple, and actually fun to understand.

When people think about health insurance under the Affordable Care Act (ACA), they often focus on premiums and deductibles for medical care. But here’s the truth: your teeth and eyes deserve just as much coverage love. Dental and vision care aren’t automatically included in most adult health plans under the ACA, but you can get these benefits on and off the Marketplace — and understanding how is the key to saving thousands.

In this guide, we’ll break down everything:

• The difference between on-exchange and off-exchange plans
• What’s considered preventive, basic, and major dental work
• Adult orthodontics coverage (yes, it exists)
• What types of lenses and vision upgrades are available
• Who wins the battle between Guardian, Ameritas, Golden Rule, and others
• Real-life scenarios to help you choose smartly
• And of course, our pro insights and CTA’s to help you get covered with XactInsure

🪥 1. Preventive Care

Covers:

• Routine cleanings
• Exams
• Bitewing X-rays

Usually covered at 100%, even on basic plans.

🛠️ 2. Basic Services

Covers:

• Fillings
• Simple extractions
• Periodontal treatment

Covered between 70% to 80% depending on your plan.

🏗️ 3. Major Services

Covers:

• Crowns
• Bridges
• Dentures
• Surgical extractions

Often covered at 50%, sometimes with waiting periods.

This one surprises people: some plans do cover adult braces or aligners, but you need to know where to look.

Carrier Adult Ortho Coverage Notes     

Guardian ✅ Yes (up to 50%) Includes a lifetime max; no waiting on some PPO plans   

Ameritas ⚠️ Limited Only on select plans; waiting periods apply   

Golden Rule (UHC) ❌ No Focuses on child orthodontics only

🦷 XactInsure Tip: If you’re considering Invisalign, Guardian should be your first stop.

Vision plans vary widely in price and scope. Here’s what’s usually included:

Standard Coverage

• Annual eye exams ($0 - $15 copay)
• Single vision, bifocal, or trifocal lenses
• Frame allowances (usually $120 - $160)
• Contacts (in lieu of glasses)

Upgrades You Should Ask For

• Progressive lenses (multifocal, no-line)
• Anti-reflective coatings
• Photochromic lenses (darken in sunlight)

Carrier Progressive Lens Coverage Frame Allowance Lens Coating Included? 

    Guardian ✅ Yes $160 ✅ Yes (varies by plan)   

Ameritas ⚠️ Limited $130 ⚠️ Add-ons often extra 

UnitedHealthcare ❌ Not always $100 ❌ Basic options only

🔍 XactInsure Insight: Guardian plans (through VSP) are ideal for adults who need advanced eyewear or have strong prescriptions.

1. You’re in your 30s, need a cleaning, a cavity filled, and might want braces.

Get a Guardian PPO plan. You’ll get full preventive, strong basic/major coverage, and access to adult ortho benefits.

2. You work remotely and spend 8+ hours on screens daily. Your eyes are fried.

Guardian vision with lens enhancements = lifesaver. Those anti-glare lenses pay for themselves.

3. You’re on a tight budget but need basics.

Consider a Delta Dental or Solstice plan on the exchange. Low premiums, no frills.

4. You want the best for your family, and you're okay with slightly higher premiums.

Guardian's bundled dental + vision plans are unbeatable in value, coverage, and provider networks.

🌟 Best of Both Worlds: Guardian is available both on and off exchange, depending on the state. Win-win.

Let’s be honest. Most plans cover the basics. But when you want comprehensive, affordable, and reliable dental and vision insurance for adults with orthodontics, advanced lenses, and fewer surprises —

🦷 Guardian wins.

🛑 Unless another plan is significantly better for your unique case, we recommend starting with Guardian every time.

And hey — we’re here to help you figure that out.

👉 Visit XactInsure.net to explore your dental and vision options. 👉 Use our ACA Subsidy Calculator to find out if you qualify for $0 coverage. 👉 Learn more about preventive care services.

📞 Or call us to speak to a licensed expert. We don’t bite. (Unless we’re talking about dental plans.)

XactInsure. Your Health, Protected. With a Smile.