Most ACA Marketplace health plans don’t include dental or vision coverage for adults — these are typically sold separately, which catches a lot of new freelancers off guard. This guide explains your options and how to decide whether coverage is worth it for your situation.
Why Dental and Vision Are Usually Separate
Under the ACA, dental and vision are considered «essential health benefits» only for children, not adults. That means most Marketplace medical plans won’t include adult dental or vision coverage automatically — you’ll typically need to add a standalone plan if you want it, whether through the Marketplace or a private insurer.
Standalone Marketplace Dental Plans
When you shop for health insurance on HealthCare.gov, you’ll usually see an option to add a standalone dental plan during the same enrollment process. These generally fall into two types:
- High coverage, higher premium: Lower copays and better coverage for major work (crowns, root canals), but a higher monthly cost.
- Low coverage, lower premium: Cheaper monthly cost, but with waiting periods or lower annual maximums for major procedures.
If you only need routine cleanings and checkups, a low-premium plan is often enough. If you anticipate needing major work, a more comprehensive plan can save money overall.
Private Dental and Vision Insurance (Outside the Marketplace)
You can also buy standalone dental and vision plans directly from private insurers, independent of your health plan. These are worth comparing against Marketplace options since pricing and coverage can vary significantly — shopping both channels before choosing is generally worth the extra few minutes.
Dental and Vision Discount Plans: A Cheaper Alternative
Unlike insurance, discount plans aren’t coverage — you pay an annual or monthly fee for discounted rates at participating providers, with no claims process and no waiting periods. These can be a reasonable low-cost option if you mainly need routine cleanings and basic exams, but they won’t help much with expensive procedures like implants or orthodontics.
Is It Worth Paying for Separate Coverage?
Run a simple comparison:
- Estimate your annual premium cost for the plan you’re considering.
- Estimate your expected annual usage (routine cleanings, glasses/contacts, any known upcoming procedures).
- Compare that total to what you’d pay out of pocket with no coverage at all.
For many healthy adults who only need routine cleanings and an annual eye exam, a basic discount plan or a modest standalone policy covers the gap affordably. If you know you need major dental work or new glasses this year, a more comprehensive plan is usually worth the higher premium.
Can You Deduct the Cost?
If you’re self-employed and not eligible for other coverage, dental and vision premiums can generally be included as part of your self-employed health insurance deduction, similar to medical premiums (see our guide on health insurance premiums as a tax deduction). Keep your premium statements for tax time.
Frequently Asked Questions
Do I need separate vision insurance if I don’t wear glasses or contacts?
Not necessarily — basic annual eye exams are often inexpensive to pay out of pocket, so vision coverage mainly pays off if you already need corrective lenses or expect to.
Can I get dental coverage without buying a health plan too?
Yes. Standalone dental and vision plans are generally available on their own, without requiring you to also purchase a medical plan.
Are HSA funds usable for dental and vision expenses?
Yes, most dental and vision expenses, including cleanings, procedures, glasses, and contacts, are qualified expenses under an HSA (see our guide on HSAs for freelancers).
Disclaimer: This article is for general informational purposes only and does not constitute insurance, financial, or tax advice. Plan options and pricing vary by provider and state — compare current offerings directly and consult a tax professional regarding deductions.
Last updated: October 2, 2026