Dental and Vision Coverage
Medicare-eligible members enrolled in the HOP Medical Plan or Value Medical Plan can enroll in the MetLife Dental and EyeMed Vision Option.
You cannot enroll in the MetLife Dental and EyeMed Vision Option on a stand-alone basis or with a Medicare Advantage plan. However, certain Medicare Advantage plans offer coverage for dental and vision care.
Important Reminder
If you did not enroll in the MetLife Dental and EyeMed Vision Option when you were first eligible or if you are currently enrolled and drop your coverage, you will not be able to re-enroll in coverage in the future, unless there’s an open enrollment or you experience a Qualifying Event.
MetLife Dental Coverage
With MetLife dental coverage, you can visit any dentist you want, but you’ll save money if you choose an in-network dentist.1
Highlights:
- Preventive services do not count toward the maximum annual benefit.
- Receive up to $1,400 annually in basic and major restorative services.
- With in-network dentists:
- There is no annual deductible.
- You pay nothing for preventive care (exams and cleanings).
- You pay less than half the cost for all other services (compared to going out of network).
- You continue to receive discounted rates after reaching the maximum annual benefit.
To find an in-network dentist, visit the MetLife website and enter your ZIP code in the MetLife Dental Plan box at the bottom of the page. You can also do an advanced search and find participating dentists by name, distance, and specialty.
The MetLife Dental and EyeMed Vision Option Comparison Chart (PDF 38KB) and Brochure (PDF 74KB) contain detailed information about MetLife dental coverage, including pre-treatment estimates, limitations, and exclusions.
Each time you need dental care, you decide whether to use an in-network dentist or one that is not part of the MetLife network. While you are free to go out of network for care, using a MetLife dental provider is your lower-cost option.
Here’s why:
- With in-network providers, you never pay a deductible. If you use out-of-network dentists, you must satisfy a $100 deductible before the Plan pays any benefits for basic or major restorative services.
- Your percentage of the cost is always lower with an in-network provider.
- MetLife negotiates discounted in-network rates.* Out-of-network dentists are not required to charge negotiated rates; they can charge any amount. If you use an out-of-network dentist, you pay 100% of the difference between what the dentist charges and MetLife’s discounted rate.
* Discounted rates refer to the fees that in-network dentists have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing, and benefits maximums. Discounted rates are subject to change.
You are not required to show an ID card. Just tell your dentist’s office that MetLife is your dental carrier. In-network dentists may submit claims for you, which means you have little or no paperwork. You can track your claims online and even receive email alerts when a claim has been processed.
For questions about MetLife dental coverage, call the HOP Administration Unit at 1-800-773-7725 or MetLife at 1-855-700-7997.
EyeMed Vision Coverage
With EyeMed vision coverage, you can visit any vision provider you want, but you’ll save money if you choose an EyeMed Insight network provider.
Highlights:
- Eye examinations, frames, and prescription lenses or medically necessary contact lenses are covered once every other calendar year.
- When you visit a PLUS Provider (e.g., LensCrafters and Target Optical), you are eligible for an additional $50 frame allowance.
- The HealthyEyes wellness program keeps the focus on your eye health with online tools, articles, and videos.
Find a vision provider
To find a provider in the EyeMed Insight network, use EyeMed’s Enhanced Provider Search.
The MetLife Dental and EyeMed Vision Option Comparison Chart (PDF 38KB) and Brochure (PDF 74KB) contain detailed information about EyeMed vision coverage, including limitations and exclusions.
Each time you need vision care, you decide whether to use an in-network provider or one that is not part of the EyeMed Insight network. While you are free to go out of network for care, using an EyeMed provider is your lower-cost option.
Here’s why:
- For most in-network services, including eye exams, most lenses and frames, you’ll pay nothing—a $0 copay—when you need care.
- When you purchase frames from a PLUS Provider (e.g., LensCrafters and Target Optical), you’ll receive an additional $50 toward frame allowance.
- EyeMed negotiates discounted in-network rates.* Out-of-network dentists are not required to charge negotiated rates; they can charge any amount. If you use an out-of-network provider, you pay 100% of the difference between what the provider charges and EyeMed’s maximum reimbursement level.
* Discounted rates refer to the fees that in-network providers have agreed to accept as payment in full for covered services, subject to any copayments, deductibles, cost sharing, and benefits maximums. Discounted rates are subject to change.
EyeMed will send you two ID cards, but you don’t have to show the card when you visit your eye doctor. For lost ID cards, print a replacement, or show a digital version through the EyeMed Members app (App Store or Google Play).
- Savings from enrolling in the MetLife Preferred Dentist Program will depend on various factors, including how often participants visit the dentist and the costs for services rendered. ↩︎
Last Modified: April 22, 2024
