How Dental Insurance Works
Understanding dental plans will help you find the dental coverage that’s right for you
Dental insurance plans
There are many quality dental individual and group plans available from Guardian and other insurance companies. They can cover cleanings and fillings, and depending on the plan, also help ensure you don't end up with a hefty bill when you need more extensive dental work. Here's how different kinds of dental plans work.
There are two main kinds of dental plans: Dental PPO and Dental HMO
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Dental PPO: More dentist choice |
Dental HMO: Less dentist choice |
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Like a PPO health insurance plan, these dental plans typically have an extensive network of providers that lets you "shop around" and see out-of-network dentists. But when you stay in-network, you typically pay less and don't need to submit claims. Is your dentist in Guardian's network? Find out here. |
These dental plans tend to offer lower premiums, but there's also less flexibility with a limited network of providers. Like HMO health care plans, members choose Primary Dentists and have to go through them for all their care, including specialist referrals. Many DHMO dental plans have no deductibles or maximums – and while there may be a flat-rate copayment for non-preventive treatments, your overall costs will likely be lower. |
There's also another type of plan with no provider networks:
An indemnity plan lets you see any dentist. The insurance company reimburses at the "reasonable and customary" charge. These plans tend to have higher premiums and are harder to find.
- Preventive care helps keep you healthy
Most plans pay all or most of the charge for checkups and cleanings – so there's no reason not to see your dentist for regular preventive dental services.
- Early detection to catch potential problems
Regular visits to the dentist help keep teeth and gums in good health, so you can help catch and fix a minor issue before it turns into a bigger, more expensive (and painful) oral health problem.
- Lowering your out-of-pocket expenses
A dental crown can cost $2,000 or more. A good full-coverage plan can lower that to under $700.*
- In-network discounts
Insurance companies negotiate discounts with their PPO network dentists (the average Guardian discount is 36%). So you save even on dental services that aren't covered under your plan.
We care about protecting more than your teeth
Guardian makes it easy for members to access quality preventive dental care because of its clear connection to overall health, as well as the savings gained by avoiding major services and dental procedures down the line. With good oral care, people are 67% less likely to have heart disease, 50% less likely to have osteoporosis, and 29% less likely to have diabetes8.
Why dental insurance can be a good investment for individuals, families, and businesses.
The majority of dental care is preventive. So, even a basic dental insurance plan that focuses on preventative care can be a good investment.
Oral health issues are among the most common — and preventable — health concerns impacting the American public. The Centers for Disease Control and Prevention (CDC) calculates that 80% of the U.S. population has had at least one cavity by age 34, and more than 50% show signs of periodontal (gum) disease.1 And while everyone wants a nice smile, a growing body of research2 shows that maintaining good oral health can help adults avoid or better manage serious health-related issues:
- Diabetes
Periodontal infections contribute to problems with glycemic control, which compromises the health of diabetic patients. - Heart disease
The inflammation associated with periodontal disease has a high potential to contribute to coronary artery disease. Good oral health can help lower that risk. - Pregnancy
Studies have indicated that mothers with high levels of certain oral bacteria were found to have children with similarly high levels of bacteria, along with a higher risk of tooth decay. - Self-esteem
A smile is important. Research shows that healthy teeth and gums are important to a person's self-esteem and how they feel about themselves.
Supports employee's well-being
Group dental insurance is a popular benefit that can help attract and retain employees. And when you give workers access to dental coverage, it also encourages good oral health. That can translate into all sorts of positive benefits, including savings for businesses. A recent Guardian study found that employers whose employees regularly use their dental benefits may see fewer claims for major and restorative work, resulting in lower premiums for employers and reduced out-of-pocket costs for employees.3
What you can expect for the cost of your dental plan
Low-cost, basic dental plans typically cover regular dentist checkups at little or no cost – but may not cover much beyond that. Mid-level dental plans may cost a bit more per month but will also help pay for other dental services. A full-coverage dental insurance plan typically has the highest premiums but helps pay for a variety of services that might otherwise cost thousands. Some dental plans may even cover orthodontic procedures to help improve your smile. No matter what level of coverage you get, the monthly premiums will likely be lower than what you are paying for health insurance, especially if you are able to purchase dental through an employer. Here are some examples of the different categories of services that may be covered when an individual visits the dentist – but every dental plan is different, so look at the Plan Summary for specifics.
With most plans you don't have to file claims
When you see an in-network dentist in a Dental PPO or HMO plan, you don't have to pay the whole bill up front and wait for reimbursement. However, depending on the plan's coverage level and treatment needed, there may be an out-of-pocket expense. Here’s what you should know about plan costs:
Frequently asked questions about dental plans
- Which is the best dental insurance?
Different dental plans from different insurance companies offer various combinations of benefits, features, and coverage options, so it can pay to shop around. But generally speaking, the best dental insurance for individual and family needs is a plan that lets them see a dentist they like and offers coverage for the treatments they're likely to need at a price that fits their budget.
- How much is full coverage dental insurance?
There are many dental plan options available from different companies. The average cost for dental insurance ranges from $15 to $50 a month.4 That cost varies depending on the state you live in, the insurance company, coverage benefits, and other factors.
- Can I purchase dental insurance on my own?
Yes, as with health coverage, you can buy dental insurance as an individual or family if coverage isn't available through your employer. Affordable dental insurance plans - and vision plans - are readily available, and you don't need to go through an insurance agent. Major insurance companies like Guardian make it easy for individuals and families to shop, compare quotes, and buy a plan directly online.
- Is it worth getting dental insurance?
One of the most important advantages of having a dental insurance plan is that preventive checkups are usually covered at 100%. That encourages people to get regular dental care, which helps catch minor issues before they become major issues. So even basic dental insurance plans can be a worthwhile investment in your health and the health of your family. Some plans may also give you access to low-cost vision coverage.
- Does Medicaid cover dental care costs?
According to HHS.gov, states may elect to provide dental services and benefits to their adult Medicaid-eligible population or elect not to provide dental services at all as part of its Medicaid program.
Are you a dental professional? Find out how to join Guardian's growing network of dental benefit providers.
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