There are two main kinds of dental plans: Dental PPO and Dental HMO

Dental PPO: More dentist choice

Dental HMO: Less dentist choice

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.

Four important reasons to get dental insurance

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. 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:

Need dental insurance?

Find a plan that fits your needs and enroll today!

There are two easy ways to get dental insurance

Frequently asked questions about dental plans

  • 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.

  • 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.

  • 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

  • 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.

  • 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

Disclaimer

* Here's how we calculated: We'll assume you have a PPO dental plan that covers major procedures at 50%, you're past the waiting period, and your dentist's customary fee for the treatment is $2,000. With a 35% in-network discount, the fee goes down to $1,300. After paying your $50 deductible, the insurance company pays half of the remaining $1,250 charge, and you owe the other half ($625). You save $1,325, and your total out-of-pocket expense is $675. 

REFERENCES

1 https://www.nadp.org/Dental_Benefits_Basics/Dental_BB_1.aspx

2 "Diabetes and Periodontal Disease," WebMD, April 2015

3 https://www.nidcr.nih.gov/sites/default/files/2017-10/hck1ocv.%40www.surgeon.fullrpt.pdf

4 https://www.moneyunder30.com/is-dental-insurance-worth-it, 2020

Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice. Although the information has been gathered from sources believed reliable, please note that individual situations can vary, therefore the information should be relied upon when coordinated with individual professional advice.

Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.

DentalGuard Insurance is underwritten and issued by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents are the final arbiter of coverage. This policy provides DENTAL insurance only. Policy Form #GP-1-DG2000, et al.

Important Information about Guardian's DentalGuard Indemnity and DentalGuard Preferred PPO Plans: This policy provides dental insurance only. Coverage is limited to those charges that are necessary to prevent, diagnose or treat dental disease, defect, or injury. Deductibles apply. Waiting periods may also apply for some services. The plan does not pay for: oral hygiene services (except as covered under preventive services), orthodontia (unless expressly provided for), cosmetic or experimental treatments, any treatment to the extent benefits are payable by any other payor or for which no charge is made, prosthetic devices unless certain conditions are met, and services ancillary to surgical treatment. The plan limits benefits for diagnostic consultations and for preventive, restorative, endodontic, periodontic and prosthodontic services. The services, exclusions, and limitations listed above do not constitute a contract and are a summary only. The Guardian plan documents are the final arbiter of coverage.

Individual Dental Insurance products are underwritten by The Guardian Life Insurance Company of America, New York, New York or by one of its wholly owned subsidiaries. Products are not available in all states. Policy limitations and exclusions apply. The actual limitations and exclusions that apply to your Dental Plan are governed by the policy forms approved for use in your state. Please refer to your policy for a complete list of limitations and exclusions. In the event of a conflict between this document and the language stated in your Guardian insurance policy, the language of the policy shall control. This policy provides DENTAL insurance only. Policy Form IP-DEN-16 ET. AL. FLORIDA Policy Form IP-1-MDG-DHMO-FL-OFF-17, NEW YORK Policy Form IP-MDG-NY-FP-OFF-17, NEW JERSEY Policy: IP-MDG-DHMO-NJ-17, TEXAS Policy: IP-1-MDG-DHMO-TX-17, ILLINOIS Policy: IP-FCW-DHMO-IL-17.

Guardian Direct plans are underwritten and issued by The Guardian Life Insurance Company of America or its subsidiaries, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. In the event of a conflict between this document and the language stated in your Guardian insurance policy, the language of the policy shall control. Dental provider networks vary by state, by market and by plan type.

Guardian® is a registered trademark of The Guardian Life Insurance Company of America, New York, NY. © Copyright 2022 The Guardian Life Insurance Company of America

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