What does a full coverage dental plan cover?

If a dental plan doesn't cover the services you and your family need, it's probably not going to provide the best value – even if the monthly premiums are a bit lower than another insurance plan. Unfortunately, it can be hard to make an apples-to-apples coverage comparison because there's no strict definition of full coverage dental insurance. However, if you know what to look for, you can get a better idea of which insurance plans will work better.

Four different categories of treatments and services

There are literally hundreds of different kinds of dental procedures and treatments that a person might need, from things like fluoride treatment and dental cleanings to root canals. Dental insurance companies tend to group the services they cover into four categories:

  • Routine preventive care:  Checkups, cleanings, routine x-rays and sometimes, fluoride treatment
  • Basic care: This may include fillings, extractions, and other simple services
  • Major care: Things like bridges, crowns, dentures and root canals
  • Orthodontic treatment:  Braces and other types of teeth aligners  

Many, if not most, DPPO and DHMO insurance plans (more on that below) cover routine preventative care at 100%, with no out-of-pocket cost to you. Some basic plans go beyond preventative care by providing coverage for at least some basic care. A mid-level plan should cover preventative care, a range of basic procedures and may offer some coverage for major care. A quality full-coverage plan offers coverage for routine, basic, and major procedures. Some dental insurance also covers orthodontic work – and if you have children with crooked teeth, you probably want that.

It's important to note that these service categories aren't set in stone. One insurance company might categorize a procedure as basic, and another might call it major. So, while these categories can give you a broad idea of what the insurance company pays, you should also look at the Plan Summary to get more specific details about what's covered and what's not. Coverage for the things you need is the key to getting the most value from a full coverage dental plan.

What are the monthly and out-of-pocket expenses?

Some people assume that a dental plan with lower monthly premiums will save them money compared to a plan with higher insurance premiums. That's not necessarily true. As we've noted, a lower price dental plan may not cover all the things you need. There are also out-of-pocket expenses and other items that can affect the total amount you'll pay for dental care, including:

  • Deductibles This is the amount you have to pay before the insurance plan starts paying for treatments. It's often around $50 for an individual or $150 for a family – but it can be higher in some plans, and with other plans, there is no annual deductible. 
  • Coinsurance and copays After you've met your deductible, you may owe a percentage of the dentist's fee for each visit or treatment, called coinsurance. Or you may have a fee, which varies by treatment – called a copay. 
  • Annual Maximums The total amount your insurance plan will pay in a given year. You are responsible for any expenses over that amount.
  • Waiting Periods Many full coverage dental plans have a waiting period – for example, six or twelve months – before the insurance company will cover major treatments like a root canal.

Different kinds of plans have different costs

The two most common types of dental insurance plans are called DPPOs and DHMOs. Here's how they work and the kinds of costs you can expect to have: 

DPPO stands for Dental Preferred Provider Organization. These plans have a relatively large network of dentists (Guardian's network has over 120,000 dentists in 400,000 locations). While you can also see an out of network dentist, it's worth your while to stay in-network since you don't need to submit a claim, and you get significant discounts which lower out-of-pocket expenses. If your dentist typically charges $100 for a filling, when he or she is in-network, you may only be charged $60-$70 – even if you've already met your annual maximum (the average Guardian DPPO discount is 36%).

A good way to compare out-of-pocket costs between DPPO insurance plans is by looking at the preventive/basic/major coverage formula. Let's say one dental plan is 100/80/50, and the other is 80/60/30. The first plan covers preventive care at 100% (so you owe nothing); basic procedures (e.g., fillings, extractions) at 80%; and major procedures (like crowns, bridges, and root canals) at 50%. The second plan offers less coverage for each category of service – so your out-of-pocket coinsurance costs are higher for every dental visit. If you're looking to save money, it may make sense to get the 100/80/50 dental plan – even if the monthly premiums are a bit higher. 

How a full coverage DPPO can lower the price of a crown

What exactly is a crown? It’s a cap dentists put over a tooth to restore its shape and function. It's usually needed after a root canal or if the tooth has been broken or weakened by a large cavity. Insurance plans consider it to be major dental work. It can cost between $500 and $2,500

Here's what you could owe with a 100/80/50 plan. We'll assume 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). So your total out-of-pocket expense is $675. You save $1,325.

DHMO stands for Dental Health Maintenance Organization. Like HMO health insurance plans, these tend to have lower premiums but give you less flexibility. The network of dentists is very limited, so it's likely you won't get to see your current dentist. Notably, there's no out-of-network option: you have to choose a Primary Dentist and go through him or her for all your care, including specialist referrals if needed. The upside is that many DHMOs have no deductibles or maximums – and even though there are copayments for most non-preventive procedures, your overall costs will likely be lower.  

You may come across two other kinds of dental plans. Indemnity plans let you see virtually any dentist. You pay the entire fee upfront, and the insurance company reimburses a portion of your expenses – usually between 50% and 80% of what they consider to be "reasonable and customary." While preventive care is often covered in full, there is no network discount for services. These insurance plans also tend to have higher premiums and are a little harder to find. 

Discount plans aren't really insurance at all – they're more like a warehouse club. There's an annual fee, and you're given a card that entitles you to reduced charges at participating dentists. The dental savings vary depending on the procedure – but with these plans, you will have out-of-pocket expenses every time you see a dentist. There's an extensive range of plans and discount structures, so it's difficult to make any generalizations as to what your actual dental care costs would be with a discount dental plan.

How can I get the best value for my needs?

The real value of dental insurance is that it can help keep you healthier. Checkups and cleanings are covered at 100% with most plans, and research shows that eliminates the #1 reason for skipping dental visits – perceived cost. And oral health is important for your overall health and wellbeing. Guardian studies1 – and a growing body of third-party research – show 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 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 Research shows that tooth and gum health is important to a person's self-esteem and feelings about themselves.

Here's how to get a dental insurance plan that helps keep your mouth, body – and budget – in good health.  

First, think about what dental care you may need. If you or someone in your family has had dental health issues in the past, look at the insurance plan summary to see if those issues are covered. Even if you don't have a specific concern, you should look at the dental procedures covered. You may not recognize them all—but the longer the list, the better. Finally, if you have kids, consider a dental insurance plan with orthodontic coverage.

Next, think about what dentist you want to see. When people find a dentist they like, they tend to stay loyal to him or her: Over 60% of working Americans have been going to the same dentist for at least three years, and 32% have been with the same dentist for ten years.1 If you have a dentist you want to stay with, look for a DPPO (or a similar type of plan called a DEPO); then check with him or her to see if they are part of the insurance company’s provider network. Plans with a large provider network – like those from Guardian – will increase the odds of your dentist being in-network. 

But what if affordability matters more to you than loyalty to a specific dentist? You may find that a DHMO insurance plan is a better value. However, since their networks tend to be limited, you might have to go a little farther out of your way to find care.

Lastly, think about where to get insurance coverage. 

If you can get dental insurance at work, that's probably your best choice. Employers get lower group rates because they are buying benefits for many employees at once. Compared to individual dental plans, group PPO dental plans often offer higher coverage levels. The employer may also pay a portion of the costs, making it an even better value. 

If you need to get dental coverage as an individual, that's okay too. There are plenty of affordable options, and it's easy to find and buy online.  Just remember that the plan with the lowest premium may not provide the best value for your family's dental health needs, so look at a few sites and compare plan options. Insurance companies should display plan benefits and dental services covered in a simple and straightforward manner. As an example, here is how plan choices are displayed when you purchase coverage online with Guardian.

Frequently asked questions about full coverage dental insurance

How much does full coverage dental insurance cost?

There are many plan options available. Monthly premiums start at around $15/month per person for a good Dental HMO plan and can go up to $50/month or more for a Dental PPO insurance plan, depending on your age, location, the insurance company you buy from, and other factors. If you purchase coverage at work, the cost will likely be lower: employer dental plans offer lower group rates and sometimes provide coverage for more dental services. In many cases, the employer also subsidizes a portion of the insurance premiums, as they do with health insurance plans.

What is the best full coverage dental insurance?

Different insurance plans each offer their own combinations of benefits, features, and coverage options but generally speaking, the best full coverage dental plans cover the broadest assortment of services and treatments while giving you access to the largest number of dentists .

What is the best affordable dental insurance?

Your most affordable full coverage dental insurance option is likely to be a plan you get through work, if available. However, you can also get affordable coverage directly from an insurance company. Either way, to get the best dental plan for your needs, look for a plan that lets you see a dentist you trust, offers coverage for the treatments you and your family are likely to need, and works within your budget. 

Are dental discount plans worth it?

A discount plan is not the same as dental insurance coverage. You get a discount card that can lower the cost of a checkup and some procedures -- but it doesn't cover routine dental care at 100%, the way most dental plans do. Many people with a discount plan will still put off simple checkups and cleanings.

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