How to purchase dental insurance on your own

How to get dental insurance on your own

Even though dental insurance plans are one of the most sought-after employee benefits¹, less than 52% are estimated to offer them.² So, what should you do if your employer doesn’t offer dental? Or you’re self-employed?

Need dental insurance?

Don’t worry. Getting your own coverage isn’t difficult at all. Individual and family dental insurance plans are widely available – and affordable. In fact, many carriers, such as Guardian, let you compare and buy dental plans conveniently online. This article can help you make the right choice for your needs by answering three common questions about getting dental insurance plans:

• Do I really need coverage?

• How do dental plans work?

• How do I get the right plan for my needs?

Do you need dental insurance?

While most people would rather have dental coverage than not, some people put off getting it because they don’t want to pay more in premiums than they’ll get back. While that can happen (at least in some years), it misses the real point: Like other kinds of insurance – from health to home & auto – people get dental coverage to help protect their finances and well-being – and because not having it could leave them far worse off. Here’s why.

Dental coverage leads to earlier and better dental care – and better health. Research conducted by Guardian shows that access to dental coverage significantly increases the use of preventive dental care and improves oral health.³ Other studies conducted by Guardian⁴ reinforce this:

• Nearly 6 in 10 working Americans (58%) with dental benefits at work visit the dentist two or more times a year, compared to a quarter (25%) of those without any coverage.⁴

• Perceived cost is the #1 reason for skipping dental visits.⁵

When people have dental insurance, preventive care is typically covered at 100%. So, there’s no reason to let cost get in the way of a checkup – in fact, paying for their own coverage encourages many people to see a dentist in order to “get their money’s worth.” Checkups, cleanings, and X-rays can help prevent many issues, and help catch others early on when they are far easier and less costly to treat. Oral health can significantly impact your overall health care and well-being – even more than you may realize.

The importance of dental health goes beyond detection: a growing body of third-party research⁶ shows that it can help adults avoid or better manage serious health-related issues including:

• Diabetes - Periodontal infections contribute to problems with glycaemic control, which compromises the overall health of diabetic patients.

• Heart disease - The inflammation associated with periodontal disease has a high potential to contribute to coronary artery disease.

• Pregnancy - Studies have indicated that mothers with high levels of certain bacteria in the mouth were found to have children with similarly high levels of bacteria, along with a higher risk of tooth decay.

Is having dental insurance worth it?

For people who care about protecting their teeth and their health – yes, dental insurance plans are a worthwhile investment. It’s a form of health insurance for your mouth. And like general health insurance, some dental plans offer basic coverage while others offer more comprehensive coverage. Generally speaking, basic dental plans typically cover preventive care such as exams, dental cleanings, X-rays, and a few basic procedures, like cavity fillings. Comprehensive coverage plans typically cover much more, but carry higher premiums –often at a lower out-of-pocket cost to you.

Most dental plans have a provider network

Most of the plans you’ll find are either a Dental Health Maintenance Organization (DHMO) or a Dental Preferred Provider Organization (DPPO). In a DHMO, you must select your Primary Care Provider (PCD) and see that dentist for all your oral care needs and because DHMO networks are more limited, you probably won’t get to see your current dentist. The trade-off is generally lower costs and a simpler fee structure.

A DPPO also has a network of dentists. You’ll save more when you visit an in-network dentist, but a DPPO plan enables you to visit any dentist you choose. If you decide to go with a large insurance carrier like Guardian with a broad provider network, your current dentist may well be “in-network.” It’s almost always worth your while to see a network dentist because with a DPPO the insurance company negotiates in-network discounts on your behalf. So for example, if your dentist typically charges $100 for a filling, when they are in-network you may only be charged $60-$70 – even you haven’t met your deductible yet.

Don’t want to be limited by a network? There’s another type of coverage – indemnity plans – which reimburse you for a portion of your dentist expenditures; however, you must pay the bill first and submit a claim. These plans can also be costly and somewhat harder to find than a DPPO or DHMO.

The preventive/basic/major coverage formula

You may see a plan described as having 100/75/50 coverage. This means preventive care – checkups and cleanings – are 100% covered (you usually don’t even pay a deductible); basic procedures – like fillings and extractions – are covered at 75%; and major procedures like crowns, bridges, and root canals are covered at 50%. There are variations on this formula, and some procedures may be considered “basic” in one plan and “major” in another.

Deductibles, plan maximums, and waiting periods

Like health plans, dental plans typically have a deductible – an amount you must pay out of pocket each year before the insurance company starts to cover their portion of costs. Dental deductibles are generally relatively low, usually around $50 for an individual, and $150 for a family. While a health plan will cap the maximum you can pay in out-of-pocket costs, dental plans typically cap the total amount they will pay for care – commonly between $1,000-$2,500 per member per year. Any dental expenses over your plan’s maximum are your responsibility. Finally, most plans also have a waiting period before they will cover major procedures such as crowns.

How to get the right plan for your needs?

Consider who needs coverage

Are you getting a plan for yourself? You and a spouse? Just your kids? If you just want coverage for your children, they may be covered under your existing health plan. Under the Affordable Care Act (ACA), basic pediatric dental and vision benefits must be included in or offered as standalone plans as part of the ACA’s “essential health benefits” (EHBs). If getting coverage outside of work, and you’re just getting coverage for yourself and you’ve never had oral health problems, basic coverage may be a good choice. If it’s for you and a spouse – and at least one of you have had issues – you should look into getting a comprehensive coverage plan. And if you have kids, a comprehensive coverage plan may offer more benefits – especially for things like orthodontic care – compared to an ACA plan.

Do you have a pre-existing condition?

Some dental plans don’t cover “pre-existing conditions".⁷ Replacing a missing tooth or needing dental implants could be considered a pre-existing condition if your tooth was lost or extracted before you joined your dental insurance plan. Your plan may also not cover services such as the replacement of crowns, bridges, and dentures unless they’re older than a certain number of years.

When shopping for plans, find out what a pre-existing condition is, and determine if the out-of-pocket expenses to cover the needed dental services will fit into your budget. If not, you may want to keep shopping for a plan that will help cover these costs.

Think about what dentist you want to see.

When people find a dentist they like, they tend to stay loyal to him or her.⁸ 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 your dentist to see if he or she is part of the plan’s provider network. Plans with a large provider network – like those from Guardian – can increase the odds of your dentist being in-network.

But what if cost matters more to you than loyalty to a specific dentist? A DHMO might be a better value for you. However, since their networks tend to be limited you might have to go a little farther out of your way to get care.

Look at what each plan costs – and what’s covered.

Top dental insurance carriers tend to have large provider networks, and let you buy coverage directly online. They also offer a range of DPPO and DHMO (Guardian does not offer individual DHMO plans) options and make it easy to compare their plans. Look for the best value by considering premiums, deductibles, and other costs as well as plan features such as:

• Types of services and treatments covered: You may not recognize the names of all the services covered—but the longer the list, the better.

• Waiting periods: Major services and procedures, such as root canals, usually have a waiting period (for example, 6 months) before they are covered.

• Primary dentist requirement: This is typical of DHMOs but some DPPOs also have this requirement. It means that you must go through your regular dentist to get a referral to see a specialist.