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 the NADP shows that Americans with dental benefits are more likely to go to the dentist, take their children to the dentist, receive restorative care, and experience greater overall health. Guardian’s own studies2 reinforce this:
- Perceived cost is the #1 reason for skipping dental visits
- More than 70% of working adults with coverage visit the dentist at least once a year – but that drops to 40% when there is no insurance
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 actually encourages many people to see a dentist in order to “get their money’s worth.” Checkups, cleanings, and X-rays can prevent many issues, and catch others early on when they are far easier and less costly to treat. That can have a significant impact on your overall health care and well-being – even more than you may realize.
The fact is, more than 90% of all common diseases show symptoms in the mouth.3 And the importance of dental health goes beyond detection: a growing body of third-party research4 shows that it can help adults avoid or better manage serious health-related issues including:
- 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.
- 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 it worth it to have dental insurance? For people who care about protecting their teeth and their health – yes, dental insurance plans are a worthwhile investment.
What is dental insurance? It’s a form of health insurance for your mouth. And like general health insurance, some dental plans offer more basic coverage while others offer more full coverage. Generally speaking, a basic dental plan covers preventive care such as checkups, cleanings, X-rays, and a few basic procedures, like cavity fillings. Full coverage plans can cover much more – and often at a lower out-of-pocket cost to you. For example, they may cover a wider range of preventive procedures such as fluoride treatments and sealants – and they may cover those treatments in full or with just a small copay. In addition, a full coverage plan (like the ones offered by Guardian) may cover other types of procedures, including:
- Basic restorative care: This includes fillings, extractions, and non-routine X-rays
- Major restorative care: Bridges, crowns, dentures, and the like
- Orthodontic treatment: Braces and other types of teeth aligners
Most dental plans have a provider network
Most of the plans you’ll find are either a Dental HMO or a Dental PPO. In a DHMO, you have to see an in-network dentist, and because their networks are 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, but typically lets you go out of network to see another dentist. But if you 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 he or she is 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 have to 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 – is 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, caps, and waiting periods
Like health plans, dental plans typically have a deductible – an amount you have to pay out of pocket each year before the insurance company starts to cover their portion of costs. But it’s relatively low, usually around $50 for an individual, and $150 for a family. While a health plan will cap the maximum you can pay out of pocket, dental plans typically cap the total amount they will pay for care – at $1,000-$2,000 per member per year. Any dental expenses over your plan’s maximum cap are your responsibility. Finally, most plans also have a waiting period before they will cover major procedures such as crowns.
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 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 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 full coverage plan. And if you have kids, a full coverage plan will likely 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”4. Replacing a missing tooth 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 is considered to be a pre-existing condition, 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: Over 60% of working Americans have been going to the same dentist for at least three years, and almost a third have been with the same dentist for 10 years. 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 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 have to go through your regular dentist to get a referral to see a specialist.
Can I purchase dental insurance on my own, and is it worth it?
Guardian research based on actual claims data shows that dental plan members who received regular preventive care services (i.e., received an oral exam and cleaning at least once a year), required less major dental services and, consequently, experienced lower out-of-pocket costs over a three-year period. This means that having and using dental insurance can not only improve oral health, but help reduce overall long-term dental costs.
Can I buy a Guardian dental plan as an individual?
Yes. Follow the link to see your plan choices and buy dental insurance directly from Guardian Direct®.
How much does a full coverage dental plan cost?
Prices vary from one insurance company to the next, as well as the age of each person being insured, and where you live. The table below shows a typical range for monthly insurance premiums.
What is the best dental coverage for individuals?
The plan with the lowest premium and costs may not provide the best value for your needs, or those of your family. To make the best choice, you should also look for a plan that covers the types of treatment you think you’ll need, while letting you see a dentist you’re comfortable with.