What to look for in a dental insurance company

Good oral health isn't a "nice to have" – it's an essential part of your health care and overall well-being.¹ According to the National Association of Dental Plans (NADP), Americans with access to affordable dental insurance benefits are more likely to go to dentists, take their children for dental care, and experience better overall health. Why? For starters, dental coverage can help eliminate the #1 reason for skipping dental care visits – perceived cost – because services like checkups and cleanings are 100% covered with most dental insurance plans. And dental checkups can uncover a lot more than just cavities.

The fact is, more than 90% of all common diseases have oral symptoms.²  And Guardian studies³ – as well as other third-party research – show that 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.

What exactly is a dental crown? A cap that your dentist puts over a tooth to restore its shape and function. Crowns are usually needed after a root canal or if the tooth has been broken or weakened by a large cavity. One can also be put on for cosmetic issues. No matter the reason, it's a procedure that requires a lot of precise work, over at least two visits to the dentist. 

• The dentist prepares the tooth by making an impression to use as a mold for the new crown. Each crown is custom-made for a specific tooth in a particular person's mouth.
• The outer portion of the tooth is removed and shaped to fit and support the underside of the crown.
• You get a temporary crown that lets you eat while the permanent crown is being made.
• When the permanent crown is ready (a week or two later), the dentist inserts it in your mouth, makes any needed adjustments, then cements it into place.

All those services can cost between $500 and $2,500. If you don't have a dental plan, you'll have to pay out of your pocket.

When you sign up for a dental plan, you pay a premium every month. In return, the dental insurance company helps you pay for covered services. You'll find that most dental plans share the following features:

• Preventive care – The most common dental treatments – preventive checkups and cleanings – are usually covered without any out-of-pocket charge.
• A dental network – Some plans only cover "in-network" treatment; other plans let you go out of network, but you'll typically save more if you use a network dentist. 
• A deductible – There's a certain amount you'll pay out of pocket before the plan starts paying for treatment – typically around $50 for an individual and $150 for a family.
• Co-pays or co-insurance – You pay for a portion of many procedures. Co-pays are flat fees; co-insurance is when you pay a percentage of the dentist's charge.

The preventive/basic/major coverage formula

You may see a dental plan described as having 100/75/50 coverage. Here's what that means: 

• Preventive care, including services such as checkups and cleanings – is covered at 100% (you usually don't even pay a deductible). 
• Basic procedures – like fillings and extractions – are covered at 75%. 
• Major procedures like crowns, bridges, and root canals are covered at 50% – and there will typically be a waiting period before the plan will pay for major care. 

Some services may be considered "basic" in one plan and "major" in another. But whatever the insurance coverage formula, there's typically a maximum on the total amount dental insurance companies will pay for care in a given year – usually between $1,000 and $2,000 per plan member. Any dental expenses over the insurance plan maximum are your responsibility. 

Basic or full coverage? It's your choice.

Some dental plans cover more than others, and they are priced accordingly. Generally speaking, a basic dental insurance plan covers preventive care services such as checkups, cleanings, and a few basic procedures, like cavity fillings, with little or no major treatment coverage. Full coverage plans generally cover many more services – and many times at a lower out-of-pocket cost. For example, insurance companies may cover a broader range of preventive procedures such as fluoride treatments and sealants – and they may cover those services and treatments in full or with just a small co-pay. A quality full-coverage plan may also cover many types of major procedures, including:

• Basic restorative care This includes services such as fillings, extractions, and non-routine X-rays
• Major restorative care Bridges, crowns and dentures
• Orthodontic treatment  Braces and other types of teeth aligners  

Don't know which services you'll need? Can't choose between a basic or full coverage dental plan? Guardian actually offers three coverage levels, plus a low-cost Dental HMO option in many states. We also believe a dental insurance company should provide costs and complete details that can be easy to understand and compare plans. So here's the kind of information we'll show when you buy dental insurance from Guardian.

When you shop for dental insurance plans, you'll see a lot of Dental HMOs and Dental PPOs. Before we go into the difference between the two, ask yourself: Do you have a dentist you like and want to continue seeing? 

If the answer is yes, you should look into a DPPO plan (or a very similar type of plan called a DEPO). Dental PPO insurance plans provide access to a network of dentists but typically let you go out of network to see another dentist. If you go with an insurer like Guardian with a broad nationwide provider network, your current dentist may well be "in-network" – so check before you get a plan. It's often worth your while to see an in-network dentist because the insurance company negotiates discounted fees on your behalf. For example, let's say your dentist typically charges $100 for a filling. If he or she is in-network, you may only be charged $60-$70 – even you haven't met your deductible yet.

If you aren't partial to a particular dentist, consider a DHMO. In this type of plan, you can only see an in-network dentist. The trade-off is generally lower costs and a more straightforward fee structure.

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.³  Guardian has one of America's largest networks, with more than 120,000 dentists at more than 420,000 locations, including thousands of specialists, such as periodontists, pediatric dentists, and orthodontists. We're continuing to make our network stronger, adding more dentists in more locations every year. That means if you already have a dentist you love, there's an excellent chance they're in our network. How can you be sure? See for yourself: Guardian also makes it easy to find a provider.

Network discounts

When you see an in-network dentist, you typically pay less for services than patients who are not part of the network, because the insurance company negotiates discounted fees on your behalf – and you get that discount even if you haven't met your deductible yet. Guardian's average discounted fee is 36 percent.² 

What are some dental insurance choices with no waiting period?

Many top-rated dental insurance plans have waiting periods before they will pay for a major procedure. However, some carriers, such as Guardian, offer plans that can give you immediate access to care. For example, our DentalGuard DHMO has no waiting period for covered procedures. Also, our Dental Advantage DPPO plans cover preventive care right away – there is no waiting period for cleanings or your first dental exam.

Can I buy dental insurance on my own?

Yes. Dental insurance plans for individuals and families are widely available -- and compared to regular health insurance they are typically much more affordable. Top carriers such as Guardian make it easy to find a plan and compare services covered and sign up -- all online.

Which insurance company has the best dental plan?

There is no official rating of top dental plans that we are aware of, and no one plan is right for every individual and family. Basic plans can be valuable for those on a budget who just want access to preventive care. Someone concerned about out-of-pocket expenses for major procedures such as root canals and crowns should consider looking for more comprehensive full-coverage plan options. As with other health insurance options, we suggest reviewing the dental coverages offered by Guardian and other dental carriers to see which can provide the best fit for your needs.

What is the most cost effective dental insurance?

If affordability is more important to you than seeing a particular dentist, consider a Dental HMO. Rates can vary by age and state.

Are dental plans easy to use?

In many cases, the dental care user experience is simple, especially compared to many health benefit plans. If you use a network dentist,  the dental office will typically submit claims for you. If you use an out of network dentist, you may have to submit your own claims.