The two kinds of dental plan costs: premiums and out-of-pocket expenses

Compared to regular health insurance, monthly premiums for dental insurance tend to be relatively lower. And because dental care is mainly preventive, most dental plans cover regular checkups, cleanings, and routine x-rays.  Why do people choose a more expensive policy if preventive care visits are covered at 100% even in a basic plan? Because people need other types of services and treatments as well – and basic plans typically offer little or no coverage for advanced procedures. In addition to monthly premiums paid to the insurance company, there are out-of-pocket expenses and other items that can affect the total amount you'll pay for dental care, including:

  • A deductible This is the annual amount you have to pay before the insurance company starts paying for dental work. It's often around $50 for an individual or $150 for a family – but it can be higher in some dental plans, and others may not have this requirement.
  • 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 to pay a fee, which varies by dental procedure – called a copay. 
  • An annual maximum This is the total amount your insurance policy will pay in a given year. You are responsible for any expenses over that maximum amount.
  • Waiting Period Many full coverage dental plans have a waiting period – for example, six or twelve months – before the insurance company will cover complex procedures like a root canal.

If you're looking to get a handle on your total dental care costs, it's a good idea to start with a basic understanding of how different dental plans work and what kinds of out-of-pocket charges they have.

There are four different categories of treatments and services

There are literally hundreds of different kinds of dental procedures and treatments that a person might need. Dental insurance companies tend to group the services they cover into four categories, along these general lines:

  • Routine preventive care:  Typically covers checkups, cleanings, and routine x-rays 
  • Basic care: This may include fillings, extractions, and other services
  • Major care: Things like bridges, crowns, dentures 
  • Orthodontic treatment:  Braces and other types of teeth aligners  

Different categories of treatment have different levels of coverage

Many plans use the preventive/basic/major coverage formula to explain what they pay for different types of procedures. So, for example, a 100/75/50 full coverage dental insurance plan covers preventive services in full – 100% – so you don't pay anything. Basic procedures are covered at 75% (so you pay 25% as coinsurance). And major procedures are covered 50% (and you pay the other half). If the policy includes orthodontic coverage, the orthodontic services are covered at 50%.

Two types of plans with different provider networks

DPPO stands for Dental Preferred Provider Organization. These plans have a relatively large network of dentists (Guardian's network has over 120,000 providers in 400,000 locations). You can also see out-of-network dentists, but it's worthwhile to stay in-network: You don't need to submit a claim, and you get significant discounts that lower your 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 (the average Guardian DPPO discount is 36%). And if your insurance company pays 75% for basic procedures, your part of the bill could be less than $20.

DHMO stands for Dental Health Maintenance Organization. These plans tend to offer lower premiums, but there's also less flexibility with a limited network of dentists. Similar to HMO health insurance, you choose a Primary Dentist and have to go through him or her for all your care, including specialist referrals. Many DHMOs have broad coverage with no deductibles or annual maximums – and while there are copayments for most non-preventive treatments, your overall care costs will likely be lower.

If you're shopping for coverage, you may come across two other types of plans: 

Indemnity plans let you see any dentist, but you have to pay the entire fee upfront. The insurance company reimburses a portion – usually between 50% and 80% of the "reasonable and customary" charge. These plans tend to have higher premiums for coverage and are harder to find. 

Discount plans aren't really dental insurance – 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 savings vary – but there's always an out-of-pocket charge, even for preventive checkups.

The cost of not having dental insurance

When you add the out-of-pocket costs on top of your premiums, is dental coverage still worth it? It's a fair question: in some years, you may save a lot overall, but in other years you may not. Nevertheless, dental plans may be valuable either way. Why? Because coverage can lead to better dental care – which is an essential part of your overall health care.

Research conducted by the NADP shows that Americans with dental benefits are more likely to go to the dentist, take their children to dentists, receive preventive care, and experience greater overall health. Guardian's studiesreinforce this finding:

  • Perceived cost is the #1 reason for skipping dental visits
  • More than 70% of working adults with dental insurance visit the dentist at least once a year – that drops to 40% when there is no insurance

When people have dental insurance, there's no reason to let cost get in the way of a checkup – in fact, paying for insurance 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 more manageable and potentially less costly to treat. That can provide a significant benefit for your overall well-being – even more than you may realize.

More than 90% of all common diseases show symptoms in the mouth.2  And the importance of oral health care goes beyond detection: a growing body of third-party research3 shows that it can help adults avoid or better manage serious issues, including:

  • Diabetes - Periodontal infections contribute to problems with glycemic control, which compromises the well-being 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.
  • Self-esteem Research shows that healthy teeth and gums are important to a person's self-esteem and feelings about themselves.

How to get your money's worth from a dental plan

No matter how low the monthly premiums are, you may not get your money's worth from a dental plan if it doesn't cover the treatments you and your family need or let you go to a dentist you're comfortable with. Here are four suggestions for getting the dental care you want at a price you can afford:

1. Consider what kind of dental care you may need.

  • If you've never had dental issues, a basic plan could work well and help you save money. As an example, depending on the state you live in, you could get a dental insurance plan for about $20/month1. A Guardian entry tier plan lets you see any dentist and covers preventive care plus fillings and extractions.
  • If you or someone in your family has had oral health problems – or you have children with crooked teeth - a top-tier level Guardian DPPO covers complex procedures like root canals and implants, plus orthodontic care for children. The plan lets you see any dentist, but you'll always save more if you go in-network – and you won't have to file claims.
  • To find out if Guardian DPPO plans are available in your state and get a quote, go to GuardianDirect.com.

2. 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.* If you have a dentist you want to stay with, you could consider an indemnity plan – but if your dentist is part of a Dental PPO network, you'll likely save money with a DPPO plan. Plans with an extensive provider network – like those from Guardian – will increase the odds of your dentist being in-network. Check to see if your dentist is a Guardian provider.

On the other hand, if affordability matters more to you than loyalty to a specific dentist, a DHMO plan may be your lowest-cost choice. However, since DHMO networks tend to be limited, you might have to go a little farther out your way to find care.

3. Take full advantage of the plan's preventive benefits.

Some plans cover one checkup every year, but others cover two. It's important to take advantage of every opportunity to have your teeth checked and cleaned. Why? Even if you are otherwise healthy and diligently brush and floss every day, you will miss little areas where plaque builds up. Over time, that plaque solidifies into tartar, which erodes teeth and cannot be removed without a professional dental cleaning. Regular preventive dental care can save you from having to deal with a painful and costly condition – and for most of us, it's not a question of "if" but "when."

4. Consider where to get insurance coverage.

If you have dental benefit coverage at work, that may be your best choice. Employers get lower group rates because they are buying benefits for many employees at once. Compared to individual dental insurance 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 dental insurance value for your family's needs, so look at a few sites and compare plan options. Insurance companies should display plan benefits and dental services covered simply and straightforwardly, which you'll find when you purchase coverage online with Guardian

Are you a dental professional? Find out how to join Guardian's growing network of dentists.

Frequently asked questions about dental insurance

How much is full coverage dental insurance?

There are many dental plans available. Monthly insurance coverage starts at around $15/month per person for a good Dental HMO plan. It can go up to $50/month or more for a Dental PPO insurance plan, depending on your age, the state you live in, the insurance company, coverage benefits, and other factors.

Can I purchase dental insurance on my own?

Yes, absolutely. If coverage isn't available through your employer, you can find an affordable dental insurance plan. Major insurance companies make it easy for individuals and families to compare and buy a plan directly online.

Can I buy dental insurance at any time?

Yes – when you buy directly from an insurance company, you can purchase coverage at any time. But keep in mind that there will typically be a waiting period before major – and even basic – procedures will be covered. On the other hand, when you purchase dental plans through your employer, you sometimes have to wait until your company's open enrollment period – contact your HR department for more information.

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Disclaimer

* Costs vary by state and available plan type selected. Certain plans not available in all states.

References

1 Guardian Stay in Good Company Dental Health eBook

2 "Periodontics and Oral-Systemic Relationship." Journal of the California Dental Association, January 2016, volume 44, number 1; pages 29-33.

3 "Systemic manifestations of oral diseases," www.ncbi.nlm.nih.gov/pmc/articles/PMC3329699/

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.

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.

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.

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.

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