What’s more, checkups and cleanings are usually covered with no additional cost to members with most plans, eliminating the number 1 reason cited by Guardian research for skipping dental visits: perceived cost. But with so many plans to choose from whether you’re buying as an individual or getting dental benefits at work, how do you find the plan that provides the most value?

This article will help you better understand:

The different types of dental insurance plans and how they work

With dental health so closely related to your general health, dental insurance is unsurprisingly a lot like health insurance: The insurance company charges a monthly premium, and in return, they help you pay for needed care. Other similarities include: 

  • Most dental plans have a network of providers 
  • There’s a deductible you pay before the plan pays for treatment
  • You pay for a portion of many procedures via copays (flat fees) or coinsurance (a percentage of the dentist’s charge)

Dental insurance differs from health insurance in the following ways:

  • Common preventive treatments – checkups, cleanings, and x-rays – are usually covered at 100% without out-of-pocket charges.
  • The deductible is much lower than a medical plan – around $50 for an individual and $150 for a family. 
  • Most dental plans cap the maximum amount they will pay for care at $1,000-$2,000 per member per year.
  • There may be waiting periods applied before plans will cover non-preventive procedures.

The two most common types of plans are DPPOs and DHMOs

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 nationwide). While you can also see an out of network dentist, it’s worth your while to stay in-network: You don’t need to submit a claim, and you get significant discounts which lower out-of-pocket costs. 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 haven’t met your deductible yet.

A good way to compare DPPO plans is by looking at their coverage formula: a 100/80/50 plan covers preventive care at 100%; basic procedures (e.g., fillings, extractions) at 80%; and major procedures like crowns, bridges, and root canals at 50% – so it offers better benefits than, say, an 80/60/40 plan.

Dental HMOs (DHMOs) tend to have lower premiums but less flexibility. The provider network may be very limited, and you have to stay in-network for covered care – so it’s likely you may not get to see your current dentist. The upside is no deductibles or maximums, but there are copayments for most non-preventive procedures.

Indemnity and discount plans

There are two other kinds of plans you can get: Indemnity plans let you see any dentist and reimburse a portion of your expenses – usually between 50% and 80% of what the insurance considers to be “reasonable and customary.” Preventive care is often covered in full. These plans tend to cost more and are harder to find; there’s also more paperwork because you have to pay the dentist up front then submit a claim.

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

What you can expect to pay for each type of plan

The average monthly premiums for each plan type are:

DHMO: $22.75

PPO: $62.75

Indemnity: $81.50

The premium amount is affected by many factors: type of plan, insurer, and coverage level, among other things; monthly costs range from $12 to $50 per person for DPPO and DHMO plans1. DHMOs will tend to be on the lower end of that range, and a comprehensive DPPO will be on the upper end. Indemnity plan premiums are higher, as much as twice the cost of a DPPO plan.2

How to go about buying a dental plan

Start by choosing the type of plan that best meets your needs. Indemnity plans may work for you if you have recurring, costly dental issues – and want freedom to see any licensed dentist. Otherwise, a top-tier DPPO plan with a broad provider network may be the right choice: Your current dentist may already be part of the network, and your overall in-network costs will likely be lower than with an indemnity plan. A DHMO with a limited network may be a good choice if you’re on a tight budget. On the other hand, if you primarily need preventive care and dentist choice is important, a DPPO could be an economical compromise.

If possible, get dental coverage through work. Employers get lower group rates because they buy for many employees at once. Also, group dental plans often cover more services, and the company may pay a portion of the costs, making it an even better value. If that’s not an option, see if you can get a group plan through a professional association or other membership groups.

Individual dental insurance is also available – and affordable. Many providers, such as Guardian, let you compare, get a quote, and buy plans conveniently online.

Frequently asked questions about dental insurance costs

Is it worth getting dental insurance?

Assuming you go to the dentist at least twice a year for preventive care, you may be able to save money or at least break even with the right dental insurance. And in years when you require additional care, you will likely come out ahead (see the scenarios above for examples).

Does dental insurance cover teledentistry?

Since the outbreak of COVID-19 and subsequent stay-at-home efforts, many insurance companies, including Guardian, have been covering online dentist visits.

Who has the best dental insurance?

Different insurance companies offer different mixes of plans, features, and networks, making it hard to say that one is definitively better than the other. The best dental insurance for you is the plan that lets you see a dentist you like, covers the treatments you and your family are likely to need and works within your budget.

What is a full coverage dental plan?

While there’s no standard definition of what distinguishes a basic dental plan from a full coverage plan, dental plans described as being “basic” generally cover preventive care and simple procedures like fillings and extractions; full plans cover major procedures like root canals and crowns, and sometimes, orthodontic care.

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Disclaimer

1 “Do You Need Dental Coverage?,” Forbes.com, last accessed September 12, 2019, https://www.forbes.com/sites/investopedia/2012/06/21/do-you-need-dental-coverage/#6da7214b501a, opens a new window.

2 “Which Types of Dental Insurance Cover Everything? https://www.dentalplans.com/dental-information/dental-insurance/dental-insurance-that-covers-everything

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.

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.

GUARDIAN® is a registered service mark of The Guardian Life Insurance Company of America® 

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