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 plans and how they work
- All the costs you can expect to pay
- The best ways to buy a dental plan
- FAQs about dental insurance costs
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.
The average monthly premiums for each plan type are:
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
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.
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.