Dental insurance – like health insurance – is an investment in your family’s well-being. But if you’re like most people, you spend more time thinking about health coverage than dental. While you probably have a fair idea of what to look for in a health plan, it’s just as important to know what to look for in a dental plan. This article will help you understand:
- Why you should have a dental plan
- How dental coverage works
- The two main types of dental plans
- How to find the best dental plan for your needs
Why you – and your family – should have a dental plan
Good oral health isn’t a “nice to have” – it’s an essential part of your overall well-being.1 More than 90% of all common diseases have oral symptoms.2 And the importance of oral health goes beyond detection: Guardian studies3 – and 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 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.
Despite the importance of oral health, too many Americans avoid going to the dentist. Like other kinds of health care, dental procedures can be expensive – and that cost deters many from getting the care they need. That’s why dental insurance is so important. Consider:
The cost of a single dental crown
What exactly is a dental crown? A cover or cap that your dentist puts over a tooth to restore its shape and function. It’s usually needed after a root canal, or if the tooth has been broken or weakened by a large cavity – but 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 removing the decayed or damaged portion of the tooth and shaping the remaining tooth structure.
- An impression of the tooth is taken and used as a mold for making the new crown. Each crown is custom-made for a specific tooth in a specific person’s mouth.
- 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 that work can cost between $500 and $2,500. If you don’t have the right dental plan, you may have to pay for it out of your own pocket.
How dental insurance plans work
Unless you have a known condition, it’s hard to predict what kind of health care you’ll need, so health insurance is primarily designed to help protect you from big bills which can result from even a simple emergency room visit. By contrast, the majority of dental care is preventive, so many dental insurance plans cover only preventive care and basic procedures, such as cleanings and fillings. There are also more comprehensive plans that cover major procedures.
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 covered 100% (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 50%. There are variations on this formula, and some procedures may be considered “basic” in one plan and “major” in another.
Most dental plans have a provider network. When you see an in-network dentist you pay less than other patients because the insurance company negotiates discounted fees 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 if you haven’t met your deductible yet.
Deductibles, maximums, 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 plan starts to cover their portion of costs. It’s usually around $50 for an individual, and $150 for a family. But 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 plan member per year. Any dental expenses over your plan’s maximum are your responsibility. Finally, most plans also have a waiting period before they will cover major procedures such as crowns.
The two most common types of plans are Dental PPOs and Dental HMOs
Before we go into the difference between the two types of plans – DPPOs and DHMOs – 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. DPPOs have a network of dentists, but typically let you go out of network to see another dentist. If you go with a insurer like Guardian with a broad nationwide provider network, your current dentist may well be “in-network” – so check before you get a plan.
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 – 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. There’s also a third type of plan, called an “Indemnity” plan, which reimburses you for a portion of your dental care expenditures; however, those plans are somewhat harder to find.
How to find the best dental plan for your needs
To get the plan and company that offers a combination of features and value for you and your family, follow these steps:
1. First of all, think about where to get your plan
If you can get dental insurance at work, you should begin there: employers get lower group rates because they are buying benefits for many employees at once. Also, group plans often feature higher coverage levels, and the company may pay a portion of the costs, making it an even better value. You may also be able to get group coverage through a professional association or other membership group.
If you need to get coverage as an individual, that’s okay too. It’s still affordable – and many insurance companies, such as Guardian, let you get quotes, compare options, and buy coverage conveniently on line.
2. Think about your budget
Many large insurance companies have different tiers of DPPO plans, e.g., bronze, silver and gold, in addition to a DHMO plan. If you need to keep monthly costs down consider a DHMO, or a bronze DPPO plan that lets you use any dentist and get coverage for cleanings and basic procedures.
3. Consider your dental care needs
If you’ve never had oral health problems, a basic, lower-tier plan may be a good choice. But if you or your spouse have had issues – or you have kids – then you should look into getting a higher-tier plan that covers more types of procedures and includes things like braces. The higher monthly premium may be more than offset by savings on major procedures.
4. Decide whether it’s important to see your current dentist
When people find a dentist they like, they tend to stay loyal to him or her: 32% of people have been with the same dentist for 10 years. If you have a dentist you want to stay with, look to see if they are in network. Guardian has an online provider search tool that makes it easy. Remember, since DPPO networks are typically larger there’s a greater chance your dentist is in a DPPO. But if your dentist is in a DHMO – or you don’t have a favorite dentist – then that can be a good option as well.
5. Compare at the features of the plans you’re considering
Look at the premiums, deductible, coinsurance, and annual maximum to help understand all the costs of the plan. In addition, you should pay attention to such things as:
- Types of services and treatments covered
- Waiting periods
- Primary dentist requirement
If you’re buying online, those types of details should be displayed in a simple and clear manner to help you with comparisons between plans and to make a well-informed choice. As an example, here is how plan choices and features are displayed when you purchase coverage online with Guardian.
Frequently asked questions about how to compare dental plans
Why do I need a dental insurance plan?
Even a basic dental insurance plan helps lower the cost of preventive care that is essential to your oral health and overall well-being. A more comprehensive plan will also help pay for major procedures such as root canals and crowns, which could cost thousands in out-of-pocket expenses.
Do all dental plans have waiting periods?
Plans typically have a waiting period before they will pay for a major procedure. However some insurance companies, such as Guardian, want you to have immediate access to preventive care so there is no waiting period for cleanings or your first dental exam.
Can I purchase dental insurance on my own?
Yes. Individual and family dental plans can be very affordable, and major insurance companies such as Guardian make it easier to shop for and compare plans online. Plans are open to seniors, families, couples, and individuals of all ages.
How much is dental insurance per month?
Rates vary by age and state, but as an example, a 40-year-old individual in New York can get a DHMO plan for just under $15/month, or a basic lower-tier plan for just over $20/month. A comprehensive plan with coverage for braces and major procedures can be purchased for under $50/month.