Family and individual dental insurance plans
You want to get dental coverage for yourself or your family. After all, it can be an important investment in your overall health. But you probably have a few questions: What are the different kinds of dental insurance plans? How do they work? What do they cover? And of course, how much does it all cost? We can help with all of that. You can start by getting a quote or keep reading to get your questions answered.
What's the difference between a Dental PPO plan and a Dental HMO plan?
| Dental PPO | Dental HMO |
|---|---|
|
Also called a DPPO, short for Dental Preferred Provider Organization. These dental plans typically provide preventive checkups, cleanings, and x-rays at 100% coverage, but there is usually a coinsurance (see below) for other more advanced treatments. The big advantage to a Dental PPO is dentist choice: there's typically an extensive network of dentists, but the insurance company also lets you see out-of-network dentists. Still, it pays to stay in-network because you pay less and don't need to submit claims. Is your dentist in Guardian's network? Find out here. |
Also called a DHMO, or Dental Health Maintenance Organization. These dental plans work like an HMO health care plan: you choose a Primary Dentist and have to go through him or her for all your care, including specialist referrals. DHMOs may give you less dentist choice because the networks are limited, and there's no out-of-network coverage. On the plus side, premiums tend to be lower, and many DHMOs have no deductibles or annual maximums (see below). While there are copayments for most non-preventive treatments, your overall costs will likely be lower. |
Are there other types of dental plans?
Yes, but they may or may not provide the coverage you need. 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 and may be harder to find.
Discount plans aren't really dental insurance – and they may not even come from an insurance company. The plans work 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 and cleanings.
How do dental insurance plans work?
Dental plans focus on preventive care because that can be key to keeping teeth and gums healthy. So even a basic dental plan will cover regular checkups at little or no cost, and a mid-level insurance plan will help pay for basic treatments as well. A full-coverage dental insurance plan can cover major services and even some orthodontic care – which can be valuable if you have kids with crooked teeth. Every insurance company and plan has somewhat different coverage, but here are some examples of the different categories of services that may be included.
| Preventive | Basic restorative | Major restorative | Orthodontic |
|---|---|---|---|
|
Checkups, cleanings, routine x-rays, and sometimes, fluoride treatments |
Fillings, extractions, and other services |
More complex treatments, such as root canals, crowns, bridges and dentures |
Braces and other types of teeth aligners |
I'm not sure if I need a basic plan or full coverage. Is there something in the middle?
Yes. Guardian offers three different DPPO plan tiers – Entry, Mid, and Top – to help you get the level of coverage that's right for your individual needs. And we make it easy to compare plans and buy online - see for yourself by getting a quote at Guardian Direct.
How can a dental insurance plan help me save money?
| Paying for preventive care | Catching problems early | Paying for major services | Giving you discounts |
|---|---|---|---|
|
Most insurance plans provide 100% coverage for checkups. That not only can save money, it helps remove a significant barrier to going to the dentist for regular preventive care. So it can also be good for your health! |
Regular visits to the dentist help keep teeth and gums healthy so you can catch and fix a minor issue before it turns into a bigger, more expensive (and painful) dental health problem. |
A dental crown can cost $2,000 or more. A full-coverage plan from a top insurance company can lower that to under $700*. |
Insurance companies negotiate discounts with their PPO network dentists (the average Guardian discount is 36%). So even if major services aren't covered under your plan, you can still save. |
Why is dental care important for my overall health?
Guardian studies1 – and a growing body of third-party research2 – show that maintaining 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.
- Self-esteem Research shows that healthy teeth and gums are important to a person's self-esteem and feelings about themselves.
What should I look for in a dental insurance company?
1. A broad provider network
The bigger the network, the more likely you are to find a dentist you like. That's why Guardian networks have over 120,000 dentists in 400,000 locations.
2. A range of plans
It's good to have choices. Depending on where you live, Guardian offers Entry, Mid, and Top Tier Dental PPO plans.
3. An easy way to buy online
If you're buying online, plan benefits and details like deductibles and waiting periods should be displayed in a simple and straightforward manner to help you make a well informed choice – like they are when you purchase coverage online with Guardian.
Do dental plans usually include vision plans?
Dental and vision plans are sometimes bundled together, but they don't have to be. At Guardian Direct, you can buy individual dental insurance, vision insurance - or both - depending on your needs and your budget.
What do all those different insurance terms mean?
|
Premium |
The cost of the dental plan – what the insurance company charges a member each month for coverage |
|
Deductible |
The yearly amount plan members have to pay before the insurance company starts to cover services |
|
Coinsurance |
The percentage of costs an individual owes for services once the deductible has been met |
|
Copay |
A fee charged for a specific service or treatment |
|
Annual Maximums |
Annual maximum on what's covered; the most the insurance company will pay for dental services in a given year. The member is responsible for all charges over the maximum |
|
Waiting Periods |
Major procedures such as root canals usually have a waiting period (e.g., six or twelve months) before they are covered |
What should I consider before buying a plan?
Where to get dental coverage
If you or your spouse can get dental benefits through your employer, that's almost always the way to go. Companies get lower group rates than individuals typically can. But if workplace dental benefits aren't an option, you can get affordable coverage directly online from an insurance company like Guardian.
What your dental care needs are
If you have never had oral health problems, you may be able to save money with a basic dental plan. But you may save more in the long run with a plan that offers coverage for more dental services and treatments.
Dentist choice
If you have a dentist you want to stay with, look for a DPPO, then check with your dentist to see if he or she is part of the plan's network. But if cost matters more to you than loyalty to a specific dentist, a DHMO might be a better value for you.
Frequently asked questions about dental insurance
What is the best dental insurance for individuals?
Different dental insurance plans offer various combinations of benefits, features, and coverage options. But generally speaking, the best dental insurance for an individual or family is the plan that lets them see a dentist they like and offers coverage for the dental health services they're likely to need at a price that fits their budget.
Is individual dental insurance worth it?
Dental coverage is an investment in your health. One of the most important advantages of having dental insurance is that preventive checkups are usually covered at 100%. That encourages people to get regular dental care, which helps catch minor issues before they become major oral health problems.
Can I buy dental insurance on my own?
Yes, absolutely. If coverage isn't available through your employer, you can find an affordable dental plan. Major insurance companies make it easy for individuals and families to compare and buy a plan directly online.
Why is there a waiting period for dental insurance?
Waiting periods can help keep premium costs lower. They discourage people from getting a plan just before they need major treatment, then dropping coverage. That could raise costs for all other plan members. However, some DHMO plans are available which cover major services without these restrictions.
How much is full coverage dental insurance?
There are many dental plan options available. Monthly insurance coverage starts at under $25/month per member for a Dental PPO plan and can go up to $50/month or more, depending on your age, the state you live in, the insurance company, coverage benefits, and other factors. As with health insurance, if you get coverage as part of a group plan through your employer, the cost will usually be lower.
Are you a dental professional? Find out how to join Guardian's growing network of dentists.
