While Consumer Reports notes that there are other ways to save on dental care, lack of coverage remains a concern: One in four Americans doesn't have dental insurance, and of those over 65, half have no coverage, according to the National Association of Dental Plans (NADP). As one of the nation's largest dental insurance carriers, Guardian clearly believes in the value of dental insurance; to help make the best decision for your needs, there are a few things you should consider:
- Dental insurance coverage leads to earlier and better dental care
- Ways to get your money's worth from dental insurance
- How to get a plan that makes sense for you
- Frequently asked questions about the value of dental insurance
People don't get health insurance – or even auto insurance – because they expect to get every premium dollar back. They get it to protect their finances and wellbeing – and because not having coverage could leave them far worse off. The same is true for dental insurance.
Research conducted by the NADP shows that Americans with dental benefits are more likely to go to the dentist, take their children to the dentist, receive restorative care, and experience greater overall health. Guardian's own studies 1 reinforce 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 – either through the workplace or purchased individually – preventive care is typically covered 100%. So 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 far easier and less costly to treat. That can have a significant impact on your overall health and wellbeing – even more than you may realize.
The fact is, more than 90% of all common diseases show symptoms in the mouth.2 And the importance of oral health goes beyond detection: a growing body of research 3 shows that it can help adults avoid or better manage serious health-related issues including:
- 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.
- 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.
Why get a dental plan that may or may not save you money this year? Because it's really about protecting your teeth – and your health.
Health insurance is primarily designed to protect you from big bills, which can result from even a simple emergency room visit. But dental care is different – so the insurance coverage is different as well. Since the majority of dental care is preventive, many dental insurance plans cover only preventive care and basic procedures, such as cleanings and fillings. While that alone has value, there are also more comprehensive insurance plans that cover major procedures. If you're looking to get the most value, it's a good idea to start with a basic understanding of how dental insurance plans work:
- The preventive/basic/major coverage formula - 100/75/50 coverage means preventive services like checkups and cleanings are covered 100% – you don't owe anything; basic procedures such as fillings are covered at 75%, and major procedures like crowns and root canals are covered 50%. There are variations on this formula, and some procedures may be considered "basic" by one insurance company and "major" for another.
- Network discounts - When you go to a dentist in the plan's network, you get a discount on basic and major dental services. So for example, if your dentist typically charges $100 for a filling, if he or she is in-network, you may only be charged $60-$70 – you'll save money even if you haven't met your deductible yet.
- Deductibles, maximums, and waiting periods - There's usually a small deductible amount you have to pay out of pocket each year before the plan starts to pay, typically around $50 for an individual, $150 for a family. Most insurance plans also cap the total amount they will pay at $1,000-$2,000 per year. Any expenses over this maximum amount is your responsibility. Finally, the plan may have a waiting period that is applied to certain services such as major dental services. This waiting period must be met before services can be covered.
While dental insurance cost is a small fraction of a good health insurance plan, you still want to get the greatest benefit for your monthly premium. Here's how to do that:
1. Find a dentist you like, and stay with them
While you may never actually enjoy going to the dentist, it's important to find someone you trust and are comfortable with. Why? Because dentist loyalty results in more dental visits and better outcomes: People who have been with the same dentist for ten or more years are more likely to go regularly and report having excellent or very good dental health.1 If you have a dentist you like, make sure he or she is in-network. If you don't already have a dentist, a larger network can increase your odds of finding a provider you like.
2. Take full advantage of the plan's preventive benefits
Some plans cover one checkup a 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."
3. Find out about – and use – your in-network discounts
Insurance plans negotiate discounts for each procedure with their in-network dentists, and those discounts still apply even after you go over the plan's yearly maximum. So for example, if you have a lot of dental work and go over your $2,000 maximum, if you get a 35% discount, a $600 procedure would only cost about $400. And if you're referred to another provider for a specialized procedure, make sure he or she is in-network as well.
4. Get coverage before you have a major problem
Most plans have waiting periods before they will cover non-preventive procedures. For something basic like a filling, that could be six months. Major procedures like root canals might not be covered at all during the first year (although you would receive the in-network discount). So, it quite literally doesn't pay to wait until your teeth hurt to sign up.
Look for coverage that matches your needs
Top-tier insurance companies, such as Guardian, offer a range of options. Some plans focus on providing preventive and basic coverage, and other plans offer more comprehensive coverage, which includes things like implants and orthodontics. If you're young, single, and your teeth have never given you problems, a basic plan will offer lower premiums. If you have children – and especially if they have crooked teeth – consider more comprehensive coverage.
Find out how big the provider network is
Remember: a big part of maintaining good dental health is finding a dentist you like. Whether you already have one or you're still looking, network size is key. On the other hand, if you really don't believe dentist loyalty is important for you, you may want to consider a DHMO with a limited network: premiums are usually lower, and the fee structure is simpler.
Find out what the in-network discounts are
All dental insurance plans limit coverage to a lesser or greater degree, but in-network discounts no matter how much you use your dentist's services. What's a good discount? Guardian negotiates discounts of up to 35%, among the best in the industry – so make sure you're in that range.
If possible, get coverage through work
Getting dental insurance through your employer makes sense for most people: 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. If you can't get group-rate insurance at work, check to see if you can get coverage through a professional association or other membership groups.
However, if you need to get insurance as an individual, that's not a problem. It's still affordable – and many dental insurance carriers, such as Guardian, let you compare, get a quote, and buy coverage conveniently online.
What's the point of getting dental insurance?
In a nutshell, it's about getting essential preventive care, lowering your costs for other procedures, and maintaining your overall wellbeing. Having dental coverage leads to more consistent dental care, which is important to your general health.
What is the best dental insurance?
The best dental insurance for you is the plan that lets you see a dentist you like and trust, covers the treatments you and your family are likely to need and works within your budget. Your best value may be a plan through work, but affordable plans with good coverage are also available to individuals.
Are dental discount plans worth it?
Discount plans can lower the cost of a checkup or other procedure – but it doesn't take away the cost of preventive services, the way most dental insurance does. Many people with a discount plan will still put off simple checkups and cleanings – and their health will suffer as a result.