Find your dental preferred provider
It’s a fact: Millions of Americans skip regular dental visits. It’s not because they’re afraid of getting their teeth cleaned or cavities filled. The biggest roadblock to proper dental care in America is cost.
But it doesn’t have to be prohibitive – especially if you have a dental insurance plan to help pay for care, starting with regular checkups. Guardian claims data indicates that people enrolled in a dental plan who received regular cleanings at least once a year needed fewer major dental services and had lower out-of-pocket expenses1. When you have dental insurance, basic preventative costs are often free of charge or discounted, so there’s no reason not to take care of your teeth – and your health. This article will help you answer four important questions:
How to choose a dentist
Going to the dentist can be a bit nerve-racking, even if you’ve been going to the same person for years. Finding a new dentist can be downright stressful. If you don’t already have a dentist you like, or if your plan doesn’t cover your dentist, here are some ways to find a good fit:
- Consider your immediate and future needs. Do you just need routine teeth cleaning, or do you have a problem, like a painful tooth that needs to be treated quickly? Somedental benefit providers won’t treat emergencies on new patients. Others don’t provide emergency care. When it comes to a dental emergency, like an abscessed tooth, you may be at the mercy of whoever can fit you into their schedule. But, if you’re starting with a cleaning, find out what other services they provide.
- Consider your needs. Different dentists specialize in different customers. For example, if you have children, you may want to choose a pediatric dentist over a general dentist. If you are older, you may want to look for a dentist that specializes in geriatric dentistry.
- Ask for recommendations. Whether it’s talking to your friends or relatives or posting in local social media groups, asking for dentist recommendations has never been easier. If you have particular concerns that you are comfortable sharing, it’s a great way to get feedback from those who’ve had similar issues.
- Consider convenience. How far is the dentist’s location from your home or work? What are their office hours? How long is the waiting list to get an appointment? All of these factors come into play when choosing the right dentist for your needs.
- Is the dentist in your dental insurance plan’s provider organization? Depending on the type of dental insurance plan you have, you may be limited on which dentists you can use. A PPO (which we’ll cover next) provides more flexibility than some types of plans and allows you to see whichever dentist you choose – you just may have to pay more out of pocket.
If you’re covered by Guardian’s PPO plan, there’s a good chance that the dentist you have (or want) may be in our extensive dental network. And with over 120,000 participating providers in 420,000 locations across the United States, you may not have to travel far to find your dentist.2 The Guardian dentist lookup tool makes it easy to find in-network options near you.
What is a Dental PPO?
The term "Dental PPO," or DPPO, refers to a dental insurance plan with a Dental Preferred Provider Organization (or network). With a Dental PPO, you can use any dentist - even if they're not in the network - but you will pay less out of pocket if you use someone in the DPPO network.
However, not all DPPO plans are the same. What may be fully covered by one may not be covered at all by another, so it's essential to review the policy's Plan Summary.
Like PPO health plans, most PPO dental coverage plans have a deductible that you are required to pay out of pocket before your insurer starts covering services. However, the deductible is typically significantly lower than that of a regular health insurance plan. With Guardian, for example, deductibles are around $50 for an individual policy or $150 for a family policy.
Additionally, there's likely a cap on the maximum amount the plan will cover per member, typically between $1,000 to $2,000 annually. Most PPO policies also have a waiting period between the time you sign up until you can have major services conducted, such as a root canal. Still, many people prefer DPPO plans. Here's why:
- You don't have to go through a primary care dentist before seeing a specialist. You can go to anyone in the network and save.
- An extensive PPO network, like Guardian's, gives you numerous options and may include your current dentist.
- DPPOs negotiate discounts with in-network dentists so that you pay a lower fee, even if your policy does not cover a procedure or you haven't yet met your deductible.
- DPPO plans, such as those from Guardian, may come with different coverage options. The specific policy you choose will dictate which dental services are covered. Many policies fully cover basic preventative measures like regular checkups and cleanings and sometimes routine x-rays. Additional procedures may be partially covered by the plan, such as covering 75% of the cost of fillings, leaving you to pay the remaining 25%. Guardian offers three tiers of PPO plans with different levels of coverage.
In most cases, you don't have to file a claim with the insurance company if you stay in the PPO network. Your dentist will do it for you. To find out how much you'll be paying out of pocket, ask your dentist for a pre-treatment estimate.
What other types of dental insurance plans are available?
While DPPOs are often preferred, they aren't the only plan type available from dental insurance providers. Here are some other options and networks you may want to consider:
Dental HMOs (DHMO)
Dental Health Maintenance Organizations are typically less expensive than DPPOs, but their networks offer less flexibility. For example, you have to choose a primary care dentist and go through them for all care. The network of dentists and specialists is usually much smaller, so you may have to travel farther. Also, your current dentist is less likely to be on the approved list. However, you typically don't have to pay a deductible, and there's no cap, but you will have to pay a flat copay amount for most non-preventative procedures.
These dental plans have no network and allow you to go to any dentist you choose. The plan will reimburse a percentage of what the insurer considers "reasonable and customary" expenses. Like the other plans, your preventive care is often fully covered. On the downside, indemnity plans are expensive, difficult to find, and generally require that you pay your dentist up-front then file paperwork for reimbursement.
Dental Discount Plans
These "plans" work more like a discount club membership. For an annual fee, you receive a card that allows you to access care from participating dentists at a reduced price. Expect to have out-of-pocket expenses every visit.
How can I get dental insurance?
If your employer offers a dental plan, that may be a good option. An employer gets reduced group rates, and group plan members often enjoy higher benefits than an individual plan. Your company may also pay a percentage of the premium for you.
However, there are available options if you need to get dental coverage yourself. You can find several affordable individual dental insurance plans online. Remember, however, that just because a plan costs less doesn't necessarily mean it's the best option for you. Make sure to read the plan summary and know what will and will not be covered, along with your costs.
Studies find that people with dental benefits tend to receive better dental care, which can make them healthier overall. Dental health issues have been connected to many severe health problems, including heart disease, diabetes, osteoporosis, and others.2 By investing in dental coverage, you're investing in your overall health and the health of your family.
Frequently asked questions about dental providers
What is a dental preferred provider?
It's an "in-network" dentist or other dental specialist. They have contracted with your dental insurance company to provide services at a discount. Many preventative services, such as teeth cleaning, are often free of charge for members. They typically handle all the claims processing for you as well.
Should I choose an HMO or PPO dental plan?
Both DHMO dental plans and DPPOs can be a good choice, and both have their advantages and disadvantages. If dentist choice is more important to you, then a Dental PPO may be a good solution for your needs. A DPPO typically has higher premiums, but the network gives you more dentist choice.
If the premium price is more important, then an HMO may be a better choice for you. DHMOs are usually less expensive but are much more restrictive in which dentist you can use. The location may not be as convenient. DHMOs also typically don't require that you pay a deductible, and they don't have caps on how much they will pay for dental services. They do, however, have a copay that is typically charged each visit.
Who has the best dental insurance?
This is a complicated question because not everyone has the same needs. Various dental insurance plans offer different combinations of features, network providers, benefits, and coverage options. That's why the dental policy that may suit the needs for individuals and families is the one that lets them see a trusted dentist in a convenient location, covers the treatments they need, and does so at a price that fits their budget.