|Direct from an insurance company||Through the healthcare exchange||Through a member organization|
|This is usually the quickest and easiest way to buy dental plans. See for yourself.||This can be an affordable option, but there are limitations. Read more about the pros and cons below.||This can be a good way to get group rates, but you have to belong to an organization that offers dental coverage.|
The tradeoffs between the different ways of getting dental coverage typically come down to access vs. cost. Just about anyone can get a quote and buy dental coverage direct online in minutes from an insurance company. When you confirm whether you qualify for subsidized coverage, you might be able to save by purchasing a dental plan on your state's exchange (also known as the health insurance marketplace). However, individuals can only elect dental plans from the federal exchange if they also buy a health plan. Certain member and professional organizations also offer dental coverage at attractive group rates. However, if there's an annual cost to joining, it could cancel out your potential savings.
Also, keep in mind that dental coverage generally costs much less than a health plan, and there's a lot of competition between dental insurance companies. So, the cost differential between an unsubsidized exchange plan, a member group plan, and an individual direct plan is unlikely to be more than a few dollars a month per person. More important than where you buy a plan is getting the type of plan that will best protect your oral health.
Entrepreneurs and employers with 2+ employees can qualify for certain small business dental insurance plans with group rates and other advantages.
|Dental PPOs||Dental HMOs|
|Also called a DPPO, short for Dental Preferred Provider Organization. These dental plans typically provide 100% coverage for preventive checkups, cleanings, and x-rays, but other more advanced dental care procedures cost more. The big advantage to a Dental PPO is dentist choice: there's typically an extensive network of dentists, making it easy to find a dental provider in your area - 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.||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 dental care, including specialist referrals. DHMOs 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 DHMO insurance policies have no deductibles or maximums (see below). As with HMO health plans, there are flat-rate copayments for most non-preventive treatments, but your overall costs will likely be lower.|
If you answered yes – you want access to a specific dental provider – consider a DPPO plan. DPPOs let you save when you go to a dental provider in their network, and you don't have to file a claim. These plans typically allow you to go out of network to see other dentists as well, even though you may have to pay more and submit a claim. However, if you go with a large insurer (like Guardian, with over 120,000 providers in 400,000 locations), your current dentist may well be "in-network." Check if your dentist is with Guardian.
If you aren't partial to a particular dentist, consider a DHMO. There's never a need to submit claims in this type of plan, but you can only see in-network dentists. Because the networks are limited, you probably won't get to see your current dental provider, and you may have to travel out of your area. The tradeoff is generally lower costs and a more straightforward fee structure, similar to HMO health plans.
Two other types of dental insurance plans
Indemnity plans let you see any dental provider, but you may have to pay the entire fee upfront, and the insurance company reimburses a portion of the cost. Like indemnity health insurance plans, these policies tend to have higher premiums and are harder to find.
Discount plans aren't really dental policies – they more like a warehouse club: you pay an annual fee that entitles you to discounts with some dentists. The savings vary – but there's always an out-of-pocket charge, even for preventive checkups.
While health care plans cover a broad range of treatments, dental plans focus on preventive dental care - because that's the 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 help cover major services and even some orthodontic care – which is great if you have kids. Every insurance company and plan has somewhat different coverage, and there may be waiting periods for some treatments. Here are some examples of the different categories of services that may be included.
|Preventive||Basic restorative||Major restorative||Orthodontic|
|Checkups, routine x-rays, and sometimes fluoride treatments||Fillings, extractions, and other basic services||More complex treatments such as root canals, crowns, bridges and dentures||Braces and other types of teeth aligners|
Yes. Guardian Direct® offers four different DPPO plan tiers –Achiever, Core, Starter and Diamond- to help you get the plan that's just 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.
|Paying for preventive care||Catching problems early||Paying for major services||Giving you discounts|
|Most insurance plans pay all or most of the charge for checkups. That not only saves money; it takes away a significant barrier to getting regular preventive care. That's important for your health.||Regular dental visits help keep teeth 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 dental providers (the average Guardian discount is 35%).|
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 problems:
- 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.
- Self-esteem Research shows that healthy teeth and gums are important to a person's self-esteem and feelings about themselves.
Dental and vision insurance
Dental and vision plans are sometimes bundled together, but they don't have to be. At Guardian Direct, you can buy individual dental coverage, vision insurance - or both - depending on your needs and your budget.
|Premium||The cost shown in a dental plan quote – 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 (but typically, plans cover preventive care without a deductible)|
|Coinsurance||The percentage of costs an individual owes for services once the deductible has been met|
|Co pay||A flat fee charged for a specific service or treatment|
|Annual Maximums||Annual caps on what's covered; the most the insurance company will pay for dental services in a given year. The plan 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 months) before they are covered in a new policy|
Can I purchase dental insurance alone?
Yes. Self-employed individuals, independent contractors, and others who can't get dental benefits through an employer have many options for getting affordable dental coverage. Major insurance companies make it easy for individuals and families to compare and buy a plan directly online. In many cases, vision plans are also available.
How much is independent dental insurance?
If you're willing to shop around, you'll find there are many dental plan options available.
Is there any dental insurance that covers everything?
We are not aware of any insurance provider or plan that covers every type of charge from every dental provider. 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. And it should do so at a price (including premiums, cost shares, and co-pays) that fits their budget.
What's the point of getting dental insurance?
Just as a health plan is the key to having access to healthcare providers, dental coverage leads to more consistent dental care. That benefits your overall wellbeing because research shows oral health is vital to overall health. Dental plans can help you get essential preventive care, lower your costs for other procedures, and, when bundled with vision insurance, provides benefits for your eyes as well.
What are other insurance benefits and plans should I consider as a self-employer?
Think about all the benefit plans you would want to have as an employee. A health plan and retirement savings accounts are important to consider if you don't already have such plans in place. Life insurance may also be of importance as a source of protection for your family finances, and disability insurance can help replace your income if you can't work due to illness or accidental injury. You can shop for many of these plans and policies online, or you can also choose to work with a financial professional.
Are you a dental professional? Find out how to join Guardian's growing network of dental benefit providers