What is Dental Insurance and What Does it Cover?

Dental Insurance

Having health insurance is a good idea. We all know that, but dental insurance is a little different. For some, it may not be as cost-efficient as we’d like.

Getting insurance seems like a no-brainer. Medical insurance, more often than not, saves you money in the short and long term. If your monthly premium is high, you’ll pay a lower deductible, and vice versa.

Dental insurance works a little differently.

There are pros and cons to purchasing a dental policy, either from your employer or from an insurance marketplace like Healthcare.gov. In some cases, dental coverage won’t save you money at all, even if you’re getting dental care.

Dental insurance can significantly help lower the cost of dental care and make it affordable for people to get routine dental care. According to the Kaiser Family Foundation, nearly 37 million people who use Medicare as their primary insurance have no dental insurance at all.

That lack of coverage typically means that people are going without dental care, which can have a potentially very serious impact on their overall health.

Individual dental insurance plans are available for everyone who doesn’t have dental coverage through their employer or through medical insurance.

Individual dental insurance plans help make it easier to pay for routine care and to cover the costs of dental emergencies. And dental insurance can be more affordable than many people think.

Dental insurance monthly premium costs 

If you immediately tense up when you think about monthly insurance premium costs, that’s normal considering how high most medical premium costs typically are.

According to one study, the average cost of medical insurance premiums for one person is around $450 a month, and it can cost over $1100 per month to insure a whole family.

But the average dental insurance premium is usually between $15 and $50, a month, and maybe slightly more to cover a whole family. Costs will vary depending on your state.

If you’ve been on the fence about whether or not to get dental insurance for your entire family, you should consider that the average market rate cost of dental care for a child between the ages of seven and 12 is over $800 per year, according to the ADA. 

If you have multiple young children you can easily see that dental insurance will help save you money as well as ensure that your children are getting the dental care they need.

Dental insurance will also likely help cover your children’s dental expenses if they have an emergency, like if they have a tooth injured or knocked out while playing sports or in a schoolyard accident.

More than 40% of households in the U.S. would likely have trouble coming up with $400 in an emergency, could you come up with the money for an expensive dental emergency without turning to high-interest credit cards?

If you have family dental insurance, you won’t have to. Depending on your insurance plan, your child’s emergency dental expenses will be covered.

There are a lot of variables that go into dental insurance plans, so the premium costs will vary depending on factors like your coverage amount, your deductible, depending on your state, and the services that you want to have covered by your insurance.

Plan options

Dental insurance plans typically cover a wide variety of services. Depending on your budget and needs, you can choose a plan based on the coverage that it provides or on the monthly cost.

Throughout the dental insurance industry, there are three basic classifications of services: preventive, basic, and major.

  • Preventive treatments typically are treatments designed to help keep your teeth healthy and strong. Regular cleanings, fluoride treatments, and other preventive treatments are usually covered at 100% or close to 100% in most dental insurance plans.
  • Basic treatments are routine services like tooth extractions, fillings, and root canals. They are necessary procedures that can also help prevent more significant and harder to treat problems down the road.
  • Major treatments would typically include treatments like implants, bridges, and emergency care than can involve multiple treatments to fix a problem.

Dental insurance plans provide varying coverage for these three types of services so you can pick a plan that covers the treatments that are the most important to you and has a monthly premium cost that fits your budget.

Coverage amount

Another factor that impacts dental insurance costs is the maximum coverage amount of the plan that you choose. Some dental insurance plans have a maximum benefit amount that will be paid per year.

If the cost of your services goes beyond that maximum cost, you are typically responsible for paying any overages. If you want a plan with no cap your premium cost will likely be higher.

Choosing a top-tier dental insurance plan means that you will typically pay a higher monthly premium, but you will likely pay less, or even nothing out of pocket for dental care, including some costly procedures.

If you can afford to pay a higher premium there’s a financial advantage to choosing an insurance plan that covers more procedures or a higher amount of procedures.

For example, subject to exclusions and limitations, a Guardian Direct® Dental Achiever plan covers 100% of the cost of cleanings and x-rays and 70% of the cost of filings. But a less expensive Guardian Direct® Dental Core plan covers 80% of cleanings and X-rays and 50% of filings.

Deductible

A dental insurance deductible works the same way as your car insurance deductible works. You are responsible for paying for the cost of dental care up to the cost of the deductible. Once you have met that amount, your insurance will kick in and start covering costs.

The amount of the deductible is usually the maximum out-of-pocket expense that you will have to pay for treatment, which is important during a dental emergency.

Picking a dental insurance plan with a high deductible will help lower your monthly premium costs but likely makes you responsible for paying more out of pocket. Choosing a dental insurance plan with a high deductible can be a way to help you keep the cost of monthly premiums low.

Copays

The amount that you pay out-of-pocket for a dental visit is called a copay. The amount of your copay is typically based on the type of plan that you have and the coverage that you have. If you have a family dental insurance plan or if you have coinsurance, your deductible might be higher.

Do costs vary by in-network or out-of-network providers?

With most dental plans, a big factor in dental insurance costs is whether you get treatment from a dentist that is in-network. You will often pay lower rates if you see an in-network dentist instead of an out-of-network dentist.

Dental insurance company’s networks are composed of dentists who have agreed to provide services to subscribed clients at reduced rates negotiated by the insurance company. If you choose to see a dentist that isn’t in the insurer’s network, you will usually have to pay the entire cost of the treatment out of pocket.

The size of the dental network typically depends on the insurer and what type of insurance plan you have. It’s important to understand the differences in types of dental insurance before you pick a plan to make sure you’re picking the plan that will give you the most options.

Most dental insurance companies provide easy access to lists of dentists in your area who are members of their network. You can usually find these on company websites or in written materials sent to you annually by the insurance company.

PPO

A preferred provider organization (PPO) dental insurance plan will typically give you access to a larger network of dentists than a DHMO and is more likely to offer reimbursement for services rendered by an out-of-network dentist.

If you live in a rural area, or in a smaller city, you might have an easier time finding a dentist that is in-network if you have a dental PPO insurance plan.

The up-front cost of a PPO  insurance plan might be a little higher than the cost of a DHMO because the network is larger but if being able to choose a dentist that you’re comfortable with is your priority the higher cost may be worth it.

DHMO

A dental health maintenance organization (DHMO) operates in a similar way to a medical HMO. You are encouraged to choose a primary care dentist from the DHMO’s network of dentists, which will likely be smaller than a PPO’s network.

DHMOs are popular because they typically have low costs and no deductible if you see an in-network dentist. However, because they are smaller organizations it may be tough to find a dentist that is part of the DHMO’s network, and typically there is no out-of-network coverage.

How can you save money on dental care without insurance?

If you decide to skip dental insurance, you’ll still want to get your teeth cleaned once or twice a year. And you’ll want options if unexpected dental work comes up. Here’s where you can look for care outside of the typical insurance marketplace.

Visit a dental school

You’ll see students whose work is supervised by trained dentists. In exchange, you pay a low cost for appointments, even if you’re uninsured. The ADA lists dental schools across the country; find one near you.

Visit a dental clinic

Some clinics offer a sliding scale fee based on income, and diagnostic exams may be free. Find a local branch of a national clinic like America’s Dentists Care Foundation, or see what low-cost care options your state and local dental societies have to offer.

Dental school and clinic appointments are often in high demand. Be prepared to schedule far in advance or put your name on a waiting list. Even with walk-in clinics, it’s best to call ahead and find out their procedures before you go.

Look into a discount dental plan

Discount dental plans or dental savings plans can give you the security of coverage without the cost. You’ll pay an annual fee and get a discount, anywhere from 10% to 60%, on average dental care prices. Unlike insurance plans, there are no annual caps or waiting periods.

Policygenius has an analysis of dental discount plans, which (again, like insurance plans) require some comparison shopping for the best deal.

Self-insure

Maybe paying a monthly premium or fee isn’t worth the cost to you for a few appointments, but you still want some cash on hand for dental work if the need arises.

Set aside separate savings account for dental appointments and emergencies. Contribute at your own pace, and take care of your teeth in the meantime.

Average dental insurance cost per month 

When you are shopping for dental insurance, it may be the monthly premium cost that makes you choose one plan over another. The average cost of dental insurance is about $360 per year, or between $15 and $50 a month, depending on your dental insurance plan and the state you live in.

The monthly premium cost is typically based on the plan coverage primarily, but other factors influence the cost of dental insurance each month, like where you live and what the going cost of procedures in those areas are.

Have you wondered why you need to input your zip code to get a dental insurance quote? It’s because if you live in a large city where the cost of living, and the cost of dental care, is high then your premium will likely be higher than it would be if you lived in a rural area or smaller city

How much do dental implants cost?

Dental implants are one of the strongest devices available to replace missing teeth. They are artificial tooth roots that support crowns, bridges, or dentures.

You can typically get a single implant to replace a missing tooth, or you can have implants put in that will hold a bridge steady if you have several missing teeth that need replacing.

Implants can be expensive, but dentists recommend them because they are considered a reliable and long-lasting replacement for natural teeth. 

A single implant can typically cost between $3,000 and $4,500 without insurance. But you may find that implants cost less where you live based on the going rate of dental work and the agreement that your dental insurance company has with the dentist. 

Other factors that typically affect the cost of dental implants are things like the metal used for the implant. For decades, titanium has been the preferred metal to be used to create an implant.

Titanium is easily tolerated by most people and it is biocompatible, meaning it can fuse with your jawbone without your body rejecting it. It’s also a relatively low-cost metal.

But titanium can also cause an infection at the implant site and provide a pocket where bacteria can because titanium requires a dual post insertion to hold the crown. 

If you want to get dental implants to replace missing teeth but the cost is out of reach, you should consider getting dental insurance. Some dental insurance plans may help cover a part of the cost of dental implants. Guardian Direct® Dental Achiever and Core PPO plans cover 50% of dental implants. 


Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents, and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.

The material discussed is meant for general illustration and/or informational purposes only, and it is not to be construed as tax, legal, investment, or medical advice and is not intended to influence any reader’s decision to select, enroll in, or disenroll from a Medicare plan.

This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist’s office.

Summary

So is dental insurance worth it?

That depends on your dental health and the plan you choose. With more extensive procedures, having insurance can help cover the high cost, but chances are you’ll still be paying out of pocket for some of it.

The best thing dental insurance can offer is a safety net in case you end up needing these extensive procedures.

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