There is not a one-size-fits-all dental insurance plan that may be the best for everyone. Different plans have different benefits and limitations. Before you choose a plan, it is important to understand exactly what you are choosing based on your budget and needs.
When you are selecting a dental insurance plan it is important to consider and weigh in a few key factors before deciding which insurance plan is the best for you and your family.
Three of the most common important factors to consider when selecting a dental plan are:
The size of the network – The bigger the network that your insurance provider has, typically the more choices you get when finding a dentist, orthodontist, oral surgeon, or any other specialist you may need.
No waiting periods for preventative care – As soon as your dental insurance coverage is active, you should be able to use it for preventative care so small problems don’t become large problems.
No claim forms – You shouldn’t have to wonder how much you will pay for a treatment when you go in to the dentist. With a Guardian Direct® dental insurance plan, if you choose an in-network dentist you do not have to submit a claim form, the confidence of knowing what is covered, and how much you will pay before you have any work done.
Once you have decided on an insurance provider, it is important that you tailor that plan to fit your specific needs. Take into account your budget, what you can afford in terms of both premiums and deductibles, and your overall oral health.
What is the best dental insurance for seniors?
As we age, our need for dental care gets even more important. People over 65 are at an increased risk for gum disease.¹ However, as of 2017, approximately 29% of seniors aged 65 and older carry dental insurance, and only 66% of seniors have visited a dentist in the last year.²
It doesn’t have to be this way. There is affordable dental insurance for seniors, even after losing an employer-sponsored dental plan.
Coverage options for seniors
For seniors on Medicare, dental costs are not typically covered by Parts A or B. You must have a Medicare Advantage, or Part C, plan in order to receive dental coverage through Medicare³. Even with a Medicare Advantage plan it may still be possible that comprehensive dental coverage is not included because the type of coverage varies from provider to provider⁴.
There is another option. Seniors can get comprehensive dental coverage through an individual dental insurance plan. These plans can typically be customized to meet the budgetary concerns and oral health concerns of seniors.
Should I bundle my dental coverage?
There are health insurance plans that include vision and/or dental benefits. These can be offered by an employer or purchased on your own.
Dental insurance and medical insurance operate differently. Depending on your policy, dental care is often designed to be preventive, you typically pay a small amount for going in for routine visits and to receive care like X-rays, cleanings, and check-ups. Health insurance is typically the opposite. It is designed to be used when something really bad happens. This difference may seem small but when you bundle dental and medical insurance, you may run the risk of paying more for your dental insurance than you would normally, even if the monthly premium is lower when bundled.
Another important consideration in terms of bundling is that insurance companies that specialize in dental coverage often may have attractive rates due to their relationships with dentists in their plans. They also may have structures that allow them to process claims quicker than bundled services.
Individual dental insurance typically may also offer more flexible plans in terms of deductibles and premiums. These plans also typically allow each individual to determine which services are most important to them and which are not.
Difference between PPO and HMO
There are many things to consider when you are looking for a dental insurance company that best fits your oral health needs. The right company for you can give you flexibility, choice, and a wide range of options in terms of monthly plans to meet your budget.
In dental insurance, there are two types of plans that you can typically choose, PPO plans or DHMO plans. The right plan that best first your individual needs may be the one that fits your budget. It is important that you have all of the information on each before making a decision.
Preferred Provider Organization (PPO) plans
Preferred Provider Organization or PPO plans allow you to pick your dentist, whether in network or out of network. When you receive care, your provider will typically cover a portion of its cost, and you will be responsible for the rest.
PPO common benefits
Flexibility – typically you can choose any dentist that you like, although you may typically pay less if you choose an in-network dentist.
Larger network of dentists – this is especially nice if you are in a rural area or an area without many dentists. It could mean that you do not have to commute to a large city in order to see the dentist.
No referrals – typically you do not need to get a referral in order to receive other care like orthodontics or oral surgery.
PPO common drawbacks
Include a deductible – although preventive care usually may not require you to pay a deductible, typically almost all other care will. This will likely raise your out-of-pocket costs.
Higher premiums – typically with the added flexibility, comes an added cost in terms of premiums.
Annual maximum – PPO plans typically cap the amount of coverage that you can receive each year. After you hit this maximum all costs will likely come out of your pocket.
Dental Health Maintenance Organization (DHMO) plans
In a DHMO plan you are encouraged to pick an in-network provider to serve as your primary care dentist. All of your dental care will be funneled through this dentist, as such, there is no out-of-network coverage under the DHMO plan. With your DHMO plan, you are likely to pay a small office visit fee and a copay for any services that you are provided and typically there is no deductible.
DHMO common benefits
Lower costs – with a DHMO there is typically no deductible and premiums are likely to be less when compared to a PPO plan. Preventative care is usually covered at no additional cost. For most procedures you will likely pay a copay and insurance will cover the rest.
Comprehensive coverage – almost all procedures are covered typically at a discount rate when compared with a PPO plan. All claims are filed by the in-network dentist directly, so you don’t have to worry about filing claims.
No annual max – typically there is no limit to the number of services that you can receive.
DHMO common drawbacks
Referral for other services – for example, if you need to see an oral surgeon or orthodontist you will likely need a referral from your in-network dentist.
Limited network – this is often a much more limited network of dentists, if you live in a rural area this could make finding a dentist that is in-network more challenging.
Out-of-network coverage – typically out-of-network dental work is not covered.
Depending on your budget, choosing a dental insurance provider for your family can be tough. When choosing it is important to find an insurer that allows your family flexibility. Some dentists work specifically with children and others are more generalists. You may want a provider that will allow each family member to choose their own dentist whether it is in-network or not so that you can pick a dentist that each member of your family is comfortable with.
Affordable dental insurance for retired military
Retired members of our military and armed forces have a few options for dental care that are typically not available to the general public. Retired military members who have a service-related dental problem, are former POWs, or are rated as totally disabled as a result of their military service may be eligible for dental coverage through Veterans Affairs (VA). Only about 8% of veterans qualify for dental care through the VA.⁵
When selecting a plan as a veteran you want to look for providers that have robust dental treatment plans and provide good follow-up work. Going to the dentist annually is critical to preventing painful oral health issues before they get started.
How to get dental insurance & insights
There is a wealth of information and resources available to you to help you pick the best dental insurance that works for you and your family. Regardless of which plan you pick it is important that you understand the ins and outs of what is covered and what is not as well as total costs to you.
Dental insurance for veterans: 3 typical ways to get it
What is the best dental insurance for individuals?
Individual dental insurance is on the rise: do you need it?
A comprehensive guide to dental insurance
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.
Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. 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 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.
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https://www.medicare.gov/Pubs/pdf/12026-Understanding-Medicare-Advantage-Plans.pdf, accessed December 2020
https://www.ehealthmedicare.com/medicare-advantage-articles/do-medicare-advantage-plans-cover-dental-services, accessed December 2020