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Over the past decade, dental fees have risen by 20%.¹ And it’s taking a toll on oral health and preventative care: One in four Americans forgo necessary dental visits because they can’t afford it.²
Dental insurance and discount dental plans are both ways that you can get the dental care you need while saving on out-of-pocket expenses. Explore which option is best for you and compare their coverage of preventive care, dental procedures, network size, costs, waiting periods, and annual maximums.
There are three types of dental insurance plans, each with their own unique rules and benefits:
Dental Health Maintenance Organization (DHMO)
Dental Preferred Provider Organization (DPPO)
Dental Indemnity Insurance
Many dental insurance plans will cover 100% of two preventative care visits a year, including routine cleanings, exams, X-rays, topical fluoride, and sealants. Dental insurance can also lower the cost of procedures like fillings, extractions, crowns, and root canals.
With some plans, you can pay as little as $15 a month after your monthly premium. However, there is an annual maximum that dental insurance plans will pay for coverage — usually between $750 and $1,500.³
DHMOs have the lowest premiums of all dental insurance plans, rarely have an annual maximum, and have no limit on annual dental services. However, DHMO plans limit which dentists you can see and still receive coverage.
DPPOs pay the most for services you receive from dentists on your plan’s list. However, these plans pay less for the services you receive from dentists outside your plan’s list.
DPPOs also have higher premiums and deductibles than DHMOs and have an annual maximum for coverage. When the annual maximum is reached, you pay the remaining cost of dental services at a discounted rate determined by the plan.
Dental Indemnity Insurance Plans allow you to see any dentist and receive full coverage. But these plans also have the highest premiums of any dental insurance plan and require deductibles and co-payments like DPPOs. After insurance pays the claim, you pay for the balance up to the dentist’s usual fee.
If your employer doesn’t offer dental coverage, you can purchase your own plan from a state health insurance marketplace, or on a private exchange.
Dentist offices may offer discount dental plans to their patients, which are separate arrangements from dental insurance plans.
Dental discount plans can make services and procedures more budget-friendly for you and your family. Plans typically average between $120 for individuals and $169 for families annually.⁴
Dental discount plans usually have a much lower annual fee than insurance premiums, and offer patients around a 10% discount on dental services.⁵
You pay the dentist directly for your dental services, and only pay for things you need — there are no premiums to cover potential procedures or potential emergencies. Plus, there are generally no waiting periods like there are with dental insurance plans.
With dental discount plans, it’s rare for the plan to cover more than half of your procedure or visit cost. You pay the remaining balance on all services and procedures after the discount.
Additionally, you can’t bundle a dental discount plan with a vision plan to save money like you can with dental insurance.
It’s up to your dentist whether you can combine dental insurance with their dental discount plan. Some dentists will let you use their dental discount plan to reduce your out-of-pocket dental care costs once you’ve reached the annual maximum on your dental insurance plan.
If your dentist allows you to combine a dental insurance plan and a discount plan, and your dentist is within the network of your dental insurance, you may be able to submit a claim to your insurance to receive a discount from the dental plan for the remaining out-of-pocket insurance plan balance.
However, some dentists will not allow you to use your dental insurance and your dental savings plan for the same procedure.
In sum, unless your dentist is in both networks and willing to accept both forms of payment, you may not benefit from having both an insurance and dental discount plan.
As ancillary benefits to a medical plan, dental insurance, and vision insurance are often bundled to save you money. Since a dental discount plan is not an insurance plan, it can’t be bundled with vision insurance to provide a discount.
However, sometimes bundle plans don’t get you the most in-depth benefits you’re looking for, either with dental or vision coverage.
Although your monthly premiums for a dental insurance plan may be higher than your discount dental plan annual fees, many insurance plans cover 100% of dental visits and procedures (up to a stated maximum, and after your deductible if there is one).
If you have any expensive procedures ahead, you’ll likely pay a lot more out-of-pocket with a dental discount plan.
Overall, you will likely pay less for coverage with dental insurance over a discount dental plan.⁶ However, if your favorite dentist is out of your insurance plan’s network, you will only receive partial coverage for visits and procedures, so weigh the pros and cons of each option to choose what’s best for you.
If a private dental plan sounds like the best option for you and your family, you can shop for your plan on a state or federal marketplace, or on a private exchange.
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https://www.bls.gov/cpi/tables/detailed-reports/home.htm (Last accessed December 2019)
https://www.cdc.gov/nchs/data/hus/2012/073.pdf (Last accessed December 2019)
https://www.investopedia.com/articles/personal-finance/010516/5-dental-insurance-plans-no-annual-maximum.asp (Last accessed December 2019)
https://www.dentalplans.com/dentalplans (Last accessed December 2019)
https://www.finweb.com/insurance/the-difference-between-discount-dental-plans-and-dental-insurance.html#axzz4iaFnJ5JL (Last accessed December 2019)
https://www.finweb.com/insurance/the-difference-between-discount-dental-plans-and-dental-insurance.html#ixzz4isE1pAPW (Last accessed December 2019)
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.(exp.07/19)
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