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Maintaining good oral health is important to staying healthy overall. Unfortunately, it can be costly to pay out-of-pocket for routine dental procedures, like cleanings, and even more expensive to pay for major procedures like root canals. This is why it is critical to have comprehensive, or full coverage, dental insurance.
You don't think about dental insurance until you need it. I've used other insurers and I've been happier with Guardian Direct.
While the terms “full coverage” and “basic coverage” are frequently used in describing different kinds of dental insurance, there’s no strict industry definition as to what needs to be in either type of plan. So what’s the difference between full and basic?
A basic dental plan covers preventive care such as checkups, cleanings, x-rays, and a few basic procedures, like cavity fillings. Full coverage plans cover much more – and often at a lower out-of-pocket cost to you. For example, they may cover a wider range of preventive procedures such as fluoride treatments and sealants in full or with just a small copay.
With full coverage insurance, dental procedures outside of routine cleanings are still covered in some part by your insurance. This means that if you have an unforeseen dental emergency or need to have a major issue treated you typically will not have to pay nearly as much as you would without insurance.
More than 25% of all adults in the U.S. have untreated dental decay or other serious dental problems¹. Considering that according to a 2019 study, more than 37 million adults don’t have dental insurance that is not much of a surprise². However, adults who don’t have dental insurance or don’t want to pay high premiums to get dental insurance through an employer might have another option. Private dental insurance is available to help you and your family have healthy teeth.
When purchasing full coverage dental insurance there are a few considerations to keep in mind:
They are full coverage in that they cover some portion of the majority of dental procedures.
Full coverage insurance can include a variety of different dental procedures and treatments.
Several types of dental insurance plans provide full coverage for treatments and procedures that go beyond preventive care.
Full coverage dental insurance with no waiting period.
When choosing a dental insurance plan, you often have to choose between a PPO plan or DHMO. If you choose a DHMO dental insurance plan you usually will have to select a Primary Care Dentist (PCD) from a list provided by the carrier. You must obtain services from your designated PCD. Your plan may require you to go through your PCD to get a referral to a specialist or other dental provider for the insurance to pay any of the cost. Your plan may require you to go through your regular dentist to get a referral to a specialist or another dentist from your dentist for the insurance to pay any of the cost. However, with DHMO plans there is often no waiting period. PPO dental insurance providers, on the other hand, don’t require a referral, but some of them do have a waiting period which typically means that you won’t be able to get dental care right away.
Every dental insurance plan is different. You may be able to customize your coverage by selecting an affordable dental care plan that provides the type of coverage that works for you and your family. But typically, dental insurance with no waiting period may cover the total cost of any preventative services such as X-rays, oral exams, and cleanings. A full set of dental X-rays may be expensive, but the dentist needs to see them be able to work up a treatment plan that is right for you. Subject to your plan’s annual maximum, because they’re essential for dental care, your dental insurance should cover their cost or a portion thereof. Other preventative services that almost every dental insurance plan will pay for include:
Cleanings every six months
Dental checkups and appointments
Fluoride and sealant treatments for children
Additional services like extractions, fillings, and crowns may not be covered fully but depending on your plan and your insurance carrier, you can get an affordable price on those necessary services.
Dental care is typically grouped into three main categories: preventive, basic, and major. Many dental insurance plans cover preventive care up to 80% to 100%, basic procedures up to 50% to 70%, and major services, such as surgery up to 50%. However, coverage and costs can vary depending upon the plan level you select.
This type of dental care is less complicated than major procedures and is used to treat minor issues to help maintain good oral health. Basic procedures can include fillings, non-routine X-rays, and routine tooth extractions.
These procedures are some of the most complicated forms of treatment needed for major dental issues or emergencies. Root canals, major tooth extractions, complex oral surgeries, and dentures all fall under this category. A full-coverage plan is more likely to offer coverage for these procedures.
When shopping for a full coverage insurance plan, consider your budget and what you're comfortable paying. You should consider deductibles, coinsurance, annual maximums, and your monthly premium.
Plans with high deductibles and less coverage typically also have a lower monthly premium while plans with lower deductibles and more coverage will cost more per month. It is important that you discuss your oral health needs with a dentist before selecting a plan so that you can determine how much coverage makes sense for you.
When you’re comparing the coverage options of various insurance plans make sure that you look at whether or not preventative care is covered when you’re considering a particular plan.
A smart thing to do when you’re choosing a dental insurance plan is to think about the amount of dental care that you’re going to need in the next year before you buy a plan. If you have pretty good dental health finding a plan with a lower maximum and lower premium costs that help cover the cost of preventative treatments might be a good fit. But if you know that you need several crowns, a root canal, or other serious dental work you would be better off choosing a plan with the highest possible maximum benefit.
There are a few ways to purchase full coverage dental insurance, including:
Enroll in a plan offered by your employer - If your employer offers dental insurance as part of your benefits package, or as a voluntary benefit when you start a new job or during the open enrollment, which usually occurs in the fall.
Enroll in a plan through a trade organization - If you are self-employed and belong to a trade organization or other association, they may offer group dental insurance to their members.
Purchase an individual or family dental insurance plan directly - If your employer doesn’t offer dental insurance, you can purchase individual dental insurance from a dental insurance company over the phone, through a broker, or online. Limited options are available on healthcare.gov or your state’s ACA marketplace.
The cost of comprehensive dental insurance premiums depends on the plan that you choose as well as other factors like whether you choose a PPO or DHMO and what pre-existing conditions you have. Guardian Direct® offers three different plan choices: Bronze, Silver, and Gold so that you can find a plan that is affordable for your budget and offers the coverage* that you need.
If you’re worried about paying a high monthly premium cost preventative care plans are the lowest cost options Guardian Direct offers that can allow you to get necessary care at an affordable rate. However, if you know that you’re going to need one or more major dental procedures like a root canal, oral surgery, or dentures purchasing a plan that goes beyond preventive services like the Gold plan will give you the most coverage for your dental care.
Before you schedule a major procedure it’s smart to check your coverage, your co-pay, and other details of your insurance plan so that you know what portion of the cost you will be responsible for paying.
Unlike medical insurance typically there is no set enrollment period for dental insurance. You can enroll in a dental insurance plan at any time during the year with guaranteed acceptance. If you want to get dental work done immediately after enrollment check to make sure there is no waiting period for treatment before you sign up.
Unfortunately, no dental insurance plan is going to cover the total cost of everything. 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 based on the monthly cost. Throughout the dental insurance industry, there are three basic classifications of services: preventive, basic, and major.
Preventive treatment - typically are treatments designed to help keep your teeth healthy, including, regular cleanings, fluoride treatments, and other preventive treatments.
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 - typically include treatments like implants, bridges, and emergency care that 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.
Plans with Guardian Direct include a large network of dental professionals which allows you to have flexibility in choosing a dentist that you trust. Choosing an in-network dentist is also a way to help save money, in-network dentists have lower rates that have been negotiated by Guardian Direct.
Before making any choices regarding your dental health or insurance needs it is important to have all of the information that you need. This is why Guardian Direct has a vast library of resources designed specifically to help you make informed decisions when it comes to dental insurance options for yourself and your family.
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. 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.cdc.gov/nchs/data/hus/2019/028-508.pdf (2019) Accessed June 2021
https://www.marketwatch.com/story/dental-visits-start-declining-around-age-80-and-there-may-be-a-painful-price-to-pay-2019-07-25 (2019) Accessed 3/28/2021
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.12/22)
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