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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.¹ 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.
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 study² 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 $50³, a month, and may be 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.⁴ If you have multiple young children you can easily see that dental insurance will help save you money as well as ensuring 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 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 emergency⁵, 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.
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 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.
Another factor that impacts dental insurance costs is the maximum coverage amount on 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 Gold 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 Silver plan covers 80% of cleanings and X-rays and 50% of filings.
A dental insurance deductible works the same way that your car insurance deductible works. You are responsible for paying for the costs 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.
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 higher.
With most dental plans a big factor in dental insurance cost 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 from the insurance company.
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 from an out-of-network dentist. If you live in a rural area, or in smaller city, you might have an easier time finding a dentist that is in-network if you have a dental PPO insurance plan.⁶ 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.
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. DHMO’s 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.
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 around $15 and $50 a month, depending on your dental insurance plan and the state you live in.⁷
The monthly premium costs 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.
One of the strongest devices available to replace missing teeth, dental implants 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 to $4,500 without insurance⁸. 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 crown⁹.
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 Gold and Silver 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.
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.
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http://ebusiness.ada.org/assets/docs/2201.PDF, accessed October 2020
https://www.aaid-implant.org/faq, accessed October 2020
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.10/22)
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