What is Individual Dental Insurance? | Guardian Direct

Dental Health

Affordable Care Act

Individual dental Insurance is on the rise: do you need it?

In some cases, the insurance that you get through your employer may not provide vision or dental coverage, which means you either need to purchase individual dental insurance or you end up paying out of pocket for dental care. That’s one of the reasons why the purchase of individual dental insurance is on the rise. At the end of 2016, over 7% of Americans purchased individual dental plans outside of their employer—more than a 5% jump from 2011.¹

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Why are individual dental plans becoming more popular? And why are people looking for plans via direct insurance? Because people need dental care, and the cost of out-of-pocket dental care is just too high for most people. Especially for parents who need to have some kind of insurance that will help pay for their children’s dental are as well as their own. Individual dental insurance helps fill in the gaps in employer-sponsored health care insurance and gives individuals and families the dental care coverage they need. 

What is individual dental insurance?

Individual dental insurance is dental coverage that can be purchased directly from a dental insurance provider or on the Affordable Care Act (ACA) marketplace. Unlike employer-sponsored plans, individual dental insurance lets you compare various plans and choose the one that best suits your individual needs and budget.

You may want to purchase an individual dental insurance plan if your current health insurance plan doesn’t include dental benefits, or if the benefits are too minimal for yours and your family’s needs. Buying individual dental insurance allows you to keep the employer-sponsored insurance that you’re happy with but supplement it with dental insurance so that you have additional insurance for your dental needs. You may also decide to purchase individual dental insurance if your employer-sponsored healthcare plan offers a dental plan that doesn’t cover enough or costs too much. 

Types of individual dental insurance plans

You may have multiple choices when it comes to choosing an individual dental plan. You can choose the type of plan and the coverages that will work best for your unique situation and your budget. There are two main types of individual dental plans you can purchase:

  • Dental Health Maintenance Organization Plan (DHMO)

  • Dental Preferred Provider Organization Plan (DPPO)

Unlike employer-sponsored plans, individual dental insurance allows you to compare plans before choosing the one that makes the most sense for your needs and budget.

DHMO and PPO dental plans

Dental health maintenance organization (DHMO) plans and dental preferred provider organization (DPPO) plans are the two most common types of individual dental insurance plans. DHMO plans typically have lower out-of-pocket costs and you are encouraged to pick a primary dentist and typically need a referral to see a specialist. DPPO plans allow you to visit a larger group of dentists and still get coverage but their costs may be higher than a DHMO. To decide which is the best type of dental insurance for you, you’ll have to decide whether it’s more important to you to see a wider range of dentists and have greater freedom or keep costs low. Here are a few other typical key differences between the two types of plans:

DHMO plans

  • Lower out-of-pocket costs

  • No annual maximum

  • You are encouraged to choose an in-network dentist as your primary care dentist. All dental care must be provided or arranged by your primary care dentist

  • Smaller network of dentists so it can be difficult to find a dentist near your home or work 

DPPO plans

  • Wider network of dentists you can visit

  • You can visit an out-of-network dentist, but you may have to pay a higher rate

  • You don’t have to choose a primary dentist or get a referral before seeing a dentist or specialist

  • No waiting periods for preventive care, such as cleanings and X-rays. But filings, extractions and root canals can have waiting periods of six to 12 months

  • Higher out-of-pocket costs than a DHMO

  • May limit the amount of coverage you can receive in a year through an annual maximum

Who buys individual dental insurance?

Freelancers and the self-employed

More than 6% of American workers are self-employed² and over 40 million Americans of all ages consider themselves consultants, freelancers, contractors, solopreneurs, temporary or on-call workers.³

If you decide to take the leap and become a freelancer, you may feel like you can control your destiny. However, you may still need insurance to help protect you in case you get a tooth infection or become accidentally injured. Typically, employers who hire freelancers do not offer them health insurance and benefits. However, even if you do enroll in your employer’s health insurance, you may lose coverage if your agreement ends. 

Individual dental insurance helps freelancers move from job to job and from project to project easily. You won’t be tethered to your employer because you will have coverage no matter who you work for or what projects you decide to work for. Although your dental health may not be the first thing on your mind, maintaining dental insurance coverage as a freelancer can help prevent potential out-of-pocket costs from hurting your bottom line.

Dental insurance can help lower the cost of procedures like fillings, extractions, crowns, and root canals through negotiated rates with a network of dentists and by covering a percentage of the cost of dental care.

Baby boomers

Over 10,000 baby boomers retiring each day⁴, and many are leaving employer-sponsored insurance plans as they enter retirement. Some baby boomers may need coverage that can help supplement their Medicare health coverage.

26-year-olds 

As 26-year-olds age out of their parents’ healthcare plans⁵, many turn to private health insurance plans for coverage. Adults of this age who may be unemployed, working part-time, or work freelance may not have employer dental coverage, or may want better or cheaper coverage than what their employer offers. Individual dental plans offer  26-year-olds the ability to find coverage that satisfies their lifestyle and budget as they shop for their own plans for the first time.

Unemployed Americans

Like freelancers and the self-employed, unemployed Americans who don’t qualify for dental coverage through an employer can find an affordable private dental plan that suits their coverage needs.

Americans who may qualify for dental coverage through their employer but who want a plan with different coverage options can also choose to buy a private plan that better fits their needs.

Why dental insurance is important

If you don’t already have dental insurance, you might be wondering: is dental insurance really worth it? What are the benefits of dental insurance? A good dental insurance plan helps you save money, stay protected in case of emergency, and keep your teeth and gums healthy. Dental insurance helps cover the cost of regular dental care while also help minimizing the costs of any unexpected dental procedures you might need.

Even if you’re fortunate enough not to require any major dental procedures, dental insurance can still pay off. Most dental insurance plans cover routine preventive care at 80% to 100%, which means any monthly premiums you pay can virtually pay for themselves. And according to the American Dental Association, regular dental visits are integral to preserving good oral health. They recommend that every person should regularly visit the dentist at least one or two times a year in order to help keep their teeth and gums healthy.⁶ Plus, chances are you may have more dental care needs than you even realize: The Centers for Disease Control and Prevention estimates that 31.6% of adults aged 20 to 44 have untreated tooth decay.⁷

The National Association of Dental Plans found that Americans with dental benefits are more likely to take their children to the dentist, go to the dentist, receive restorative care, and experience greater overall health.⁸ The same study also found that those without dental benefits are 67% more likely to have heart disease, 50% more likely to have osteoporosis, and 29% more likely to have diabetes.

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What to look for when choosing individual dental insurance

Once you have a good idea of what type of dental insurance is the best fit for you, look for a provider who fits the following criteria:

  • Cost-effective - Remember: the cheapest monthly option isn’t always the most cost-effective option in the long run. When choosing a plan, consider deductibles, annual caps, and coverage amounts as well as monthly premiums.

  • A large network of dentists - Many plans don’t offer any coverage at all if you visit a dentist that’s out of your insurance provider’s network. Find a dental insurance provider with a large network of dentists, especially in your area.

  • Plenty of coverage - Keep a close eye on the percentage your insurance provider will cover on preventive, basic, and major procedures. It might be a good idea to ask for a list of which dental procedures that fall into which category, since typically there’s no standardized classification system.

  • Good customer service - No one wants to spend hours talking to a customer service representative who’s unfriendly, unresponsive, and unhelpful. Look for an individual dental insurance provider who’s known for their high level of customer service.

  • Easy enrollment - The sooner you can enroll, the sooner you’ll be able to start using your dental insurance. If getting dental insurance fast is important to you, find a provider with instant approval and learn when from the approval date, coverage begins. 

  • Payment flexibility - Look for a provider who offers flexible payment plans and multiple secure payment options, especially if you’re on a tight budget.


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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Sources

  1. https://www.nadp.org/Dental\_Benefits\_Basics/Dental\_BB\_1.aspx, 2017

  2. https://www.bls.gov/news.release/empsit.t09.htm, accessed September 2020

  3. https://www.mbopartners.com/state-of-independence, accessed September 2020

  4. https://www.cnbc.com/2017/10/03/health-care-dilemma-10000-boomers-retiring-each-day.html, 2017

  5. https://www.hhs.gov/healthcare/about-the-aca/young-adult-coverage/index.html, 2017

  6. https://www.mouthhealthy.org/en/dental-care-concerns/questions-about-going-to-the-dentist, accessed September 2020

  7. https://www.cdc.gov/nchs/fastats/dental.htm, 2017

  8. https://www.nadp.org/Dental\_Benefits\_Basics/Dental\_BB\_1.aspx, 2017

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.09/22)

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