What does dental insurance cover? Is it cheaper to pay out of pocket for dental and not have insurance? Can you have two dental plans? Should my family have two dental plans? Can I purchase dental insurance on my own? When you are looking for dental insurance it’s normal to have a lot of questions. Picking a dental insurance plan can be time consuming and a little confusing. There are so many choices when it comes to dental insurance it can be difficult to find the best plan to fit your budget and give you the coverage that you want. You also need to look at things like waiting periods and copays and before you know it you can end up spending hours trying to find dental insurance that covers everything. We’ve assembled the answer to some of the most common questions about dental insurance and choosing the right dental insurance for you and your family to help you make an informed decision when looking for the best insurance for your lifestyle, budget, and family size.
Can I purchase dental insurance my own?
It’s easy to buy dental insurance on your own. With just a few clicks you can a buy a dental insurance policy for just yourself or for you and your family. If you buy a dental insurance policy from Guardian Direct® there’s no waiting period for preventative services. Depending on your payment method, your policy is active on the first of the next month and you can start getting routine care right away.
Guardian Direct® makes it easy to understand what care each insurance plan covers. With Guardian Direct® you can buy directly from the insurance provider. You can choose a plan for yourself that fits your needs and enroll in minutes.
Guardian Direct® offers three simple insurance plans that you can choose from. All Guardian Direct® plans have no waiting period for preventative care. You can choose any dentist you want to see, but you will save money when you see a network dentist with whom your insurance has negotiated preferred rates¹.
If you’re concerned about keeping premium costs low and you don’t expect that you’ll need more than routine care you can select the entry-tier plan (not available in every state). The entry-tier plan subject to applicable annual maximums, covers preventative care like X-rays and cleanings at 100% when you see a network dentist. Fillings are covered at up to 50% on this plan. But, more advanced procedures like root canals aren’t covered so you will be responsible for the full cost of those services².
If you want a little more coverage but don’t think you’ll need major services like orthodontics then the mid-tier plan is a good moderate choice. On the mid-tier plan all cleanings and X-rays are covered up to 80%, so you will only have to pay 20% out of pocket of the cost of those services. Fillings, root canals, and crowns are covered up to 50% which means you will have to pay 50% out of pocket of the cost of those services. If you haven’t seen the dentist in awhile and you know that you’re going to need some work on your teeth the Guardian Direct® mid-tier plan may be a good option for you.
The top-tier plan is the most attractive option for people who don’t want to have to worry about what services are covered by their dental insurance or people who know they or their families will need services like root canals, crowns, implants, or orthodontic care (available for covered children under 19 years of age). When you buy the Guardian Direct® top-tier plan preventative care and X-rays are covered 100%. Subject to a 6-month waiting period, fillings and extraction will be covered up to 70% . The top-tier plan also covers implants up to 50% and will pay for up to 50% of covered child braces up to plan maximums.
With those clear options it’s easy to pick a Guardian Direct® dental insurance plan because you can prioritize the services that are important to you.
Is it cheaper to pay out of pocket for dental?
People who are trying cut their monthly expenses might think they can save money by not getting dental insurance, skipping preventative care, and just paying for dental care out of pocket when they can’t put it off. That’s a big mistake. Paying for dental care out of pocket can become very expensive very quickly.
If you’re not getting the routine care that you should be getting like dental exams and cleanings your dentist won’t be able to spot and stop potential problems in a timely manner. A routine cleaning can show the dentist where you might soon need a filling so the dentist can give you a filling before the cavity gets so bad that you need an expensive root canal. And getting regular cleanings is essential to prevent cavities and other dental problems.
What dental insurance pays for implants?
Implants are a common procedure to replace missing teeth. You may need a bone graft in order to create a base for the implant before the dentist can even put the implant in. According to one study by the age of 50 most people have lost 12 teeth³, which means that most people are going to need at least one and possibly several implants in their lives. The cost of a single implant is usually thousands of dollars, which you will likely have to pay out of pocket without dental insurance⁴. If you have good dental insurance you will only have to pay a fraction of the cost of an implant. Guardian Direct® dental insurance will pay up to 50% of the cost of implants if you choose an entry or mid-tier dental insurance plan that covers implants after a 12-months waiting period.
What does basic dental insurance cover?
Basic dental care means preventative regular care such as dental exams, fillings, and other care that is designed to help keep your teeth and gums healthy. Exams are usually considered to be basic care. For children getting things like fluoride treatments is basic care because it helps their teeth grow strong and healthy, especially in areas where there isn’t fluoridated water. Guardian Direct® insurance plans cover cleanings and basic care at different rates depending on what plan you choose but all plans have no waiting period for preventative care.
Do dentists make you pay upfront?
If you are paying for dental care out of pocket, then typically most dentists may require that you pay for the services at the time of service. If you have dental insurance usually you only have to pay for your standard co-pay at the time of the visit and the dentist will bill the insurance company for you. Then you will get a bill for what’s left to be paid after the insurance company has paid their portion.
Can you negotiate price with the dentist & other Insights
Sometimes you can negotiate the cost of dental care with a dentist, or your insurance company can negotiate preferred in network rates for your plan. Network dentists who get benefits from being part of an insurance company’s network are usually open to negotiation because of the benefits that come with being in that network. When you’re picking a dental insurance plan it helps to know the difference between DHMOs and PPOs which you can learn about here. You can also look for tips on buying dental insurance to make sure you’re choosing the plan that is best for your needs. Guardian Direct® has a full library of resources to help you make informed decisions when it comes to your dental health and dental insurance.
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.bostonmagazine.com/sponsor-content/did-you-know-that-by-age-50-americans-have-lost-an-average-of-12-teeth/, accessed April 2021
https://www.guardiandirect.com/dental-insurance/does-dental-cover-dental-implants, 2020, accessed April 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.10/23)