You will also want to consider what procedures you may need in the near future, including filings and braces while also covering any costly or unexpected dental expenses that could come up, such as the need for crowns or implants.
Who needs individual dental insurance?
While everyone can benefit from dental insurance, not everyone needs to purchase dental insurance on their own. Many individuals receive dental insurance benefits from their employer. Though employers aren’t legally required to offer dental insurance in the United States, nearly 60% of Americans enjoy dental insurance benefits from an employer or other group program.¹
However, if you are self-employed, retired, or unemployed, you likely don’t have dental insurance provided by a group program. Many older Americans also don’t have dental insurance since traditional Medicare does not cover dental care. If dental insurance isn’t provided by your employer, or if your employer-provided benefits don’t meet your needs, consider purchasing individual dental insurance directly from an insurance provider.
What is individual dental insurance?
Individual dental insurance is dental coverage that can be purchased directly from a dental insurance provider or on the ACA marketplace. People often purchase individual dental insurance directly from insurance companies to enroll in policies without using a broker or another intermediary. Unlike employer-sponsored plans, individual dental insurance lets you compare various plans and choose the one that best suits your individual needs and budget.
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 maintain your oral health. Dental insurance covers the cost of regular dental care while also 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 keep their teeth and gums healthy.² 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.³
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.⁴ 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.
Questions to ask yourself before choosing a dental insurance plan
There’s a lot you should consider when choosing which dental insurance plan is right for you. Before you make your decision, ask yourself these key questions:
How much am I willing to pay out-of-pocket? Determining your budget will help you choose which type of plan to purchase. (Remember, out-of-pocket costs include factors such as monthly premiums, co-pays, deductibles, expenses beyond your plan’s yearly limit, and any services which may fall outside your plan’s coverage.)
What are my current needs? What might my needs be over the next two to three years? Higher tier plans may come with increased monthly costs but they may provide more coverage for major procedures, which can be helpful is your child will soon need braces or a dental implant is in your future.
Who needs coverage? If you’re buying dental insurance as an individual, you’ll likely be the only person who needs coverage – but if you have a spouse or any dependent children, you’ll want to make sure they’re covered under your family policy as well.
Is keeping my current dentist important to me? If so, you’ll likely want to choose a DPPO plan with a larger network of dentists.
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 have lower out-of-pocket costs but you must pick a primary dentist and get 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. In order 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 key differences between the two types of plans:
Lower out-of-pocket costs
No annual maximum
You must 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
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
Dental insurance vs. dental discount savings plans
Dental insurance and dental discount savings plans both allow you to access the dental care you need while saving money, but they differ in fees, coverage, waiting periods, network of dentists, and overall costs. Monthly premiums for dental insurance plans are often higher than discount dental plan annual fees, but they usually offer more savings per procedure.
Dental discount savings plans:
Involve an annual fee to join the discount plan
Require you to pay the dentist directly the entire cost of services provided at a discounted rate of 10% to 60% of the normal cost⁵
Have no waiting periods
Usually have smaller networks of dentists
Dental insurance plans:
Involve a monthly premium
May cover preventive care at 80% to 100%, basic procedures at 50% to 70%, and major services at 50%
Often have waiting periods for non-preventative care
Often allow you to choose from thousands of dentists the network
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.
Easy to use - If you’ve ever filed an insurance claim before, you know how much paperwork that can require. Look for a dental insurance company that is easy to work with
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 fall into which category, since 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.
Payment flexibility - Look for a provider who offers flexible payment plans and multiple secure payment options, especially if you’re on a tight budget.
Red flags when choosing individual dental insurance
Tons of paperwork - If you already have to fill out loads of paperwork just to get a dental insurance quote, that’s not a good sign. Look for an insurance provider that values your time and is efficient enough to only require minimal work on your end.
Bad reviews - No matter how nice an insurance provider’s promises may sound, a pattern of bad reviews is cause for concern. Seek out testimonials from current or past policyholders.
Small network of dentists - You could find a great deal on dental insurance – but if the closest dentist that accepts that plan is over 100 miles away, it may not be worth it.
Guardian Direct offers affordable DPPO and DHMO individual dental insurance plans in most states. Click here to learn more about Guardian Direct individual dental insurance.
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.
https://www.mouthhealthy.org/en/dental-care-concerns/questions-about-going-to-the-dentist (Last accessed May 2020)
https://www.dentalplans.com (Last accessed May 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.05/22)