What is dental insurance?

Dental insurance is a type of supplemental health insurance that can help patients save on the cost of dental care. It is separate from medical insurance, though some employers may offer benefit packages that include both medical and dental insurance benefits¹.

Dental insurance offers benefits that help pay for the cost of visits to a dentist for a range of dental services, from routine preventive care to dental surgery. Dental insurance providers typically negotiate rates with a network of dentists, further reducing the cost of dental services. While certain types of dental insurance plans may pay out benefits no matter what dental provider you visit, you’ll typically save the most money off standard dental insurance rates by visiting a dentist in your insurance provider’s network.

Many dental insurance plans cover all or a portion of the cost of two preventive care visits a year, including routine cleanings, exams, X-rays, topical fluoride, and sealants. Dental insurance may also cover a percentage of the costs of basic and major procedures like fillings, extractions, crowns, and root canals, thereby lowering your out-of-pocket costs. The exact coverage you receive from your dental insurance plan will also be subject to waiting periods and annual maximums, which may vary depending on the type of dental procedure.

Enrolling in dental insurance is a rather straightforward process, no matter your situation. You can obtain dental insurance through an employer as part of your workplace benefits package, through an insurance broker, through the Affordable Care Act (ACA) marketplace, or directly from an individual dental insurance company online such as Guardian Direct® Dental Insurance.

Guardian Direct® offers three dental insurance plans, all of which feature no waiting periods on preventative services and a large network of 100,000+ dental providers.

Dental Health Insurance

It's might be confusing to distinguish between dental insurance and health insurance. Both dental insurance and health or medical insurance help you with the cost of caring for your overall health. However, these types of insurance are two separate coverages that rarely overlap.

Health insurance is a contract that requires your health insurer to pay some, or all of your health care costs in exchange for a premium². It covers medical expenses for illnesses, injuries, and conditions. Under ACA, health insurance must cover 10 categories of essential health benefits, including emergency services, prescription drugs, hospitalization, and more³. However, while pediatric services including oral and vision care are deemed essential health benefits, adult dental coverage does not qualify as an essential health benefit⁴. Most health insurance does not include coverage for adult oral care, including Medicare. Original Medicare does not cover most dental care, dental procedures, or supplies, though some Medicare Advantage Plans may be bundled to include certain dental benefits⁵.

Dental insurance exists to help fill the gap in coverage too often left by health insurance alone. Oral health is essential for overall health – yet oral diseases, from cavities to oral cancer, may cause significant pain, discomfort, and disability for many individuals⁶. Dental insurance can help pay for the costs of treating and preventing oral disease and maintaining oral health.

Medical dental coverage

Occasionally, the line between medical care and dental insurance is a bit blurred. Medical insurance will often pay for a procedure if it’s a necessary treatment for a diagnosed medical condition – even if the procedure is performed by a dentist in a dental office⁷.

There are four main categories of billable dental procedures that may be billable as medical procedures⁸:

• Diagnostic procedures – Procedures used to diagnose a recognized medical condition, such as x-rays performed to identify the source of pain or the location of impacted teeth
  
  

• Non-surgical medical treatments – Treatment linked to a diagnosed medical condition covered by the medical insurance policy, such as drainage of abscesses or emergency treatments for infection
  
  

• Surgical treatments – Medically necessary surgery, such as the removal of impacted teeth or biopsies
  
  

• Treatment for traumatic injuries – Emergency or restorative treatment for injuries that affect the original look and function of the mouth if the injury is covered by medical insurance. (Note that if the injury is covered by liability insurance, you may want to check first whether you need to bill that insurance before billing medical insurance)

Typically when dental treatment is medically necessary, it may be covered by medical insurance.

How Do I Purchase Dental Insurance?

If your employer does not provide dental insurance benefits or you’re dissatisfied with the level of coverage, you can still purchase affordable dental insurance policy to help pay for dental care. You can purchase dental insurance online with Guardian Direct with instant approval and guaranteed acceptance.

First, request a dental insurance quote here. Since the price of dental insurance varies depending on your location, the ages of people that need coverage, among other factors, requesting a quote is an effective way to figure out exactly how much you’ll pay in premiums in exchange for coverage.

To get a Guardian Direct quote, you’ll just need to provide the following information:

• Your name

• Your address

• Your email

• Your age

• The age of any dependents who also need coverage under your plan

• Basic info about your dental needs and preferences

Once you’ve submitted that information, you’ll be able to review all of the Guardian Direct dental insurance plans available to you. Choosing the right dental insurance plan options for you depends on a variety of factors, including how much you can afford to pay each month, what procedures you may need over the next two to three years, when you’re planning on having dental work done, and whether you’d like to keep your current dentist.

• Guardian Direct top-tier plan was designed for people who visit the dentist frequently and are thinking about more complex dental work. The top-tier plan covers preventative care at 100% with no waiting period, basic care up to 70% after a 6-month waiting period, and major care and orthodontics for children under the age of 19 up to 50% after a 12-month waiting period or less in some states, subject to annual maximums.
  
  

• Guardian Direct mid-tier plan was designed for people who visit the dentist a couple of times a year and are thinking about basic dental work. mid-tier plans cover preventative care up to 80% with no waiting period, basic care up to 50% after a 6-month waiting period, and major care up to 50% after a 12-month waiting period or less in some states, subject to annual maximums.
  

• Guardian Direct Entry-Tier plan was designed for people who visit the dentist primarily for checkups and cleanings and are looking for our most affordable coverage. This plan covers preventative care at 100% with no waiting period and basic care up to 50% after a 6-month waiting period, subject to annual maximums. (This plan is not available in all states.)

While you can include multiple dependents under the same plan, each family member will still have the freedom to choose their own dentist and still receive coverage. Costs vary by state and available plan type selected.

What if you don’t have dental insurance?

You can still receive dental treatment if you don’t have dental insurance, but you’ll be responsible to pay the entire cost of dental treatment out-of-pocket rather than having a percentage of the cost covered by your dental insurance plan.

Note that some dental providers may not take patients without dental insurance. If you don’t have dental insurance and require treatment, be sure to check with your dentist in advance to make sure you’ll be able to receive treatment and discuss possible financing options.

Of course, if you don’t currently have dental insurance, it isn’t too late to change that. You can enroll in a plan with Guardian Direct and start using benefits for preventative care on your plan effective date.* Just be sure you’re aware of any applicable waiting periods that may come into play if you seek immediate care.

What to do if dental insurance won’t pay

Dental insurance does not pay for every dental treatment. If your dental insurance has refused to pay for a particular treatment, it could be because that treatment isn’t covered by your policy or a few other common reasons. Here are a few common reasons your dental insurance may not pay:

• You’ve received cosmetic treatment. Cosmetic dental treatment is typically not covered by dental insurance in any capacity.

• You’ve visited an out-of-network provider and you have a DHMO dental insurance plan.

• You haven’t yet met your deductible.

• You’ve already exhausted your annual maximum.

• You’ve received treatment before the applicable waiting period has ended.

Of course, there are many other reasons your claim could be denied – be sure to review your policy carefully to find out what is and isn’t covered by your insurance company.

If you find yourself in a situation where your dental insurance won’t pay, you may want to discuss financing options or long-term payment plans with your dental provider. You also may want to consider switching dental insurance plans so something similar doesn’t happen again!

If you still have questions about why a certain claim was rejected, reach out to your insurance provider’s customer service to find out why.

What dental insurance do I have & related insights

There’s a chance you may have dental insurance without knowing it. Maybe your full-time employer provides it and you forgot you opted in a few months ago, or perhaps you are covered by your spouse’s group plan as a dependent. Check with your benefits department to find out what type of dental benefits are offered (if any) and whether you are currently enrolled in a plan.

If you don’t currently have dental insurance provided through a group plan and you haven’t purchased an individual dental insurance policy, you likely do not have any dental insurance. Should any serious oral health complications arise, you could be saddled with an expensive dentist’s bill you’re responsible to pay entirely. Consider getting private dental insurance coverage to help pay for the cost of routine and emergency dental care.

We’ve compiled a list of resources to help you learn more about dental insurance including:

• How Does Dental Insurance Work?

• Dental PPO Plans

• How to Get Dental Insurance

• Individual Dental Insurance