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If you’re looking to have more control over your dental insurance benefits and out-of-pocket dental expenses, you may want to enroll in a personal dental insurance plan. Personal dental insurance is also known as individual dental insurance.
If you’re ready to buy your own dental insurance plan but don’t know where to start, here are four typical steps you can take to get a personal dental insurance policy that will help keep you and your family healthy.
Determine who in your family will need coverage. Is it just yourself, or do your spouse or partner and dependent child (typically 26 years old or under) need coverage too?
If you already have a medical insurance plan through your employer, your spouse’s employer, or purchased on a state or federal exchange, dental may be included in your benefits.
However, you can also purchase your own personal dental insurance separate from medical insurance if your current plan is less than comprehensive or if your medical insurance doesn’t include dental coverage.
Under the Affordable Care Act (ACA), pediatric dental benefits must be included in or offered as standalone plans as part of the ACA’s “essential health benefits” (EHBs) for children under 18, though not for adults¹.
If you’re on Medicaid, states have the flexibility to determine which dental benefits are provided to adult enrollees. While most states provide at least emergency dental services for adults, less than half of the states currently provide comprehensive dental coverage.² States are required to provide dental benefits to children covered by Medicaid and the Children’s Health Insurance Program (CHIP).
Some dental plans don’t typically cover “pre-existing conditions.”³ Pre-existing conditions are usually major issues such as deep fillings that typically require crowns.
Replacing a missing tooth could be considered a pre-existing condition if your tooth was lost or extracted before you joined your dental insurance plan. Your plan may also not cover the replacement of crowns, bridges, and dentures.
When shopping for dental insurance plans, find out what each carrier considers a pre-existing condition, and determine if the out-of-pocket expenses to cover these conditions will fit into your budget. If not, you may want to keep shopping for a plan that will help cover these costs.
A big factor in choosing the right personal dental insurance plan that works for your needs, will typically depend on how much you want to pay out-of-pocket. This includes common factors such as monthly premiums, deductibles, co-pays, expenses beyond your plan’s annual limit, and any services that may fall outside of your plan’s coverage.
Typically, there are three popular types of dental insurance plans, each with different out-of-pocket rates and coverage options:⁴
Dental Health Maintenance Organization (DHMO)
Dental Preferred Provider Organization (DPPO)
Dental Indemnity Insurance
Limited to which in network dentists you can see and receive coverage
Typically, low premiums of all dental insurance plans
Typically, does not require a deductible
Rarely have an annual maximum
No limit on dental services you can typically have in a year
Typically pays the most for services you receive from dentists on your plan’s network
Typically pays less for services you receive from dentists outside your plan’s network
Typically has higher premiums and higher deductibles than DHMOs
Typically, may limit the maximum amount your plan will pay for your dental services each year
Dental indemnity insurance⁵
Typically allows you to go to any dentist and receive coverage
Typically have the highest premiums of any dental insurance plan
Typically requires deductibles and co-payments like DPPOs
After insurance pays the claim, you pay a bill for any remaining balance
With each of these plans, it is important to consider your insurance carrier’s network size. Guardian Direct® has a network of over 100,000 dental professionals ready to help meet your oral health needs. Having a large network allows you more flexibility when choosing a dentist that you trust.
Regardless of which plan fits you and your family, it is important to know that staying in-network will help save you money and time. With a Guardian Direct plan, there are no claim forms to submit when you use an in-network dentist, your provider will do this for you.
Don’t wait to shop for your dental insurance plan until you have a dental emergency, as many dental plans typically have a waiting period between six and 12 months before you can receive coverage for basic and major procedures, such as fillings and root canals. Find out what is excluded during your dental plan’s waiting period and plan accordingly.
Dental care is an essential part of maintaining your overall health. Some people think that the only way to get good dental coverage is through an employee sponsored plan. However, this is not entirely true. Quality dental coverage is available to everyone through Guardian Direct.
Anyone in your family who is over 18 has the ability to purchase their own comprehensive coverage through Guardian Direct. Depending on the plan, each family member is also able to choose their own dentist, so you can pick a dentist who is close to home and a dentist that you trust.
In the traditional insurance market, if you needed to buy insurance through a carrier your journey typically began by calling an agent. Now, you can purchase dental insurance online, allowing you to see the costs yourself directly from the available companies, saving you time. You also have more flexibility to choose different plans by seeing all that a company has to offer firsthand.
When you are looking for a new dental insurance plan you want to keep flexibility in mind. Your own personal situation, both budgetary needs, and dental health needs, should guide your decision making.
Guardian Direct has three plans to choose from Gold, Silver, and Bronze. All of these plans have no waiting period for preventive care, though basic and major coverage plans usually involve a six to 12 month waiting period due to the complexity of the procedures involved. Guardian Direct also offers access to over 100,000 dentists.
You may be tempted to forgo dental insurance and just pay for dental needs out of pocket as needed. This strategy can be more expensive in the long term and may lead to oral health issues down the road.
With the price for a routine cleaning and exam hovering around $200⁶, people without insurance may not go to the dentist unless a painful problem arises. By the time an issue is causing pain in your mouth, it can be expensive to fix and may even lead to permanent damage. Due to the typically high cost of fixing these issues people often put them off even longer causing more pain and even more expenses.
Your in-network dentist may charge you less than someone without insurance. Many dental insurance providers have negotiated discounted prices with in-network dentists across the country. If you visit an in-network dentist, you also may not have to submit claim forms.
Get more answers to your dental insurance questions, as well as useful insurance information, tips, and resources.
What does dental insurance cover?
Why visit an in-network dentist?
What’s the difference between dental insurance and dental discount plans?
The pros and cons of DPPO and DHMO plans
How to buy dental insurance
Why some dental insurance plans have no waiting periods
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 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.
https://www.medicaid.gov/medicaid/benefits/dental/index.html, accessed January 2021
https://www.colgate.com/en-us/oral-health/adult-oral-care/is-indemnity-dentalinsurance-right-for-you, accessed January 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.01/23)
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