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6 ways to get the most out of your dental insurance policy

Get the most out of your dental plan by finding a dentist, scheduling cleanings, and visiting your member center.

8 minute read

If you’ve just purchased a dental insurance plan, congratulations you have taken the first steps in a series of choices that should benefit not just your teeth and gums, but your overall health because problems in your mouth can affect the rest of your body. People without dental benefits are more likely to have extractions and dentures and less likely to have restorative care or receive treatment for gum disease.1 Now that you've got a policy, you’ll want to get the most out of your benefits with the suggestions below.

1. Find a dentist

If your dentist is no longer in your network or you’re in a new location, starting a new policy is a good time to find a new dentist. Don't hesitate to read reviews, and most importantly, ask if they take your insurance. Generally, dental insurance carriers also have an approved list of in-network providers that you can go back to when you first acquire the policy. If you do not pay attention to the providers your carrier presents and choose to visit a dentist who may or may not take your insurance, you risk having to pay more out of pocket.

2. Schedule an appointment 

Now is a great time to schedule your regular exams and cleanings with your dentist. Most dental insurance plans cover preventive care from 80 to 100% so shouldn’t have to pay many out-of-pocket costs. Regular dental visits can help you prevent dental disease and check for signs of other problems. If you do have any signs of gum disease, your dentist can stop tooth decay from getting worse. If you’re missing any areas of your teeth while brushing, your dentist will clean your teeth and remove any surface stains and tartar buildup. 

3. Get coverage for the whole family

One of the most effective ways to take advantage of your dental insurance policy is cover your entire family. Family dental insurance keeps the whole family covered and allows you to save more money because it’s often less expensive to add dependents to your policy than have separate policies. You won't have to worry about anyone missing out on coverage, should a dental emergency arise and you don’t all have to use the same dentist. 

Bonus tip: Inquire about whether orthodontic insurance is included in your policy. This is a significant advantage, as someone in the family may need to get braces at some point.

4. Log into your member portal

Once you enroll with Guardian Direct, you will have 24/7 access to an online member portal to download ID cards, check your policy, manage payments, view claims, update information, send and receive messages, and find a dentist. If you prefer to speak with a live person, you can contact Guardian’s call center via phone or chat Monday to Friday from 6 a.m. to 6 p.m. eastern time.

5. Review your coverage 

It is important that you understand the limitations and coverage you have. You should research any additional exclusions and limitations, and most importantly, talk to your preferred dentist and ask what plans they accept, to make sure you are getting significant coverage with each visit.

6. Plan for pre-treatment and emergencies 

It may seem like a rule of thumb to plan to be on the safe side. However, many of us think that with coverage, we are always protected in case of an emergency or the sudden need for a treatment that we did not even think about beforehand. If you might need an extensive dental procedure soon, like a root canal or implant, review your policy to ensure it provides the coverage you need or upgrade to a plan that has more comprehensive coverage. Review any required waiting periods and start planning care around them now so you can take full advantage of your policy.

Find a dental insurance plan that works for you

If you are still shopping for dental insurance, the dental insurance plan that works for you will likely be one that fits your needs and budget. You will also want to consider what procedures you may need over the next two to three years, including filings and braces while also covering any costly or unexpected dental expenses that could come up, such as the need for crowns and implants. Higher tier plans provide more coverage for major procedures, allowing you to save money in the long run, but they may come with some increased monthly costs. 

There are two main types of dental plans: DHMOs and DPPOs. From co-pays to annual maximums to your provider network, each plan offers its own advantages and disadvantages for cost and coverage options to suit your needs.

DHMOs

A DHMO, also known as Dental Health Maintenance Organization plan, has the following pros:

  • Lower out-of-pocket costs 
  • Discounted dental services if participants receive services from a dentist inside of the DHMO network
  • Often no annual maximum regarding which dental services you can be covered for in a year.

While there are some fantastic perks to having a DHMO plan, there are also some cons. Some of the drawbacks of having a DHMO plan includes:

  • You must choose a primary dentist and you’ll need a referral to see specialists 
  • A smaller selection of providers that accept this coverage
  • Some people have trouble finding a dentist near them or one that meets their dental needs due to the smaller network

DPPOs

DPPO plans, also known as, Dental Preferred Provider Organization plans, offer the following advantages:

  • You can visit almost any dentist and still receive full or partial coverage for your services
  • No referrals needed, which means you don’t have to choose a primary dentist or get a referral from your primary dentist to see a specialist 
  • DPPOs often have larger networks of dentists

DPPO plans allow people greater flexibility. If you’re someone that moves a lot or if you live in a big city and want to explore your options, this may be a better plan. However, some people might find the following to be cons: 

  • You are required to pay an annual deductible for standard dental services. Once the deductible is met, then your DPPO plan will cover your dental costs. 
  • If your dentist is outside the network, a DPPO plan will likely pay less for the services you receive.
  • There may be a limit to the amount of coverage your DPPO plan will provide in a year. Once the annual maximum is reached, you’ll have to pay for the rest of your dental services, but fortunately, at a discounted rate. 

Regardless of which plan you choose, it will help make caring for your teeth and gums more affordable so go ahead and schedule an appointment for your regular exam, cleaning, and X-rays.  And know you are also prepared for more extensive procedures, should the need arise. 

 

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

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.
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