Furthermore, the majority of plans often offer exams and cleanings at no additional cost to members, which eliminates the primary reason given by Guardian study for not visiting the dentist: perceived cost. But how do you choose the plan that offers the best value when there are so many options available, regardless of whether you’re purchasing on your own or receiving dental coverage through your job?
You will gain a better understanding of:
The many kinds of plans and how they operate
All of the expenses you should budget for
How best to purchase a dental plan
FAQs regarding the expenses of dental insurance
The many kinds of dental insurance policies and how they operate
It should come as no surprise that dental insurance is similar to health insurance given how closely dental health and overall health are related: In exchange for a monthly premium, the insurance provider assists you in covering the cost of necessary medical care. Additional parallels consist of:
The majority of dental plans provide a provider network.
You must pay a deductible before the plan will cover any medical expenses.
Many procedures include a copay (fixed price) or coinsurance (a percentage of the dentist’s charge) that you pay for in part.
The following are some ways that dental insurance and health insurance are different:
Checkups, cleanings, and x-rays are examples of common preventative treatments that are typically 100% covered with no out-of-pocket expenses.
Compared to a medical plan, the deductible is far smaller, at about $50 for an individual and $150 for a family.
The majority of dental plans set a $1,000–$2,000 annual maximum for each member’s maximum payment for care.
Plans may apply waiting periods prior to covering non-preventive procedures.
Plans come in two main varieties: DPPOs and DHMOs.
Dental Preferred Provider Organization is what DPPO stands for. The dentist network for both plans is quite vast (Guardian’s network has over 120,000 providers in 400,000 sites countrywide). Although you have the option to visit an out-of-network dentist, it is preferable to remain in-network: There is no claim form to fill out, and you receive large savings that reduce your out-of-pocket expenses. Even if you haven’t yet reached your deductible, if your dentist is in-network, you might only pay $60–$70 for a filling instead of the usual $100.
A good way to compare DPPO plans is to look at their coverage formula. For example, a 100/80/50 plan offers better benefits than an 80/60/40 plan because it covers preventive care at 100%, basic procedures (like extractions and fillings) at 80%, and major procedures (like crowns, bridges, and root canals) at 50%.
Dental HMOs (DHMOs) typically offer less freedom along with cheaper premiums. It’s possible that you won’t be able to see your existing dentist because the provider network may be extremely small and you must remain in-network for covered services. The benefit is that there are no maximums or deductibles; nonetheless, the majority of non-preventive procedures have copayments.
Plans for indemnity and discounts
There are two further types of plans available to you: Any dentist can be seen under an indemnity plan, and you will often receive reimbursement for between 50% and 80% of what the insurance deems to be “reasonable and customary” costs. Many times, preventive care is fully covered. These plans are typically more expensive, more difficult to locate, and need more paperwork because you must pay the dentist in full before filing a claim.
Discount plans are more akin to warehouse clubs than they are to insurance. After paying an annual fee, you receive a card that allows you to receive discounts from dentists that are members. You will always have to pay cash for your dental visits with these plans, however the savings vary based on the procedure. It’s challenging to generalize about what your true dental care costs with a discount plan would be given the variety of plans and discount schemes.
How much each type of plan will cost you
For every type of plan, the typical monthly premiums are:
DHMO: $22.75
$62.75 PPO
$81.50 is the indemnity.
Several factors influence the premium amount, such as the plan type, insurer, and coverage level; monthly expenses for DPPO and DHMO plans vary from $12 to $50 per person1. A thorough DPPO will be on the top end of that spectrum, and DHMOs will often be on the lower end. The premiums for indemnity plans are more expensive—up to twice as much as those for DPPO plans.