Dental insurance cost: How to compare different plans
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The rationale for having dental insurance is strong: The National Association of Dental Plans (NADP) says Americans with dental benefits are more likely to go to the dentist, take their children to the dentist, and experience greater overall health. The challenge is selecting a dental insurance plan to manage dental care costs effectively.
Need dental insurance?
What’s more, checkups and cleanings are usually covered with no additional cost to members with most plans, eliminating the number 1 reason cited by Guardian research for skipping dental visits: perceived cost. But with so many plans, whether buying as an individual or getting dental benefits at work, how do you find the plan that provides the most value?
This article will help you better understand:
The different types of plans and how they work
All the costs you can expect to pay
The best ways to buy a dental plan
FAQs about dental insurance costs
The different types of dental insurance plans and how they work
With dental health so closely related to your general health, dental insurance is unsurprisingly a lot like health insurance: The insurance company charges a monthly premium, and in return, they help you pay for needed care. Other similarities include:
Most dental plans have a network of providers
There’s a deductible you pay before the plan pays for treatment
You pay for a portion of many procedures via copays (flat fees) or coinsurance (a percentage of the dentist’s charge)
Different dental insurance policies provide varying levels of coverage for preventive, basic, and major services.
Dental insurance differs from health insurance in the following ways:
Common preventive treatments — checkups, cleanings, and x-rays — are usually covered at 100% without out-of-pocket charges.
The deductible is much lower than a medical plan — around $50 for an individual and $150 for a family.
Most dental plans cap the maximum amount they will pay for care at $1,000-$2,000 per member per year.
There may be waiting periods applied before plans will cover non-preventive procedures.
The two most common types of plans are DPPOs and DHMOs
DPPO stands for Dental Preferred Provider Organization, commonly referred to as a dental PPO. These plans have a relatively large network of dentists (Guardian’s network has over 120,000 providers in 400,000 locations nationwide). While you can also see an out of network dentist, it’s worth your while to stay in-network: You don’t need to submit a claim, and you get significant discounts which lower out-of-pocket costs. If your dentist typically charges $100 for a filling, when they are in-network, you may only be charged $60-$70 – even if you haven’t met your deductible yet.
A good way to compare DPPO plans is by looking at their coverage formula: a 100/80/50 plan covers preventive care at 100%; basic procedures (e.g., fillings, extractions) at 80%; and major procedures like crowns, bridges, and root canals at 50% – so it offers better benefits than, say an 80/60/40 plan.
Dental HMOs ( DHMOs ), also known as dental HMO plans, tend to have lower premiums but less flexibility. The provider network may be very limited, and you have to stay in-network for covered care so you may not get to see your current dentist. The upside is that there are no deductibles or maximums, but there are copayments for most non-preventive procedures.
Indemnity and discount plans you can get two other kinds of plans:
Indemnity plans let you see any dentist and reimburse a portion of your expenses – usually between 50% and 80% of what the insurance considers to be “reasonable and customary.” Preventive care is often covered in full. These plans tend to cost more and are harder to find; there’s also more paperwork because you pay the dentist upfront before submitting a claim.
Discount plans, also called a dental savings plan, aren’t insurance at all – they’re more like a warehouse club. You pay an annual fee, and you’re given a card that entitles you to reduced prices at participating dentists. The discounts vary depending on the procedure – but with these plans, you will pay out-of-pocket every time you see a dentist. Given the wide range of plans and discount structures, it isn’t easy to generalize what your actual dental care costs would be with a discount plan.
What you can expect to pay for each type of plan
The average monthly premiums for each plan type are:
DHMO: $191
PPO: $271
Indemnity: $371
The premium amount is affected by many factors: type of plan, dental insurance company, and coverage level, among other things; the average monthly costs range from $20 to $50 per person.1 DHMOs will tend to be on the lower end of that range, and a comprehensive DPPO will be on the upper end. Indemnity plan premiums are higher, as much as twice the the cost of a DPPO plan.
How to go about buying a dental plan
Start by choosing the type of plan that best meets your needs: Indemnity plans may work for you if you have recurring, costly dental issues – and want freedom to see any licensed dentist. Otherwise, a top-tier DPPO plan with a broad provider network may be the right choice: Your current dentist may already be part of the network, and your overall in-network costs will likely be lower than with an indemnity plan. A DHMO with a limited network may be a good choice if you’re on a tight budget. On the other hand, if you primarily need preventive care and dentist choice is important, a DPPO could be an economical compromise.
If possible, get dental coverage through work: Employers get lower group rates because they buy for many employees at once. Also, group dental plans often cover more services, and the company may pay a portion of the costs, making it an even better value. If that’s not an option, see if you can get a group plan through a professional association or other membership groups.
Individual dental insurance is also available – and affordable: Many providers, such as Guardian, let you compare, get a quote, and buy plans conveniently online.