Choosing the right dental insurance for you
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Wondering how to choose dental insurance? If you’re shopping for a family or individual dental plan, you want to ensure you get the best dental coverage possible at a reasonable price. But you also want to make sure you choose a plan that covers your specific dental care needs, while letting you see an in-network dentist you’ll like.
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This article will help you find the best dental insurance for you by providing:
How does dental insurance work?
Like health insurance, dental insurance plans charge you a monthly premium. In return, the plan helps you pay for needed care. There are other similarities to a health insurance plan, as well:
Most dental plans have a network of dentists
There’s a deductible — an amount you pay out of pocket before the plan pays for treatment
You pay for a portion of many procedures via co-pays (flat fees) or co-insurance (a percentage of the dentist’s charge)
There are also some important differences. The most common dental treatments — preventive care and dental cleanings — are usually covered with no out-of-pocket costs. Basic and major services, on the other hand, typically have higher out-of-pocket costs and waiting periods: When you buy dental insurance, you usually aren't immediately covered for major dental work — there's a period of a few months to a year before the plan will pay (although you can typically schedule preventive treatments as soon as you have coverage).
The annual deductible is usually very low compared to a medical plan — typically around $25 to $100 per person annually. Also, most plans have an "annual maximum," the maximum total amount they will pay for care in a given year. A typical annual maximum is $1,000-$2,000 per plan member per year. Any dental expenses over your plan’s cap (or maximum) will be your responsibility.
Types of dental insurance plans
Dental coverage varies by plan and dental insurance company. This table covers some of the most common plan types and how dental benefits work for each.
Dental Preferred Provider Organization (DPPO) | Dental Health Maintenance Organization (DHMO) | Indemnity Plans |
|---|---|---|
Has a network of preferred dentists Insurer negotiates lower rates with preferred dental providers, lowering your costs Typically lets you go outof-network too, although coverage details may vary (and it’s typically more expensive to go out-ofnetwork) | Has specific contracted dentists that are pre-paid for each patient assigned to that dentist Typically has no out-ofnetwork coverage; you must use contracted dentists | May let you see any provider, but typically only pays a certain percentage of the charges billed Functions similarly to traditional medical insurance Typically have higher monthly premiums than DPPOs and DHMOs Hard to find |
What does dental insurance cover?
Basic plans tend to cover preventive care, and more comprehensive plans will cover more types of procedures and treatments. However, out-of-pocket costs vary by plan and provider, so check plan details. Additionally, major procedures usually have a waiting period before they are covered.
Preventive services | Basic procedures | Major procedures |
|---|---|---|
Routine exams and cleanings (2 per year is typical) Bitewing X-rays (1 per year is typical) Full mouth X-rays, if needed Preventive services typically have no waiting period, meaning you can be covered for preventive care as soon as you get insurance. | Dental fillings Emergency care Simple extractions Basic oral surgery Non-surgical periodontal services Fluoride treatments Basic procedures may require a waiting period for some plans. This means when you first sign up for dental insurance, it may not cover these services right away. | Crowns, bridges, inlays, onlays, dental implants, etc. Endodontics Major oral surgery Anesthesia Major restorative services Major dental care typically requires a waiting period on most plans. When you first sign up for dental insurance, coverage for major procedures typically won’t kick in for 6-12+ months. |
Dental coverage amounts differ for various dental services
Dental plans also offer different dental benefits for multiple types of procedures. Many family or individual dental plans have a dental coverage “formula," such as “100/70/50.” That means it covers:
Preventive care — checkups and cleanings — at 100% (you typically don’t even pay a deductible)
Basic procedures — like fillings and extractions — at 70% (e.g., on a $100 procedure, dental insurance would cover around $70)
Major procedures like crowns, bridges, and root canals at 50%
There are variations on this formula, and some procedures may be considered “basic” in one dental insurance plan and “major” in another. Group plans - or dental insurance through your workplace - will often have a more generous coverage formula, such as 100/80/50.
How much does dental insurance cost?
Dental insurance can range in cost from $15 to $75+ per month, depending on a variety of factors. For example, here is the pricing information for Guardian Dental Advantage (PPO) plans:
Premier | Diamond | Achiever | Core | Starter |
|---|---|---|---|---|
Starting at $57/mo** | Starting at $37/mo** | Starting at $29/mo** | Starting at $19/mo** | Starting at $15/mo** |
Factors like coverage amounts, deductibles, network availability, and your geographic location can all affect the cost of dental insurance. It’s best to request a dental insurance quote to compare dental plans and pricing for your situation.
What to look for in a dental insurance plan
Here’s a checklist of some key features to consider when selecting coverage.
Plan Feature | Considerations |
|---|---|
Cost | Look for a plan that fits your budget and that will help you save on the type of care you need |
Plan choices | There are typically 3-4 tiers, ranging from preventive-only treatment to coverage for basic and major procedures |
Preventive services Checkups, X-rays, cleanings, etc. | Typically 70% - 100% |
Basic procedures Fillings, simple extractions, etc. | Typically 50% - 70% (if covered) |
Major procedures and treatments Crowns, implants, periodontal work, orthodontia, etc. | Typically 40% - 60% (if covered) |
Waiting periods | Preventive services: Look for no waiting period (i.e., immediate coverage) Basic procedures: Look for six months or less (if covered) Major procedures: Look for 12 months or less (if covered) |
Network coverage | The larger the network, the greater the likelihood of seeing your preferred dental provider or a suitable local alternative |
In-network savings | A PPO plan should offer average in-network savings of at least 30% on all services — not just the procedures covered under your plan |
Ease of claims | In-network providers should submit all claims on your behalf; for non-network providers you may have to pay the dentist and submit a claim later |
Increasing cap | Look for a plan where the “cap” or maximum coverage level increases each year |
Other things to consider when looking at dental plans
Knowing key dental plan details will help you understand how dental insurance works. But how do you find the right plan? What factors are most important? Here are some things to consider.
Is dental insurance worth getting?
Dental insurance can help you save money on routine and major dental care. It makes basic and preventive treatments more affordable — and since cost is a barrier to getting care, coverage is a great way to help you maintain good dental health. Plus, dental insurance can reduce the financial burden if you’re hit with the cost of a major treatment, like a bridge or root canal. Having insurance also encourages proactive care, by covering most or all of the cost of preventive treatments. This can save you money in the long run.