What is full coverage dental insurance – and why does it matter?
Whatever type of dental coverage you have, it’s likely better than having no dental coverage. But some types of plans cover more services and treatments than others. And depending on your care needs, a plan with more coverage may be a better value, even if it costs a bit more.
So, whether you’re buying a dental insurance plan for yourself or your family , signing up for dental insurance at work — or you're an employer who is considering offering dental benefits — it's important to understand the cost and health benefits that may come with full dental coverage.
This article will help you understand five key issues:
What full dental coverage costs
Different types of full coverage dental care
Why better dental care helps your overall health
What really matters in a dental plan
Why it’s worth it for individuals to buy – and for employers to offer – full coverage
How a full coverage dental plan differs from a basic plan
While the terms "full coverage" and "basic coverage" are frequently used to describe different kinds of dental insurance, there's no strict industry definition as to what needs to be in either type of plan. So, what's the difference between full and basic?
A basic dental plan often covers preventive care such as checkups, cleanings, x-rays, and a few basic procedures, like cavity fillings. Full coverage plans typically cover much more — and often at a lower out-of-pocket cost to you. For example, they may cover a broader range of preventive procedures, such as fluoride treatments and sealants in full or with just a small copay.
A more comprehensive full coverage plan may cover other types of procedures, including:
Basic restorative care: This includes fillings, extractions, and non-routine X-rays
Major restorative care: Bridges, crowns, dentures, and the like
Orthodontic treatment: Braces and other types of teeth aligners
Basic and full coverage plans may require you to see an in-network dentist
You may have heard about Dental Health Maintenance Organizations (DHMOs) and Dental Preferred Provider Organizations (DPPOs). In a DHMO, you have to see an in-network dentist, even if you have a full-service plan. Their networks are more limited than a PPO plan, but the trade-off is generally lower costs and a simpler fee structure. A DPPO also has a network of dentists, but typically lets you go out of network to see another dentist. But if you go with a large insurer with a broad provider network, your current dentist may well be “in-network.”
It's almost always worth your while to see an in-network dentist in a DPPO because the insurance company negotiates discounted fees on your behalf. For example, if your dentist typically charges $100 for a filling, when they're in-network, you may only be charged $60-$70 — even if you haven't met your deductible yet.
Services that may not be covered by full coverage dental insurance
Some services may not be included in full coverage dental insurance, depending on your specific policy.
Cosmetic procedures like teeth whitening or optional veneers are not always covered by insurance and typically require partial or full out-of-pocket payment. Also, some insurance plans, including higher-level “full coverage” plans, may not cover recommended orthodontic treatments like braces.
Also note that when you purchase new dental insurance, there may be exclusions for some pre-existing conditions that would otherwise be covered. This may include missing teeth, diagnosed conditions, or even cavities that were identified but not treated before obtaining new policy coverage.
Does full coverage dental insurance cover dental implants?
Some full coverage plans may include implant coverage, though this is not guaranteed. This will vary based on the carrier and the plan selected. Many plans will instead focus on preventative care and common dental procedures like cleanings, preventative screenings, and cavity fillings. Depending on your specific policy, you may have to pay for dental implants either fully or partially out-of-pocket.
Types of full coverage dental plans
There are several different types of full coverage dental plans to choose from, including the following:
Dental PPO (DPPO): Insurance policies with a network of preferred providers that have set deductibles and negotiated discounts with the insurance carrier. Members can see out-of-network providers but may pay more.
Dental HMO (DHMO): Members can choose a primary dentist from their network, but require referrals to see specialists, with out-of-network care typically not being covered outside of qualifying emergencies.
What could full coverage dental insurance cost?
Even if you go to a network dentist, the cost you pay for a given dental treatment may vary widely depending on the provider and specific plan you choose. Your employer may offer different levels of coverage and pricing based on tiers. Talk to your HR department to learn what they offer. When you’re looking at a plan's details, the following items should be clearly spelled out:
Deductible: The amount you have to pay before the plan starts to pay for treatments. DPPO plans tend to have deductibles, but many DHMO plans do not.
Coinsurance: The percentage of costs you must pay for a visit or treatment once you've met your deductible. With a DHMO, there isn't a deductible, and you'll typically pay a flat fee depending on the services received.
Annual Maximum: The total amount your plan will pay you in a given year. You have to pay for any treatments over that amount — but remember: if you go in-network, you'll still be able to take advantage of the plan's discounted fees and stretch your annual maximum further.
In addition to those costs, you have to pay your monthly premiums. DPPOs tend to have higher premiums than DHMOs, largely because DPPOs have fewer restrictions. However, if you get your dental plan through work, your premiums will tend to be lower for either type of plan because you’re paying group rates – it’s like buying in bulk.
Why consider full coverage?
Dental care and oral health shouldn't be considered optional or secondary. According to the Mayo Clinic, problems that occur in the mouth can affect the rest of your body:1
Diabetes: People with gum disease have difficulty controlling their blood sugar levels.1
Heart disease: Inflammation and infections caused by oral bacteria are connected to cardiovascular disease.1
Pregnancy: Periodontitis (gum infection) is linked to low birth weight and premature births.1
Self-esteem: Research shows that healthy teeth and gums are important to a person’s self-esteem and how they feel about themselves.2
It's worth noting that basic and preventative care can have compounding effects over time that can impact oral, dental, and even your financial health. Guardian’s Ounce of Prevention study found that those with preventative dental care for at least two consecutive years had a $90 decrease in claim costs in the third year. During that same period, members with no preventive care experienced an average increase of $720 in claim costs.
All this should come as no surprise. It’s hard to be a happy, productive person when your mouth hurts and you’re worried about what’s happening with your teeth.
How to choose the right full coverage plan for you: Tips to consider
First of all, try to think about your dental care needs. If you're young, single, and have never had oral health problems, a basic plan may be a good choice. But if you're not so young, or you or your spouse have had dental issues — or you have kids — you should consider getting a full coverage plan.
Next, think about which dentist you want to see. According to the American Dental Association, factors to consider when choosing a dentist include proximity to your home or job, the convenience of office hours, whether your dentist is in your insurance provider network, and doctor-patient communications.3
If you have a dentist you want to stay with, look for a DPPO; then check with your dentist to see if they’re part of the plan’s provider network. Plans with a large provider network will increase the odds of your dentist being in network.
But what if cost matters more to you than loyalty to a specific dentist? A DHMO might be of better value for you. However, as their networks tend to be limited, you might have to go a little farther out of your way to get the care you need.
Look at the features and design of the plan you're considering. Some of the terms may seem confusing at first, but the concepts are actually pretty straightforward. As noted before, you should look at the premiums, deductibles, coinsurance, and annual maximum to understand all the plan costs. In addition, you should pay attention to such things as:
Types of services and treatments covered: The longer the list, the better.
Waiting periods: Major procedures, such as root canals, usually have a waiting period (for example, six months) before they are covered. So don't wait until your teeth hurt to get a plan!
Primary dentist requirement: This is typical of DHMOs. It means that you have to go through your regular dentist to get a referral to see a specialist.
Potential out-of-pocket costs. While dental policies are helpful, some patients may find themselves delaying or skipping dental care if out-of-pocket costs rise.
Why it’s worth it for employers to offer full coverage – and for employees to choose it
Everybody wants to be healthier, so the benefits of choosing a full coverage dental plan should be clear. And if you work for a company that offers a full-coverage plan, you may get an even better value.
A growing number of companies are realizing that better preventive care can help improve employee wellness and productivity, while actually reducing their overall claims costs. Working Americans who get regular preventive care are more likely to report better oral health, and they’re less likely to need expensive major treatment over time.
Many people who don't have dental insurance wish they did, with 3 in 10 Americans regretting that they do not have dental coverage in place. Approximately 50% of Americans skip dental visits or recommended procedures due to cost.4
How can an employer’s plan increase the use of preventive services? By encouraging employees and their families to go for regular cleanings and exams. Ways to do that include:
Covering preventive services at 100% (not 80% or 90%)
Including a minimum of two cleanings per year
Adding a third cleaning, especially for those with other medical risks
Expanding their plan’s list of preventive services
Frequently asked questions about dental insurance
The details of what dental insurance will cover varies greatly depending on the policy in question. Most full-coverage policies provide coverage for basic preventive care and common procedures like cavities, though some providers may offer plans that also fully or partially cover other procedures.
Guardian claims data shows that dental plan members who received regular preventive care (i.e., received an oral exam and cleaning at least once a year) required fewer major dental services and, consequently, experienced lower out-of-pocket costs over a three-year period.5
If you or your spouse have dental benefits through work, that's almost always the way to go. Companies get lower group rates than individuals typically can, and they can tailor their employee dental plans to provide a fuller set of benefits, including comprehensive preventive care.
If that’s not an option, consider buying directly from a dental plan provider. Since all major providers will offer a few options, take the time to compare the plans offered – and remember that the plan with the lowest premium may not provide the best value for your family’s needs.