Guardian dental insurance review: PPOs vs DHMOs | finder.com

Guardian dental insurance review 2021

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With this insurer’s plan lineup, you can choose what matters most to you: Low costs or flexibility.

  • Explore this policy if you want a choice of PPO plans to suit your dental needs and budget.
  • Choose something else if you’re looking for an indemnity plan.

What dental insurance plans does Guardian offer?

Guardian offers two types of dental plans.

  • Preferred Provider Organization (PPO) — Guardian Dental Advantage Gold, Silver and Bronze
  • Dental Health Maintenance Organization (DHMO) — Guardian Dental Managed DentalGuard

Generally, PPO plans are more flexible, while DHMO plans are more cost effective. If your plan has out-of-pocket costs like copays, you can find the exact dollar amounts by logging in to your member portal.

This table breaks down the specifics.

Plan typeChoice of dentistAmount Guardian paysWaiting periodDeductibleCopayAnnual maximum
PPOYou can go to any dentist, but you’ll pay less if you stay in-network.Varies based on plan. Guardian covers a higher portion of the costs with a Gold plan and less if you have a Silver or Bronze plan.

* No waiting period for preventative care, like cleanings and exams

* 6-month waiting period for basic services, like fillings and extractions

* 12-month waiting period for major dental work, like root canals and crowns

* No deductible for preventative care

* $50 deductible for all other care

NoYes — and the amount increases if you stay with Guardian for another 1-2 years
DHMOYou must choose one in-network dentist. As your primary care dentist, they’ll coordinate all your dental care.The difference between the total cost of dental services and your office charge plus your copay.No waiting periodNo deductible

* No copay for diagnostic and preventative services, like x-rays and exams

* Copay for all other dental services

* You’ll also pay a small office charge of $15 to $18

No annual limit

What does Guardian dental insurance cover?

It depends on the type of plan you have, and in the case of PPOs, which tier. Dental insurance typically only covers medically necessary services.

  • Preventative services. Most Guardian plans cover 80% to 100% of preventative services such as annual exams, cleaning and x-rays.
  • Basic services. Guardian plans typically cover 50% to 70% of basic services like fillings and extractions.
  • Major dental work. Depending on your plan, you’ll pay 50% or all the costs out of pocket for major services like crowns, implants, wisdom tooth removals, children’s braces or oral surgery.

What’s not covered?

Guardian’s dental insurance plans typically don’t cover:

  • Some oral hygiene services, like deep cleanings
  • Cosmetic procedures, like teeth whitening, tooth shaping and veneers
  • Experimental procedures

How much does Guardian dental insurance cost?

The amount you’ll pay depends on your plan and whether you’re purchasing a policy on your own or having your premiums subsidized by your employer. However, Guardian says its dental insurance plans start at $20 per month in most states.

Your plan may also have out-of-pocket costs, such as copays or deductibles. To get that info, read over your policy documents or call Guardian at 866-569-9900.

How to get Guardian dental insurance

You can buy a plan through Guardian directly, and enrollment is year-round. Otherwise, if your employer offers Guardian dental insurance as part of your workplace benefits, you can sign up during annual enrollment — which falls between October and December for most companies.

How to find an in-network dentist

For a list of in-network dentists near you, head to Guardian’s site and use the Find the Dentist tool. Enter in your ZIP code and specify whether you’re searching for a general dentist or specialist — such as an orthodontist or periodontist.

If you have a PPO plan with Guardian, you can choose any in-network dentist and change dentists whenever you like. But with DHMO plans, you’ll need to pick one primary care dentist — and they’ll coordinate any specialist care you need. You can switch dentists once a month by logging in to your member portal.

Can I see an out-of-network dentist?

It depends on your plan. PPO plans are flexible, so you can go out-of-network if you wish — but you’ll pay up to 35% more for care, according to Guardian.

DHMO plans don’t offer out-of-network coverage, which means your primary care dentist must provide or arrange all your care. If you don’t choose a dentist on your own, Guardian assigns one to you.

Pros and cons of Guardian dental insurance

Pros

  • Choice of plans. You can decide between a DHMO or three tiers of PPO plans to suit your budget.
  • Extensive network. Guardian has over 100,000 dentists across the country in its network.
  • No waiting period for most services. You may have to wait 6 to 12 months for major work, but you can typically see a dentist right away for oral exams, cleanings and x-rays.
  • Rewards loyalty. The insurer increases your annual maximum during the second and third year you hold a dental policy with Guardian.
  • Virtual appointments available. Guardian has expanded its telemedicine network during the pandemic, which means you can access virtual consults under your plan in most states.

Cons

  • Doesn’t cover some oral hygiene services. Unless the service you need falls under preventive care, you’ll need to pay out of pocket.
  • Premiums aren’t always locked in. Guardian says individual premiums are subject to change — you’ll receive 60 days notice if that happens.

Guardian customer reviews and reputation

Guardian has been accredited with the Better Business Bureau (BBB) since 1957 and has an A+ rating for its customer interaction. The BBB has recorded 93 complaints over the past three years, though most focused on life insurance billing and claims. Customers award the company 1.22 out of 5 stars as of February 24, 2021 — and again, most reviews honed in on life insurance.

Compare and find dentists

Name Product Dental exam X-ray coverage Monthly cost
Guardian dental insurance
Once Every 6 Months
100% (Coinsurance)
$23.27
Choose from flexible dental plans fit for any budget, including wide or limited dentist choices and low to no copays or deductibles.
Dentalplans.com
Dentalplans.com
Depends on provider
Yes
$39
Buy a plan and save up to 60% on dental services from over 140,000 dentists nationwide. No waiting periods or coverage caps.
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Compare up to 4 providers

How do I file a claim with Guardian?

If you visit an in-network dentist, they’ll handle the claims paperwork for you. But if you go to an out-of-network provider, you’ll need to submit a claim on your own by following these steps.

  1. Log in to Guardian Direct using your member ID number on the back of your insurance card.
  2. Download and complete the paper claims form.
  3. Mail it to Guardian Dental Claims, PO Box 981587, El Paso, TX 79998, along with any itemized receipts. You can expect a response within 15 business days.

Frequently asked questions about Guardian dental insurance

Expert review

Katia Iervasi

Review by


Katia Iervasi is a staff writer who hails from Australia and now calls New York home. Her writing and analysis has been featured on sites like Forbes, Best Company and Financial Advisor around the world. Armed with a BA in Communication and a journalistic eye for detail, she navigates insurance and finance topics for Finder, so you can splash your cash smartly (and be a pro when the subject pops up at dinner parties).

Expert review

Guardian caters to a wide range of patients with its four dental insurance plans. If you’re in the market for an individual policy, you can choose what’s most important to you: keeping costs low or having the flexibility to see any dentist you like. In terms of PPOs, the Bronze plan is best for those with low-maintenance dental needs, while the Silver and Gold plans are good choices for those who anticipate needing more extensive dental work.

With over 100,000 dentists, Guardian’s network is one of the largest in the US — and the insurer tops up your annual maximum if you stay with them for another one or two years. But the plan doesn’t cover some oral hygiene services, and premiums may change.

To explore your options, compare dental insurance companies.

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