What You Need to Know About Dental Insurance Waiting Periods

By Andrew Hickey on Oct 17, 2022 @ 09:15 AM

Some dental insurance plans impose waiting periods for major procedures.

Taking care of your teeth is essential. Poor oral health can lead to tooth loss and many health problems. These include cardiovascular disease, diabetes, infertility, and even oral cancer. Whether you are fortunate to have an employer offering a dental plan or purchased one on the insurance marketplace, you can save on routine care and extensive dental work.

Key takeaways:

Most dental insurance policies have waiting periods before they will cover complex procedures.
Many plans will still offer preventive services without a waiting period.
Dental insurance carriers typically impose waiting periods of six months to one year for specific procedures.
Waiting can be frustrating, but having dental insurance means paying less for oral care.

Dental insurance is grouped into three main coverage categories – preventive, basic, and major. It is essential to understand what is covered because policies differ in how procedures are categorized. Dental insurance policies also have a maximum cap, copays, deductibles, and waiting periods for particular care, just like any health insurance policy.

Dental insurance waiting periods can range from a few months to one year. You can still visit your dentist during that period, but you should know what will be covered and what will not. Here, we will explore the ins and outs of standard dental insurance waiting periods and answer the most frequent questions. These examples provided are not for a specific dental plan.

When do dental insurance waiting periods apply?
A waiting period applies to all new dental plan members when basic care and major dental services are not covered. The waiting period does not apply if you change plan types with your current insurer or roll over your employer-sponsored dental plan to a plan from the same insurer. You also may not have a waiting period if your employer changes insurers without a break in dental coverage. This would depend, however, on compatibility with the former plan.

Can I visit my dentist during the waiting period?
Yes! During the waiting period, you can visit your dentist. Preventive visits will likely be covered. Preventive dental care includes:

Oral exams, and usually, your insurance will cover two visits per year
Teeth cleanings
X-rays
Fluoride treatments (there may be age limitations)

If you have a dental emergency or need major dental surgery while still waiting, you will most likely have to pay those out-of-pocket costs. It is essential to check your specific insurance policy to understand what will and will not be covered during the waiting period.

There may or may not be a waiting period for basic care
Basic care is different from preventive care. Extractions, fillings, tooth sealants, and space maintainers are usually considered basic services by most dental insurers. Some plans have no waiting period for these basic care services, but others do. Additional basic services include:

Sedative fillings
Routine tooth extractions
Periodontal root planing and scaling
Re-cementing crowns

This category of care also covers stainless steel crowns and non-routine x-rays. Basic care is a step beyond preventive care.

Major dental waiting period
Almost all dental insurers institute a waiting period for major procedures. These complex dental services involve a dental laboratory and are more costly. These services include:

Dental crowns (other than stainless steel)
Inlays
Bridgework
Dental implants
Removal of impacted wisdom teeth
Complex oral surgery
Anesthesia or sedation
Partial dentures

Complete dentures, denture repair, and orthodontic treatment (teeth straightening) are also in this category. There are reasons for this waiting period, and we will discuss them next.

The reasons for waiting periods
One reason for waiting periods is to prevent people from buying insurance for a major procedure. They may then drop the plan after the procedure has been completed. Employer HR policies play a part as well. When you start a new job, there might be a waiting period before you can enroll in any offered insurance plans, including dental insurance. This period depends on your employer. After you enroll, the waiting periods kick in for specific procedures, as outlined earlier.

Good oral health begins with you.
Waiting periods are an excellent time to brush up on your oral hygiene so you can sail through them without paying for expensive care. This includes:

Brushing and flossing twice per day
Replacing your toothbrush every month. You also might want to consider investing in an electric toothbrush for better cleaning.
Use a mouthwash that helps prevent tartar, and if you usually have problems with cavities, add a fluoride rinse to the mix.

Even short waiting periods can be frustrating, but dental insurance helps offset significant dental costs and allows you to budget for maintaining good oral health. Check out our free video about dental waiting periods for even more tips.