By Andrew Hickey on Oct 17, 2022 @ 09:15 AM
Some dental insurance plans impose waiting periods for major procedures
- 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 certain procedures.
- Waiting can be frustrating, but having dental insurance means you pay less for important oral care.
Taking care of your teeth is essential. Poor oral health can not only lead to tooth loss but a host of health problems. These include cardiovascular disease, diabetes, infertility, and even oral cancer. Whether you are fortunate to have an employer that offers a dental plan, or you purchased a plan on the insurance marketplace, you will be able to save on routine care and extensive dental work.
Dental insurance is grouped into three main coverage categories – preventive, basic, and major. It is important 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 certain care, just like any health insurance policies.
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 be aware of 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 a dental insurance waiting periods apply?
A waiting period applies to all new members on a dental plan and is the time 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 if you 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. It is likely that preventive visits will be covered. Preventive dental care includes:
- Oral exams, and usually your insurance will cover two visits per year
- Teeth cleanings
- Fluoride treatments (there may be age limitations)
If you have a dental emergency or need major surgery while still in the waiting period, you will most likely have to pay those costs out-of-pocket. It is important to check your specific insurance policy so you can 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.
Waiting period for major care
Almost all dental insurers institute a waiting period for major procedures. These dental services are complex, involve a dental laboratory and are more costly. These services include:
- Dental crowns (other than stainless steel)
- 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 talk more about them next.
The reasons for waiting periods
One reason for waiting periods is to prevent people from buying insurance just 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 even enroll in any offered insurance plans, including dental insurance. This period depends on your employer. After you are enrolled, the waiting periods kick in for certain procedures as we 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 having to pay out-of-pocket 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 a better clean.
- Using 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 the expense of maintaining good oral health.