Imagine you've just signed up for a new dental insurance plan, thinking ahead to some needed dental work — perhaps a crown or an implant. You're ready to make an appointment to get the work done before your high school reunion when you encounter a common hurdle: the waiting period. This term is often in the fine print of dental insurance policies, but what exactly does it mean? This article aims to demystify the concept of a dental insurance waiting period. We'll explore why these periods exist, which procedures they apply to, and how long you typically need to wait before your coverage kicks in.
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What is the waiting period for dental insurance?
The waiting period for dental insurance is a set time after enrolling in a plan before you can use certain benefits to get treatment. Insurance companies use the waiting period to manage risk and prevent patients from signing up for insurance only when they need expensive dental procedures, then promptly drop the insurance after treatment. Insurers claim that waiting periods help keep costs down for everyone.
The length of waiting periods can vary between different plans, such as individual versus employer-sponsored, and by the level of coverage. More comprehensive plans have longer waiting periods for the most complex procedures. Understanding these differences can help you better plan dental care and avoid unexpected out-of-pocket costs.
Which procedures have waiting periods?
Not all dental procedures have waiting periods. For example, you can usually schedule an appointment for cleanings, exams, and X-rays immediately. But here are a few standard services that often do require a wait:
- Basic restorative procedures. These include fillings and simple extractions.
- Major restorative procedures. These include crowns, bridges, root canals, and dental implants.
- Oral surgery. Procedures such as complex tooth extractions and wisdom teeth removal often have a waiting period.
- Periodontal treatment. Treatments like deep gum cleaning (scaling and root planing) might have waiting periods, depending on the severity and the specific plan details. More complex treatments, like gum grafting, will almost always have a waiting period.
- Orthodontics. If you just found out your son or daughter needs braces, you may need to wait several months before they can begin treatment if you want insurance to assist.
Knowing which procedures have waiting periods may influence your decision when enrolling in a dental insurance plan, so keep your health needs in mind as you research.
Understanding waiting period lengths
The length of waiting periods can vary significantly based on your insurer and the type of procedure you are having done. Here are some typical ranges:
| Procedure | Waiting period |
| Basic and major restorative procedures | Waiting periods can range from 30 days to 12 months. Six months is a common length of time for most policies. |
| Complex surgery and orthodontics | These can have longer waiting periods, typically between 6 and 12 months. |
| Preventive care | 0–30 days. Most plans offer immediate coverage for preventive care such as cleanings, exams, and x-rays since these services are essential for maintaining oral health and preventing more severe issues from developing. |
How can you get around waiting periods?
Generally, waiting periods are a nonnegotiable aspect of most dental insurance plans. However, there are exceptions:
- Choosing a plan with shorter waiting periods. Some plans are designed with shorter or no waiting periods for specific procedures. You can get more urgent treatment done much sooner by intentionally selecting a plan with a shorter waiting period for the needed treatment.
- No waiting period. A handful of plans offer coverage of basic and major restorative procedures with no waiting period. If you need to find a plan without waiting, carefully check out policies from Humana, Spirit, United Healthcare, and Blue Cross Blue Shield. Many employer-sponsored dental plans also feature no waiting periods. Dental HMO policies are more likely to offer no waiting periods than Dental PPO policies.
- Waivers for pre-existing conditions. Occasionally, waiting periods for specific treatments can be waived. If you had dental insurance through a different company in the previous 12 months, your new insurer may ask for proof of your old policy as part of the waiver procedure.
Checking the details of your plan is essential, especially if you require immediate treatment.
Planning for dental work with waiting periods
When comparing dental insurance plans, consider your current and future dental needs. Asking about waiting periods while shopping for insurance can save you frustration. Also, maintaining good oral hygiene and regular dental checkups can decrease the likelihood you will need future extensive procedures that are typically subject to longer waiting periods.
Work closely with your dentist's office's treatment coordinator or front desk assistant. They can be a great resource to help you navigate the insurance landscape. Many are happy to contact your insurance to help determine if and when you are eligible for a given treatment. They can also help you plan and schedule your appointments to coordinate with the end of your waiting period.
Waiting periods are an integral part of many dental insurance plans. Understanding what procedures they apply to, how long they last, and planning accordingly can help you make the most of your dental insurance. When you compare plans, it's essential to consider the dental insurance cost and the benefits. Regarding dental insurance comparison, waiting periods play a critical role in the timing and affordability of care. Once you understand the types of dental insurance waiting periods, you can choose wisely and ensure your plan aligns with your health needs. So, be sure to research your plan options well and consult your insurer and dentist to help you get the care you need when you need it.
FAQ
Does dental insurance cover cleanings during the waiting period?
Yes, most dental insurance plans immediately cover preventive care such as cleanings, X-rays, and exams, even during a waiting period. This coverage helps maintain oral health and prevent conditions that might require more extensive treatment later. Most plans cover two cleanings per year, though a few will cover three.
I have a dental discount plan. Does it have a waiting period?
No, there is no wait. Dental discount plans, or dental savings plans, are not insurance policies. They are membership programs where you pay an annual fee to receive discounted dental care from dentists in the network and pay for your treatment out-of-pocket.
What if I have a dental emergency during my waiting period? Will insurance cover it anyway?
Unfortunately, no. You may visit your dentist during your waiting period, where an exam and X-rays will be covered. But if you need treatment, you will have to pay out-of-pocket. You may consider purchasing a dental discount plan if treatment is costly and the amount saved will be more than the membership cost.
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Dental insurance waiting periods can vary. Typically, preventive care has no waiting period, while major procedures may have longer wait times of 6-12 months.
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There are options to bypass waiting periods. Some plans offer no waiting periods or reduced times; comparing these can save money and expedite care.
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Knowing the specific waiting times in your policy for different procedures can help you plan your dental care effectively.
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If you had prior dental insurance during the previous 12 months, your new insurer may be willing to waive your waiting period.
2 resources
- American Dental Association. Dental benefits: an introduction.
- National Association of Dental Plans. Understanding dental benefits.
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