Why do some dental insurance plans have waiting periods?

Waiting periods help protect dental insurance companies from having people quickly enroll in a dental plan, get expensive dental work done right away, then cancel coverage once the problem is treated. Waiting periods do help control costs: if you shop around, you will likely find that policies without waiting periods generally have higher premiums than policies with them. So, a policy with a waiting period may cost you more in the short term – because (for example) if you have a filling in the first six months you will have to pay for  the full cost – but in the long term, you'll likely save by paying less each month for coverage.

Which services have waiting periods?

Dental insurance is focused on promoting oral health, so even policies with waiting periods usually cover preventive dental care right away. These covered expenses include things like routine cleanings, checkups, routine x-rays, and sometimes fluoride treatments. Dental plans often cover such preventive services in full, with no out-of-pocket cost to you. That's valuable because these services can help avert more serious and expensive tooth problems in the future. However, services beyond cleanings often require at least a 6-month waiting period. Some policies may make you wait a year for major work. The kinds of treatments and procedures not covered during the waiting period typically include:

  • Basic procedures and care: This may include fillings, non-surgical extractions, and other simple services
  • Major procedures and treatment: Things like bridges, crowns, dentures, oral surgery
  • Orthodontic treatment:  Braces and other types of teeth aligners (if covered)

It's important to note that these service categories aren't set in stone. For example, one insurance company might categorize a dental care procedure as basic; another insurance company might categorize it as major. While these categories can give you a broad idea of what's covered in full-coverage dental plans, you should also look at the Plan Summary to get more specific details about which basic and major services are covered.

Can the waiting period be waived?

In some cases, yes. You may be able to have the waiting period waived if you can demonstrate continual coverage, i.e., that you've had dental insurance in place with another dental insurance company for at least 12 consecutive months. You will need to supply a letter showing you had prior coverage and a summary of policy benefits from the previous dental insurance company. On the other hand, if you've had a lapse in coverage – even if it was just a short one – you will likely not be eligible to waive the waiting period. 

How can I buy dental insurance with no waiting period?

When searching for dental insurance without a waiting period, first try to determine what major services you need right away and how much they will cost. Full coverage dental with no waiting period is available, As DHMO plans generally don’t have waiting periods. Depending on the cost of the services you need, no-wait period dental insurance plans may not be worth the added premium cost.

What other factors should I consider when enrolling in dental insurance?

When enrolling in a dental plan, there are two primary things to consider: need and cost. The primary role of a dental plan is to help keep your teeth and mouth healthy, which in turn can help protect your overall health against conditions like heart disease, diabetes, and other health conditions that are impacted by periodontal disease. Dental care can even help mental health by building self-esteem.1

Think about what services you may need in the not-so-distant future. If you or someone in your family has had dental health issues in the past, look at the insurance policy's Plan Summary to see if those issues are covered. Even if you don't have a specific concern, you should look at the dental procedures covered. You may not recognize them all—but the longer the list, the better. Finally, if you have kids, consider a dental insurance plan with orthodontic coverage.

If you choose a less expensive plan because the premiums are lower – then skip needed dental work because of the out-of-pocket costs – it will likely cost more in the long run. You could have more toothaches as well.

When choosing a dental plan, keep a few things in mind:

  • Deductibles. This is the amount you must pay before the insurance plan starts paying for treatments (although many plans waive this for routine preventive visits). It's often around $50 for an individual or $150 for a family – but it can be higher in some plans. With other plans, there is no annual deductible. 
  • Coinsurance and copays. After you've met your deductible, you may owe a percentage of the fee for each visit to the dentist's office, called coinsurance. Or you may have a flat fee, which varies by treatment – called a copay. 
  • Annual Maximums. The total amount your insurance plan will pay each year. You are responsible for any expenses over that amount.
  • Coverage options. Some basic plans go beyond preventative care by providing coverage for at least some basic restorative treatments. A mid-level plan should cover preventive care, a range of basic restorative procedures and may offer some coverage for major dental procedures. A quality full-coverage plan provides coverage for routine, basic, and major procedures. Some dental insurance also covers orthodontic work – and if you have children with crooked teeth, you probably want that.

For those who are particular about which dentist they want to see, a plan that offers a DPPO (Dental Preferred Provider Organization) is probably a better option. It offers a wide choice of in-network dentists, but you can still see out-of-network dentists and get some coverage. On the other hand, a plan that offers a DHMO (Dental Health Maintenance Organization) may be better if you need to keep your premiums down. A DHMO may provide more affordable coverage with no deductibles or maximums, but you have to see an in-network dentist, and the choices may be quite limited.

If you can get dental insurance at work, that's probably your best choice, even if the plan has a waiting period. Employer-provided dental insurance has affordable group rates because they are buying benefits for many employees at once. Compared to individual dental plans, group PPO dental plans often offer higher coverage levels for basic and major services. The employer may also pay a portion of the costs, making it an even better value. 

Need to get dental coverage as an individual? There are plenty of affordable options, and it's easy to find and buy online.  Just remember that the plan with the lowest premium may not provide the best value for your family's dental health needs. Look at a few sites and compare plan options. Insurance companies should display plan benefits and dental services covered in a simple and straightforward manner. As an example, look at how plan choices are displayed when you purchase coverage online with Guardian.

Are you a dental professional? Find out how to join Guardian's growing network of dental benefit providers

Frequently asked questions about dental insurance coverage and waiting periods

Is there dental insurance without a waiting period?

Yes, depending on the dental insurance carrier and the plan. Employer-based group dental benefits plans are more likely to offer options without waiting periods. Also, if you've had coverage with another company for the past 12 consecutive months, you may be able to waive the dental insurance waiting period. 

Can I use dental insurance right away?

In most cases, you can use dental insurance right away for preventive services, like cleanings and x-rays. However, depending on the policy, some basic services and major dental work – such as fillings, extractions, or root canals – will not be covered until after your dental insurance waiting period is complete. The waiting period is usually between six months to a year, although more expensive procedures may have a waiting period that's even longer. 

Does full coverage health insurance cover dental?

Sometimes, but not always. An employer-provided health plan may include dental coverage. Others may offer a separate optional dental policy to help keep overall policy costs down. Some medical policies also cover some dental care for children under age 19 but not for adults. 

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1 Dental Insurance https://www.guardianlife.com/dental-insurance (last accessed Oct. 2021)

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