What is Dental Waiting Period? A dental insurance waiting period is the length of time after purchasing your dental benefits plan that you must wait before you can use your full coverage.
During the dental plan waiting period, the dental insurance company will not pay for certain procedures. A dental benefits waiting period may last anywhere from a few months to a full year, depending on the type of plan you have purchased and the insurance benefits wording.
The details of what is covered in the plan immediately versus what coverages are subject to a waiting period will be clearly outlined in your plan contract. After the waiting period is over, then full benefits become accessible to you.
What is Dental Waiting Period?
A dental insurance waiting period is a set period of time before you can receive full coverage for some specific dental procedures. Waiting periods vary based on your plan and can range from a few months to over a year. Waiting periods are primarily for basic and major dental work, and nearly all dental plans cover preventive dental care right away.
Why Is There a Waiting Period in Dental Insurance
The dental insurance company chooses to use a waiting period, so customers are not just buying dental insurance only when they have piled up a lot of dental procedures that they want to get covered and then later just drop the dental insurance after the dental insurance policy has expired.
Usually Only Applies to Certain Benefits
Typically, the dental plan will not apply the waiting period to all benefits, as it is understood that the plan will pay out on certain basic coverages every year for dental benefits plan members anyway.
Understanding which coverages fall into the waiting period is important. Your dental insurance plan likely categorizes coverages in three groups:
- 1: Basic: Basic procedures may have a three to 6 month waiting period, and “Major” procedures may have a 6 month to a 1-year waiting period.3
- 2: Preventative: Preventative procedures may not have any waiting period. Therefore some benefits may be accessible despite a waiting period, such as X-rays, cleanings, fluoride treatments.4
- 3: Major Work: Major work should be defined in your policy wording and may vary from company to company. Beware of taking on major work without consulting with your plan first.
Examples of How the Dental Insurance Waiting Period Works
If you decide to buy a dental benefits insurance plan because you just found out that you need a crown, the insurance waiting period could prevent you from being able to cover the procedure immediately when you purchase your dental insurance. Waiting periods can last up to a year on certain major procedures.
Example 1: Cynthia needed a crown. She contacted her dental insurance company to see what coverage she had for the procedure. Her insurance company said that she did not have any coverage for the procedure since she only had her dental insurance for 3 months and any crown procedures had a 6-month dental insurance waiting period. Once the waiting period has elapsed, then dental benefits will be fully accessible.
Example 2: Mary wants to visit a dentist for a checkup and cleaning, but her dental plan waiting period is not over yet. She is worried that the dentist will need to take x-rays and charge her a lot for these services. She calls her dental benefits plan administrator and finds out that although she has a 1 year waiting period for “Major” work like crowns, and bridges, that all the basic coverages are included. She is delighted to find out that her x-rays will be covered, as well as her cleaning, and if they find any cavities, her plan will cover that too. Since every plan is different, she was happy she called as was able to get access to some of her benefits right away.
In the insurance industry, “Adverse Selection” is when someone attempts to obtain coverage at a lower premium than what the insurance company would charge if it were aware of the actual risk regarding the applicant. Insurance, by its very nature, is based on risk sharing, and many people pay into the system and only a smaller percentage of those that paid in require payouts at any given time. If everyone signed up for insurance only when they expected they would need it, the entire industry would collapse. A waiting period is one method insurance companies utilize to protect against such practices.
Can you visit a dentist during the waiting period?
Knowing which procedures require a waiting period before you schedule a visit can help you prepare and avoid unexpected costs. Here are some of the most common categories for dental insurance waiting periods tat you need to know.
1: Preventive. Most dental insurance plans do not require a waiting period for preventive care. That means you and your family may receive exams, cleanings, x-rays and fluoride treatments as provided in your plan.
2: Basic. Some basic procedures may have a three- to six-month waiting period. Basic procedures typically include fillings or non-surgical extractions.
3: Major dental work. Major work may have a three-month to one-year waiting period. Major work generally include crowns, bridges and dentures.
How do dental insurance waiting periods benefit you?
Dental insurance waiting periods help keep dental insurance costs under control. They prevent patients from receiving costly dental procedures and then dropping the coverage shortly after, which can result in higher premiums for everyone. Basically, waiting periods help keep dental insurance affordable for all customers.
How to get affordable dental insurance
You can either buy dental insurance directly or access dental coverage through an employer. Consider the needs of you and your family so you can get quality dental insurance at the most affordable price.
1: Decide who will be covered: It’s possible that everyone in your family will need preventive care. But dental needs may differ from person to person. For example, children may require services such as fluoride treatments or sealants. Active kids may need help protecting their teeth from injury if they play sports. Adults may need services that help them prevent gum disease, or replace teeth that are lost due to aging or disease. Whatever dental coverage you choose, make sure it will accommodate as many of your family’s needs as possible.
2: Consider pre-existing conditions: While medical insurance may cover certain pre-existing conditions, dental insurance doesn’t always work this way. Many dental plans are designed to help you prevent oral health conditions that can cost a lot of money to fix, such as tooth decay. While it’s still possible to get dental insurance if you have an oral condition that needs to be fixed, there are dental insurance companies that will place waiting periods on certain procedures. This means if you delay signing up for dental insurance until you have an emergency, such as a painful broken tooth, you may end up either having to wait until the procedure is partially or completely covered by your plan, or pay out of pocket to fix the problem immediately.
3: Out-of-pocket dental costs: What your dental insurance will not cover is just as important as what it includes. It’s important to consider how much you can afford to pay for dental services out of pocket in a given year. Dental plans on the market may include any combination of the following out-of-pocket costs:
- Deductibles that must be met before your services are covered.
- Waiting periods before coverage for certain services kick in.
- A coinsurance percentage for which you may be responsible.
- Fee-for-service arrangements where you must pay for services up front and receive reimbursement for some of the cost later.
These costs can be important to consider in the event you need oral care, especially if it’s an emergency.
Disclaimer Information provided above is for informational purposes only and it is not to be construed as tax, legal, investment or medical advice. Please note that individual situations can vary, therefore the information should be relied upon when coordinated with individual professional advice.