Medicare dental plans with no waiting period

What is a dental benefit waiting period?

A dental benefit waiting period is the amount of time after purchasing a dental insurance plan that you must wait before you are eligible to receive benefits for treatment. Waiting periods differ from plan to plan, but there is typically no waiting period for preventive or diagnostic services such as routine cleanings and basic exams.

Conversely, your dental plan may have a 6- to 12-month waiting period for restorative services such as filings and non-surgical extractions, where a 12-month waiting period is often standard for major services such as crowns or dentures. If you receive services during a waiting period, your dental coverage may not pay for them.

Types of dental insurance waiting periods

1. Employer waiting period: Employers that offer benefits may institute a waiting period ranging from a few days to a full year. Check your coverage for details.
2. Pre-existing condition exclusion period: This is the period of time during which dental insurance will not pay for care related to a pre-existing condition. This is designed to avoid situations where an individual buys insurance solely to cover a major procedure or oral health condition learned of prior to enrollment.1 Some basic pre-existing conditions, however, such as cavities, will be covered right away.  The waiting period is typically applied only to more serious procedures and conditions.

Do all dental insurance plans have a waiting period?

No, not all dental insurance plans have a waiting period. DHMO plans commonly have waiting periods, whereas most dental discount plans usually do not. It is important to check with your dental insurance administrator to determine your applicable waiting periods.  

Do waiting periods vary for different dental services?

Yes! As mentioned above, there are no waiting periods for either diagnostic services, such as x-rays, or preventive services, like cleanings. In most cases, major dental work, such as crowns, bridges, and dentures, has a waiting period of 6,12, or 24 months.

What other factors should I be aware of?

Because waiting periods will differ depending on the plan, it’s important to read your description of benefits carefully and ask the right questions. Waiting periods are not the only factor that will affect costs. Here are some other factors to consider.

Prior coverage

In certain cases, a waiting period will be waived if a comparable dental insurance plan was terminated in the 30 to 60 days prior to the effective date of your new plan, but your former dental plan must include very similar coverage.

Graduated benefits/incentive based

Graduated dental benefits increase or otherwise change over time. For example, with Delta Dental of Tennessee’s Advantage Plans you can receive basic services that are covered at 25% in year one, 50% in years two and three, and 80% in year four and beyond.

For major services such as crown repair and oral surgery, members are covered at 10% - 25% in their first year, and 25% - 50% in year two and beyond depending on the plan purchased. Many individuals are drawn to this option because it allows them to receive a discount for the services they need and takes the weight off having to pay in full during a waiting period.

Discount plans like Delta Dental Patient Direct

Discount plans, like Delta Dental Patient Direct, have no waiting period and no paperwork to file. Enrollees simply pay the discounted fee directly to the dentist at the time of treatment.

After enrolling in a new dental plan, coverage for certain treatments could be subject to a waiting period. So, it’s important to be aware of your plan's specifications prior to enrolling.

When possible, remain enrolled in your current insurance plan until you purchase a new plan, and avoid a coverage gap of more than one month. In many cases, a waiting period can be waived if you recently had comparable coverage.

Always do your research, ask for detailed information about new dental coverage, and stay on top of your dental health so you can have a healthy smile for years to come.

Additional resources

Looking for more information? Brush up on dental benefit basics.

• Understanding your explanation of benefits
• Choosing a dental insurance company
• What is the value of dental insurance

Want to learn more about dental insurance? Visit our individual dental insurance page.  

This article was developed jointly by Delta Dental Plans Association and Delta Dental of Tennessee

Sources:

1https://www.healthcare.gov/glossary/pre-existing-condition-exclusion-period-job-based-coverage/

Just found out you need a major dental service (such as a crown, bridge, or dentures) and don’t currently have dental coverage? You could be in luck with dental insurance with no waiting period.

What is Considered Major Dental Work?

Major dental work refers to services that replace missing or damaged teeth. In dental insurance, major work falls into the most extensive of the three groups used to categorize most dental care:

• Preventative Services: Diagnostic and preventive services, such as cleanings and X-rays
• Basic Services: Basic restorative care, such as fillings and extractions
• Major Services: Major restorative care, such as root canals and crowns

Why Does My Dental Insurance Have a Waiting Period?

Dental insurance waiting periods help insurance companies keep costs low. Establishing a waiting period helps prevent consumers from purchasing plans only when they need extensive work they can’t afford on their own, then dropping their coverage. Waiting periods for major work help encourage regular exams and help keep membership high enough for premiums to provide coverage for those insured.

How Dental Insurance Waiting Periods Work

Depending on the insurance plan, dental policies may require that you have your policy for up to a year for major dental work before it’s covered. If you receive major dental work before the completion of the waiting period, you will be responsible for the entire bill.

One important point to note: if you had dental coverage prior to enrolling in a new plan, the waiting period might be waived. Check with your insurance company prior to any procedures so that you are aware of their waiting period policy.

What Services Does Dental Insurance With No Waiting Periods Cover?

Dental Insurance With No Waiting Period:

• Provides fast coverage for major work such as crowns, bridges, and dentures
• Reduces your out-of-pocket expenses
• Helps you receive prompt dental care to prevent further deterioration

Full-coverage dental plans with no waiting periods insure services such as:

• cleanings
• fluoride treatments
• fillings
• X-rays
• extractions
• root canals
• crowns

Dental Coverage Options

DPPO

A Dental Preferred Provider Organization plan (DPPO) gives you the ability to visit the dentist of your choice, but using an in-network provider will cost less out-of-pocket. You don’t have to designate a primary-care provider and there’s no referrals needed. However, these plans typically have waiting periods for major dental work. With DPPOs, you’ll also need to meet an annual deductible and pay coinsurance before your plan covers eligible benefits.

DMO/DHMO

A Dental Health Maintenance Organization (DMO or DHMO) requires members to use in-network providers but usually grants coverage for a broad range of services, including major dental work. With DHMOs, you typically pay a specific dollar amount based on the service you are obtaining with no waiting period, no annual maximum, and no deductible.

Graduated Benefits

Some dental insurance plans provide increasing benefits the longer you keep your plan. For example, the plan might pay 25% the first year of your plan, 50% the second year, and 80% for years three and beyond. Keep in mind that full coverage doesn’t mean that all your services are paid for. Full-coverage dental insurance means that many major services are at least partially covered.

Discount Dental Plans

An alternative no-waiting period dental care option is a dental discount plan. Discount dental plans are not dental insurance. These plans offer a wide array of discounts on various dental services from in-network dentists. Discounted services vary depending on the plan.

What Is The Best Dental Insurance for You With No Waiting Period?

With a variety of dental plans to choose from, there’s no one plan that works best for everyone. HealthMarkets makes it easy to find full coverage dental insurance with no waiting period from multiple companies to find the best plan for you. Compare dental plans today.

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