Dental insurance waiting period explained

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.

 

Want to learn more about dental insurance? Visit our Dental 101 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/