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Why Do Dental Insurance Plans Have Waiting Periods?

March 30, 2021

Filed under: Uncategorized — Ben Tindal @ 12:29 pm
woman confused about dental insurance waiting periods

You purchased a dental insurance policy so that you could save money on treatments to keep your smile healthy. However, you then learned that you have to wait a certain length of time before you can access the full benefits of your plan. Don’t worry – this period won’t last forever. Read on to learn more about dental insurance waiting periods and how you can make the most of your coverage.

Dental Insurance Basics

Unlike medical insurance, dental insurance focuses more on preventing health problems than treating them. Research shows that regular preventive care can greatly reduce the chances of needing an expensive dental procedure down the road. If an issue arises, though, your insurance will help decrease the amount you’ll have to pay out-of-pocket. While each plan differs, most of them cover:

  • 100% of preventive care (checkups, cleanings, etc.)
  • 80% of minor restorative care (fillings, crowns, etc.)
  • 50% of major restorative care (dentures, tooth extractions, etc.)

After signing up for insurance, you might have to wait a certain amount of time before you can utilize all of your coverage. Depending on the specifics of your plan, this waiting period might last from a few months to an entire year. However, that doesn’t necessarily mean you can’t use your insurance. Instead, there may be some benefits that you can’t use right away.

What You Need to Know About Dental Insurance Waiting Periods

Dental insurance can often be confusing. Here are some important facts to know about dental insurance waiting periods:

  • Waiting periods do not always include routine services.
  • Not all insurance policies have waiting periods (such as employer-based plans).
  • If you’ve switched employers but still have the same benefits plan, you might not have a waiting period.
  • If you’ve recently had dental insurance but changed to a new provider, some of your limitations might be waived.

What Treatments Are Covered During Dental Insurance Waiting Periods?

Dental insurance companies established waiting periods to ensure that a person does not simply purchase a plan, use it to help pay for a major procedure immediately afterward, and then cancel their plan.

Generally, only certain services are affected by waiting periods based on the category they fall under. For example:

  • Basic care may have a waiting period of three to six months, while major procedures may require six months to a year of waiting.
  • Most preventive services (exams, X-rays, etc.) are unaffected by waiting periods.

If you’re worried about the limitations of your dental insurance coverage, your dentist’s team can help you navigate your plan and make the care your smile needs affordable.

About the Author

Dr. Ben Tindal is a prosthodontist who achieved his Doctor of Dental Medicine degree from the University of Florida where he later obtained his master’s degree and certificate in prosthodontics. His office gladly accepts virtually all dental insurance plans and can help you traverse the ins and outs of your coverage. To learn more or to schedule an appointment at his Sarasota dental office, visit his website or call (941) 225-2520.