How to Navigate Dental Insurance Waiting Periods

When you’re looking to purchase dental insurance, you’ll often see the term “waiting period.” If you need dental care soon, this can present a problem. This article explains what a waiting period is, how you may be able to work around it, and what to do if you can’t wait to see a dentist.

What is a dental insurance waiting period?

When joining a dental insurance plan, you may have to wait before you can receive your full benefits on specific procedures. You typically pay out of pocket during the waiting period without reimbursement for dental services, excluding preventive care.

Not all dental insurance plans have a waiting period. Dental Health Maintenance Organization (DHMO) is a type of dental insurance with no waiting periods.. But there are restrictions, the most significant is that DHMO plans typically don’t offer out-of-network coverage. If you see a dentist out of network, unless it’s an emergency you will likely pay out of pocket. Check to see what dentists near you accept the plan, as DHMO networks may offer less choice than other types of dental insurance.

Dental Preferred Provider Organizations (DPPO) insurance plans typically do have waiting periods, which vary depending on the type of treatment you’re seeking. With DPPO, you can opt to see a dentist out of the plan’s network, but your costs may be higher.

If your dental insurance has a waiting period, here’s what you might expect:

• Preventive services — Services like checkups, X-rays, and cleanings don’t typically have a waiting period.
• Basic procedures — Procedures such as fillings, non-surgical extractions, and treatment for gum disease may have a partial waiting period of approximately three to six months.
• Major procedures — Major services like crowns, dentures, and dental bridges often have a long waiting period, you may need to delay care for up to 12 months.

Check your insurance plan’s information for details about any waiting periods that may be in effect.

There’s a waiting period … but you can’t wait?

Prioritize your health. If your insurance makes you wait for months before you can use it, your oral health will suffer, which may cost you more in the long run than getting treatment right away. For example, a small cavity can easily turn into an infection that needs root canal treatment (and perhaps even a dental crown) if left untreated.

Here are some actions you can take to get treatment right away:

• Talk with your dentist. Ask your dentist if they can do anything to help manage the cost. If you’re a regular patient, they may be able to give you a treatment plan that prioritizes treatment based on what you need right now, allowing you some time to save up in the meantime.

• Get a waiver. If you did have dental insurance until very recently, you may be able to get the waiting period waived. Talk to the insurance provider or your insurance agent about this, they will likely require proof of prior coverage. This is more likely to be successful if your previous insurance was with the same provider.
• Join a dental savings plan. Dental savings plans are an affordable alternative to dental insurance. Plan members report saving an average of 50% on their dental care.

Dental savings plans vs. dental insurance

Dental savings plans are an affordable alternative to traditional dental insurance. Plan members report saving an average of 50%* on their dental care.

And, unlike dental insurance, with a dental savings plan you don’t have to worry about deductibles, annual spending limits or waiting before you qualify for reduced rates. You can use your plan within 72 hours of joining to save on virtually all dental care, from checkups to root canals, crowns, bridges and dentures – many plans even include discounts on treatments like dental implants and cosmetic services that insurance rarely pays for. There are plans that fit every dental care need and budget.

Want help choosing the dental insurance or dental savings plan that’s right for you? Give us a call at 1-833-735-0399. If you’re considering a dental savings plan, you can also use our calculator below for a quick look at how much you can save on virtually all of your dental care.

*Discount Health Program consumer and provider surveys indicate average savings of 50%. Savings may vary by provider, location, and plan.