People buying individual dental insurance (not group-sponsored dental) may receive an unwelcome surprise when enrolling: a waiting period. Unlike regular health insurance, in which coverage usually starts immediately or soon after issue, dental plans often come with a delay between enrollment and the actual onset of coverage for some or all services. The delay could be six months to a year or even longer.
What’s the big idea? The waiting period prevents people from signing up with the intent of receiving coverage for a procedure and then canceling the plan once complete.
- Some individual dental insurance plans require participants to wait before covering certain services.
- Main alternative types of dental insurance coverage are group, PPO, and discount dental plans.
- Six highly rated dental insurers are Delta Dental, Humana, Cigna, Spirit Dental, Denali Dental, and Physicians Mutual.
- Delta, Humana, Physician’s Mutual, and Cigna have no waiting periods for preventative and diagnostic services.
- Spirit Dental and Denali Dental have no waiting periods for preventative and major services.
Types of Coverage
Some categories or types of dental insurance plans offer immediate coverage. Understanding what types of plans you qualify for aides in the decision-making process and prevent surprises.
Often, there is no waiting period in a group plan (e.g., employer-sponsored plan). Of course, if you were eligible for a company-based plan, you probably wouldn’t be shopping around on your own. However, the same privilege might be available in a group plan offered through an organization, such as AARP. With their plans, there’s no waiting period for preventative services, at least.
Preferred Provider Organization (PPO)
Some insurance plans organized as preferred provider organizations (PPO s) do not have a waiting period. “Preferred provider” refers to a dentist who is in the insurer’s network. It’s advantageous to visit one; some plans cover non-participating practitioners’ services, albeit to different degrees and at different rates.
Blue Cross Blue Shield has a plan called BlueCare that does not have a waiting period for preventative services and many non-surgical procedures. United Healthcare’s United Health One is another. Major surgical treatments and restorative work do require some wait time; although, that can be curtailed to some extent if you’re coming off another dental plan.
Discount Dental Plan
Discount dental plans are not technically insurance. They are, as the name implies, organizations that have negotiated discount prices with participating dentists who make up their network. You pay an annual fee to have access to these dentists and their reduced rates.
Discount dental plans do not have a waiting period. If you want to sample some options, you might want to search a source, such as DentalPlans.com.
Specific Dental Insurers
The following highly rated dental insurers have plans with no waiting periods for one or more classes of service. Note that the benefit of immediate coverage often comes with conditions.
Delta’s PPO Direct and PPO Direct Plus plans feature no waiting periods for Type I diagnostic and preventative services, includes exams, cleanings, and X-rays. Delta 100% covers Type I services.
Covered at 70%, Type II services (basic procedures like fillings and extractions) have a six-month waiting period.
Covered at 30%, Type III services (major procedures, including crowns and dentures) have a 12-to-24-month waiting period.
Humana dental plans vary by state. Some plans have no waiting period for preventative services. Others have a six-month wait for fillings and basic types of oral surgery.
The HumanaOne Dental Loyalty Plus plan provides immediate coverage; there is no waiting period, even for oral surgery. The “catch” is that coverage amounts and percentages are lower in the beginning and gradually increase each year, reaching their maximum in year three.
Cigna’s Dental 1500 Plan provides 100% in-network coverage for exams, X-rays, and cleanings, with no waiting period for those who previously had dental coverage. There is no deductible for these services either.
Basic restorative procedures require a six-month wait. Major restorative services have a wait time of one year. However, Cigna waives the waiting periods if you present acceptable proof of previous dental insurance. There is also a $1,000-lifetime orthodontia benefit with a one-time $50 deductible.
One unique company, Spirit Dental, provides full coverage for all classes of service immediately with no waiting period. Depending on your state of residence, orthodontia may require a waiting period.
Coverage varies by state and is subject to state regulations. Plans range from Spirit MaxCare Silver to Spirit MaxCare Gold to Spirit Dental Indemnity Gold. The percentage of the cost of the service that is covered goes up each year for three years and can be adjusted for a higher annual maximum based on the premium you pay.
Another company with no waiting periods for any services is Denali. Like Spirit, Denali offers a range of coverage (based on the premium you pay) as well as increasing coverage based on the number of years you have an active policy in force. Rates vary by state and coverage is regulated by the state in which you reside.
If you live in an area where dental care is inexpensive and/or you rarely require major dental procedures, you may want to consider plans from Physicians Mutual.
The policies have no waiting period for preventative care, a three-month waiting period for basic care, and a twelve-month waiting period for major care. The company pays a set amount for each procedure – based on the plan you choose – no matter where you live.
The Bottom Line
In addition to companies listed here, you can check out other options by using a dental insurance search engine, such as the one available at the Dental Insurance Store. There you can plug in your age and ZIP code and get a list of plans available in your area. You can also select various options that may be important to you, such as “no waiting period.”
Finally, don’t wait for your oral problems to reach a crisis stage before you start researching. A true emergency is not a time to shop for anything, including dental insurance.