No matter how tight your budget, it’s not a good idea to play a waiting game with dental insurance. Why? Because if you delay purchasing insurance until oral health problems are too severe to ignore, chances are good that you will end up paying for both insurance and the dental care that you hoped the insurance would cover.
A lot of people figure they can hold off on buying insurance until they absolutely need to get dental care. What they may not know is that dental insurance imposes “waiting periods” – a set time that has to pass before you are covered for more expensive dental treatments. And chances are good that if you’re delaying dental care, eventually you’re going to need a lot of expensive treatments to address the damage.
But during the waiting period, your insurer will not pay anything for specific treatments or procedures. You will need to pay the full price for that care, right out of your pocket. You will not be reimbursed after the waiting period is over. You’re on your own.
Insurance companies tend to organize dental procedures into three groups: Preventive, Basic and Major:
- Preventive dental care usually includes annual checkups, x-rays, routine cleanings and similar treatments.
- Basic procedures are relatively uncomplicated services, such as fillings, simple extractions and some types of deep cleanings.
- Major procedures, often described as “restorative,” often take more than one visit to complete, and may require multiple steps. Crowns, root canals, bridges, oral surgery, dentures and implants would be considered major/restorative procedures by most insurance plans.
There is usually no waiting period for preventive care. You may have to wait for three to six months for basic procedures, and six months to a year for major procedures. Plans vary, so make sure to check a plan’s documentation for the waiting periods associated with any plan you’re considering purchasing.
Some insurance companies also impose restrictions, or additional waiting periods, that control how often the insured can get particular treatments. A policy holder may, for example, be restricted to getting their dentures replaced once every five years, or fillings replaced every six years.
There are also some treatments that many plans won’t ever cover, such as replacements for teeth that were missing when you joined the plan, or dental work that is already in progress. Cosmetic services and dental implants are also rarely covered by traditional dental insurance plans.
It’s always a good idea to check with your insurance company about whether a specific treatment is covered before your dentist begins working in your mouth. Ask for a treatment plan with ADA dental codes, call your insurance company and review the treatment plan with them to avoid any unpleasant financial surprises.
So why buy dental insurance at all, if you have less than perfect teeth? Because in some cases, you get a discounted price for care as a member of an insurance plan, even if your plan won’t cover the cost of treatment. Check with your plan provider to see if this benefit applies to the plan you’re considering buying.
Also, there are some dental insurance plans, such as myCigna 1000 and myCigna 1500, that will waive the waiting period requirements if you can prove that you’ve had dental insurance in the recent past.
This is an excellent feature that can save you a lot of money if you were recently insured by an employer but no longer have coverage, or if you’re simply unhappy with your current plan and want to switch but are worried about dealing with waiting periods again.
Additionally, dental insurance does a good job of helping people afford the preventive care that they need to keep their teeth, gums and mouth healthy. With regular checkups and cleanings, and good oral health practices at home, you’re much less likely to need costly treatments intended to salvage or replace decaying, weak teeth. Everyone wins the insurance company controls cost, insured patients have healthier smiles and save on their out-of-pocket dental treatment costs.
According to the Children’s Dental Health Project, children who have their first preventive dental visit by age one are less likely to have subsequent restorative or emergency room visits. Their average dental-related costs are almost 40% lower over a five-year period for children who receive their first preventive visit after age one ($262 compared to $546).
Older people also benefit from preventive care. An analysis of the public records of Medicare beneficiaries by researchers from the University of Maryland found that those seniors who accessed preventive dental care had significantly reduced needs for expensive restorative procedures and lower dental expenses than beneficiaries who saw the dentist only for treatment of oral problems.
Unlike medical insurance, which really is a necessity, dental insurance may not be the right choice for everyone.
Your options for getting the care that you need now include buying a dental savings plan, the affordable alternative to traditional dental insurance. Dental savings plans do not have waiting periods, annual spending caps, deductibles or exclusions for pre-existing conditions. Members of a dental savings plan can expect to pay 10%-60% less at the dentist.Many of the dental savings plans offered by :DentalPlans also include savings on general healthcare needs, including telemedicine, vision and hearing services, prescriptions, chiropractic, and more. Dental savings plans can help make essential healthcare affordable for people who are under-insured, want to save on services not covered by their insurance, or those who have exhausted their benefits.
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