A dental insurance waiting period is the time period for new members where basic care (such as tooth extractions, fillings and spacers) and/or major dental services (such as oral surgery, dentures and crowns) are not covered. For many dental insurance plans, preventive dental coverage (which typically includes cleanings and X-rays) are not subject to waiting periods and are included as soon as your dental coverage starts.
A waiting period for your dental insurance will typically not apply when you:
- Change plan types with the same insurer
- Roll over your employer-based dental plan to select a plan from the same insurer
- Select a dental insurance plan featuring no waiting periods
Can you visit the dentist during the waiting period?
Yes, you can visit the dentist during your waiting period, and preventive visits will likely be covered, as most dental insurance plans include coverage for preventive services without a waiting period.
If you require basic care like an extraction or fillings, you may want to consider dental plans that feature short or no waiting periods.
If you need emergency dental work or major surgery within the waiting period, you will likely have to pay the costs of those services out-of-pocket. Be sure to check with your new dental insurer to understand your coverage if you anticipate dental work within a waiting period.
Here's what you can expect for dental insurance coverage, based on the type of care you need, during the waiting period:
Most dental insurance plans will provide coverage for preventive visits, even during a waiting period for other dental procedures.
Most dental insurance plans consider basic care services such as extractions or root removals, cavity fillings, steel crowns and even space maintainers. Some plans do not include a waiting period for these basic care services, while other plans may have a waiting period before basic care services are covered.
Oral surgery, root canals, dentures and inlays/onlays/crowns are typically considered major dental procedures. For major dental procedures, most dental insurers typically have a waiting period of either 6 or 12 months after you enroll. You’ll want to check the plan’s details to understand how long the waiting period is for major dental procedures.
Why is there a waiting period for dental insurance?
As dental insurance is often considered supplemental insurance, some people don’t enroll until they have major dental work to be done. To prevent the risk of policyholders enrolling in a dental insurance plan for major dental coverage then dropping the plan after the procedures are completed, insurers institute a waiting period. This also helps to ensure that patients are receiving appropriate preventive care before any major dental procedures.
Types of dental waiting periods and coverage exclusions
Generally, there are 3 main reasons why your new dental plan will not include immediate coverage:
Employer-based plan waiting periods
If your dental insurance plan is secured through your employer, there may be 2 waiting periods that can affect your coverage.
Your employer may have a waiting period before you are eligible to receive benefits.
Once you are eligible to enroll with a new dental plan through your employer, your dental plan may also include a waiting period for certain services, typically for basic and major services.
Individual dental plan waiting periods for new policyholders
When you purchase a new dental insurance plan, the plan may include standard waiting periods of 3, 6 or 12 months before all dental procedures are covered, as dictated by the terms of the plan.
Most dental insurance plans have no waiting period for preventive care, but may include waiting periods for basic care or major dental services.
Understanding benefit limitations
It’s important to understand if any conditions are (or are not) covered by your new dental insurance plan. The best way to understand what dental procedures will be covered by your new plan is to review your policy, or talk directly with your insurer to explain your concerns and understand their policies.
The following are typical items that a new dental insurance plan may limit coverage for or deny:
- Continuation of dental work performed through a prior dental insurance plan
If you started a dental procedure that was covered by your previous dental insurance plan, your new dental insurer may not cover the completion of that procedure.
- Repairs for crowns, bridges or dentures less than a certain number of years old
Many dental insurance plans will deny coverage for repairs of dental work like crowns, bridges or dentures when the original procedure was less than 3 to 7 years ago.
- Dental appliances (bridges, implants and dentures) for teeth that were extracted through coverage from your previous plan
If your extraction occurred with coverage from a previous plan, additional work on those teeth (such as bridges, implants or dentures) may not be covered under your new plan.
As you transition to a different plan, be sure to work with your new insurer to understand how to best maintain coverage for continuing dental work and obtaining repairs for previous dental work.
Can dental insurance waive your waiting period?
There are some instances where your new dental insurer may waive your waiting period, such as:
- When you continue coverage with the same insurer after you change employers.
- When you choose to roll-off your employer-sponsored plan and purchase individual insurance with the same insurer.
- If you change insurers, but do not have a break in your dental insurance coverage, some new insurers will waive the initial waiting period for new policyholders. Your new insurers will likely want to see similar dental plans used to accept this waiver.
Find the right dental insurance plan for your needs
If you are planning on getting basic dental care (like extractions or fillings) or major dental services (such as root canals, dentures or crowns), dental insurance plans with waiting periods may mean paying out-of-pocket or delaying dental care until the waiting period expires.
There are several ways to ensure that a waiting period doesn’t translate to out-of-pocket costs or a potentially painful wait for care:
- Speak with your new insurer about waiving your waiting period based on your continuation of coverage from a previous dental insurance plan.
- Seek out new dental insurance plans with no waiting periods for basic care or major surgery.
To learn more about waiting period waivers or Humana dental plan options that have no waiting periods, talk with a Humana dental insurance expert by visiting our Help page.