When you get dental coverage, you may want to know one thing first. What will it pay for right now?
This guide explains waiting periods. It also covers the other limits that decide what you can use, and when. It is general. It does not describe any one plan.
What a waiting period is
A waiting period is a set time after your coverage starts. During that time, the plan won't pay for some kinds of care.
Many plans have waiting periods for basic or major work. The wait can differ by type of care.
HealthCare.gov warns about this for separate dental plans. A plan with a waiting period won't cover those services until the wait ends. You still pay your monthly premium during that time.
How dental plans group care
Many dental plans sort care into three groups. Plans don't all sort the same way, so check the list in each plan.
- Preventive: checkups, cleanings, and X-rays.
- Basic: fillings and some simple oral surgery.
- Major: crowns, bridges, and dentures.
Many dental plans pay preventive care in full, basic care at a lower share, and major care at a lower share still. Many have waiting periods for basic or major work, and a yearly maximum.
Plans also limit how often they pay for some care. For example, a plan may cover only a set number of cleanings each year.
The deductible and the yearly maximum
A deductible is what you pay before the plan starts to pay its share. Some dental plans don't apply the deductible to preventive care.
A yearly maximum is the most a plan will pay in a year. After you reach it, you pay the rest. Ask each plan how much it is.
Braces
Braces are often not covered right away. Many plans have a waiting period for orthodontia. Some cover it only for children. Some don't cover it at all.
What some plans don't cover
Every dental plan has limits. Some plans don't cover cosmetic work or implants. Ask before you choose.
Some dental plans have a missing-tooth clause. It means the plan won't pay to replace a tooth that was missing before your coverage started. Ask whether a plan has one.
In network vs. out of network
In network, dentists agree to the plan's prices. Out of network, the plan pays up to a set amount. The dentist may bill you for the rest. This is called balance billing.
Check that your dentist is in the network before you get care.
Questions to ask about any dental plan
- Is there a wait for preventive, basic, major, or orthodontic care?
- What is the deductible? Which care does it apply to?
- Is there a yearly maximum? How much is it?
- How often are cleanings, X-rays, and fillings covered?
- Are implants covered?
- Is there a missing-tooth clause?
- Is my dentist in the network?
- Is orthodontia covered for adults, children, or neither?
Read the plan's policy or certificate. It has the full rules.