Learn several secrets to dental insurance that covers cosmetic dentistry before entering an online maze searching for a unicorn you might never find.
First, you are unlikely to get a plan without a waiting period – especially for planned treatments that improve appearance only.
Second, you will find optional riders that pay for designated cosmetic procedures such as veneers, tooth whitening, and Invisalign, but the issuing companies formulate designs that make money for them – not you.
Finally, the tie-breaker is pre-tax payroll deductions. IRS-approved savings on the premiums make the numbers work in your favor!
Cosmetic Dental Insurance no Waiting Period
The first secret is that dental insurance covering cosmetic procedures without a waiting period is either a bait-and-switch, contains obscure exclusions buried in the fine print, or leans on a medically necessary reason rather than improved appearance.
Dental loans and credit cards can get your treatment started right away if you do not want to delay things further – as many impatient patients learn they must do.
Implants
Cosmetic dental insurance covering implants without a waiting period provides an example of hidden exclusions. Dental implants are permanent tooth replacement options that improve appearance while also restoring function but cost far more than removable dentures.
Because implants are not just about aesthetics, some plans will offer immediate benefits but include caveats that rule out many patients or scale back claims.
- Missing tooth clauses exclude coverage for molar, bicuspids, or incisors removed before the policy effective date
- Graded benefits reduce how much the plans pay to replace teeth pulled after the effective coverage date
Crowns
Dental insurance without a waiting period covering cosmetic crowns exemplifies the crossover from medically necessary to purely aesthetic. Crowns are tooth-shaped caps that restore size, strength, shape, and appearance.
A new plan could promise immediate graded benefits (pay less in early years) for crowns because of this procedure’s medically necessary reasons.
- Protect a weak, cracked, or decayed tooth from breaking
- Refurbish a broken or chipped tooth to full function
- Secure dental bridges in place
However, a crown placed over a discolored or misshaped tooth addresses only aesthetics and might not qualify for coverage under the plan. The same logic holds for bonding.
Veneers
Cosmetic dental insurance covering porcelain veneers without a waiting period is an example of a bait-and-switch marketing scheme. If you find an online resource suggesting immediate benefits, they are most likely touting a discount plan.
Discount plans can help you save money on labial veneers right away. However, they are not insurance and leave patients to self-fund the majority of the bill. Participating providers merely agree to charge less to card-carrying members.
Veneers are laminates that adhere to the front tooth surface to improve appearance, strength, and resilience. The treatment typically does nothing to restore oral function, and the primary purpose is aesthetics.
Therefore, most traditional dental plans will not cover veneers unless the provider can establish a medically necessary reason. For example, patients suffering from acid reflux might need to treat the eroded enamel.
Otherwise, you must purchase a rider.
Riders for Cosmetic Dentistry Procedures
Optional riders attached to supplemental dental insurance plans often cover designated cosmetic procedures but include lengthy (24 months) waiting periods. This requirement reveals the second industry secret: issuing companies design products that take in more premium dollars than they pay in claims.
Supplemental dental insurance pays a fixed benefit amount for each covered treatment, making it easy to make illuminating comparisons.
- 3 to 5 years of fixed, upfront premium costs
- 2 to 3 years of variable, downstream claims
As you will see from two examples, funding the premiums via pre-tax payroll deductions via your employer is the best way to make the math work in your favor. For illustration purposes, a married couple filing jointly and earning $60,000 per year avoids two sets of levies.
- Federal income taxes: 22%
- FICA taxes: 7.65%
- Total: 29.65%
Without these savings, the two riders are not suitable investments.
Tooth Whitening
An optional cosmetic dentistry insurance rider covers tooth whitening and other aesthetic services after you make at least twenty-four premium payments. As you can see, this method of funding a brighter smile is not a money-saver at first blush due to the limitations.
- Annual premium: $324
- Benefit maximums
- Yearly: $600
- Lifetime: $1,800
A patient would need to fund five years of premiums ($1,620) to realize the maximum lifetime benefit ($1,800) for tooth whitening and other aesthetic oral care services, which is not compelling. However, a pre-tax savings of 29.65% reduces the upfront costs to $1,140, making the numbers more appealing.
| ADA Code | Description | Benefit |
|---|---|---|
| D2960 | Labial veneer | $200 |
| D3960 | Bleaching discolored tooth | $100 |
| D9952 | Occlusion adjustment | $250 |
| D9970 | Enamel microabrasion | $65 |
| D9971 | Odontoplasty | $125 |
| D9972 | External bleaching arch | $250 |
| D9973 | External bleaching tooth | $25 |
| D9974 | Internal bleaching tooth | $100 |
Invisalign
An optional orthodontic dental insurance rider might cover a portion of Invisalign – a cosmetic procedure to straighten crooked or misaligned teeth. Clear aligners are more expensive than traditional metal braces, which do an adequate job of addressing medically necessary malocclusions.
Let’s walk through a similar example of how the rider might pay for a portion of your Invisalign expenses. Once again, you will see that the investment numbers are not compelling at first.
- Monthly Premium: $27
- Waiting Period: 24 months
- Initial Benefit: $600
- Quarterly Benefit: $200
- Lifetime Maximum: $1,200
In this case, the patient would need to fund at least 33 months of premiums upfront totaling $891 to receive $1,200 in return at the end, which is also unexciting. However, the 29.65% savings from pre-taxing makes the investment less onerous: $627.
Final Thoughts
In summary, dental insurance covering cosmetic dentistry is a misnomer. Traditional plans rarely approve claims for procedures designed to improve appearance alone.
However, the industry knows that people want this type of coverage. So they design features to attract new members while making sure they collect more in premiums than they pay out in claims.
Patients who learn how to read between the lines are best suited to make the right choice. Plans without waiting periods are not what they seem at first glance, so be prepared to fund 24 months of premiums in advance. Then, buy the coverage at work if you can because pre-tax savings tip the scales in favor of a sizable return on your investment in a brighter smile.