Can an individual buy full coverage dental insurance with no waiting period for pre-existing conditions? You know – something that is real and not a discount plan.

For most people, the answer is probably not for anything beyond exams, X-rays, and cleanings.

The companies would lose money by offering immediate coverage for everything. Patients frequently cancel after the dentist completes the work (adverse selection).

Therefore, the companies devise features to discourage this behavior. Read the fine print to learn about graded benefits and exclusions for pre-existing conditions such as missing teeth.

On the other hand, PPO plans do contain instant coverage when you use an in-network provider. The difference between the submitted and allowed amounts is often quite large.

Individual Dental Insurance With No Waiting Period

Individual dental insurance that covers everything with no waiting period often contains caveats. Unlike group plans through employers, the issuing company cannot pool risks. Therefore, the companies place restrictions such as graded benefits and exclusions for pre-existing conditions.

Dental financing programs allow patients with existing issues to get started right away with treatment. The extra cash also helps fund premium payments for plans that kick in later.

Treatment Category

Individual dental insurance that covers everything without waiting periods often contains graded benefits or specific exclusions related to certain treatment categories. Be sure to read the fine print before signing up. Instant coverage is very rare – despite what the headlines often read.

Preventive Services

Most dental insurance plans will cover preventive services without a waiting period, graded benefits, or exclusions listed in the fine print. Preventive care does what it suggests. It keeps your mouth, teeth, and gums healthy and minimizes future claims for the carriers.

Therefore, expect most private plans to offer these immediate payments for preventive care. The plan would pay at 100% of allowed charges.

  • Oral exams
  • Prophylaxis (cleaning)

Basic Services

Many no waiting period dental insurance plans will feature graded benefits for basic services. Graded benefits mean that the plan pays a smaller percentage of the “allowed charges” during the early years of the policy.

  • Year 1: 50%
  • Year 2: 60%
  • Year 3: 80%

The patient or member is responsible for paying the remaining charges for these basic services. Below are some of the treatments that may fit into this category.

  • Bitewing X-rays
  • Fillings
  • Anesthetics
  • Fluoride
  • Sealants
  • Space Maintainers

Major Services

Dental insurance without waiting periods for major services feature lots of fine print. Read the policy language carefully if you are seeking instant coverage for crowns, dentures, implants, or root canals.

Be on the lookout for graded benefits or exclusions for pre-existing conditions such as a missing tooth.

  • Graded benefits will limit the percentage of “allowed charges” the plan pays for major services such as crowns, dentures, extractions, implants, or root canals. The percentages begin at the lower end.
    • Year 1: 25%
    • Year 2: 30%
    • Year 3: 50%
  • A missing tooth clause means that the plan will never cover major services such as dentures or implants. Members will have to pay 100% out-of-pocket to replace any tooth that was missing before the coverage effective date.

Orthodontic Braces

Dental insurance without a waiting period for orthodontic braces should not be necessary. The need to straighten crooked teeth rarely comes as a surprise. This holds true for adults as well as teenagers.

Do the right thing. Buy a plan with plenty of lead-time.

However, some people are surprised by the need for braces. In certain cases, health insurance can pick up much of the tab immediately.

  • Non-biting injuries requiring the repositioning of teeth
  • Malocclusion caused by a cleft palate

Cosmetic Treatment

Dental insurance with no waiting periods for cosmetic services should also be unnecessary. Cosmetic procedures address appearance rather than decay, infection, malalignment, or tooth pain. Patients can schedule these elective procedures at their convenience.

Cosmetic dentistry riders are optional features that patients can add to their base plan. A rider could make these services more affordable after a 24-month delay.

  • Bonding
  • Labial veneers
  • Occlusion adjustments
  • Enamel microabrasion
  • Odontoplasty
  • Internal and external bleaching

Plan Design

What is the best individual dental insurance without a waiting period that covers everything? The varying plan designs that you can choose between can help you spot the optimal choice.

PPO

A PPO dental insurance plan with no waiting period has a hidden upside – despite the graded benefits and exclusions noted above. PPO stands for Preferred Provider Organization.

A preferred provider is a practice that agrees to accept the “allowed amount” as payment in full for any service. The allowed amount is a pre-negotiated “wholesale” fee that is often quite lower than the “retail” price charged to other patients.

In other words, a PPO provides instant baked in savings. See the section below on Network savings.

Supplemental

You are unlikely to find supplemental dental insurance without waiting periods. By design, supplemental plans pay a fixed amount for each ADA coded service. Therefore, you will not find deductibles or graded benefits as with other plan designs.

The fixed payment amount means that imposing waiting periods is the only way to make the premiums affordable. However, you will find that supplemental plans will contain a missing tooth clause.

Discount

Discount dental plans are the only design without a waiting period. However, discount offerings are not insurance. A third party company is not paying claims to your provider after a covered service.

Discount plans do what they say. In exchange for an affordable monthly fee, you gain access to a network of dentists, oral surgeons, periodontists, and orthodontists who agree to charge lower prices to card-carrying members. They offer instant savings.

Medicaid

Medicaid can act as a form of no waiting period dental insurance for low-income families and pregnant women. In fact, this public program will often agree to pay claims three months retroactively for new enrollees.

However, Medicaid does not cover everything for every enrollee. Each state determines what the entitlement will cover. Therefore, expect to find plenty of variety across all 50.

  • Emergency extractions only: 18
  • Medically necessary (non-biting accidents): 50
  • Preventive (exams, X-rays, cleanings): 27
  • Restorative (fillings, root canals): 25
  • Periodontal (gum surgery, scaling): 18
  • Full & Partial Dentures: 25
  • Oral Surgery (wisdom tooth extraction): 24

This state-by-state chart depicts possible coverage for the three most common procedures. Contact the company managing the plan in your state to verify coverage. Do not rely on the information in this chart.

Root Canal Braces Implants
Alabama
Arizona
California X X
Colorado X X
Florida
Georgia
Illinois
Michigan
Missouri
New York X X
North Carolina X
Ohio X
Oregon X X
Pennsylvania X X
Texas
Utah

Veterans

Dental insurance for Veterans without a waiting period will be hard to find. The U.S. Department of Veterans Affairs operates two programs for retired service members and their families.

Be careful to note that both options require advance enrollment and do not cover pre-existing conditions without a waiting period.

  • Former service members may be eligible for VA dental care under Class IIA, IIC, IV, or I for any necessary treatment to maintain or restore oral health and masticatory function.
  • The VA Dental Insurance Program (VADIP) is available for enrollment in the program beginning November 15, for coverage to start December 1.

Private companies also market programs aimed at veterans. However, they follow the same parameters already noted above for the individual market.

Affordable Full Coverage Dental Insurance Plans

Full coverage dental insurance with immediate benefits will also have cost-sharing features that make the premiums more affordable. The company simply cannot market cheap coverage that pays 100% right away. Something has to give in order to make the numbers work.

Member cost sharing is the method to make the numbers work. When requesting a quote, make sure that you compare the annual maximum, network, deductible, and coinsurance baked into each plan.

Annual Maximum

Full coverage dental insurance with no annual maximum may not be as affordable as it first seems. The annual maximum caps the benefits that the plan will pay in any year. Without a yearly limit, the company exposes itself to huge losses – with little premium to offset the claims.

Patients needing lots of very expensive oral care would snap plans that cover everything without an annual maximum. Therefore, expect the company to throttle back other cost-sharing elements in order to keep the premiums low.

  • Narrower networks of participating providers such as with a DMO
  • Larger deductibles to discourage patients from seeking care initially
  • Higher co-insurance percentages for each service to boost patient investment
  • Bigger copayments for each treatment to discourage overuse

Network

Full coverage dental insurance with immediate benefits can also have narrower networks of participating providers in order to keep the premiums low. A narrow network could mean that you have to change dentists in order to make your comprehensive oral care more affordable.

A dental plan network is a list of participating providers who agree to accept a pre-negotiated fee for each service they perform. Look at the explanation of benefits for any claim and you will see three sets of charges with names similar to these.

  1. Submitted amount: is the retail price the dentist charges
  2. Allowed amount: is the wholesale price negotiated in advance
  3. Network savings: is the difference between the two figures

If you pick an out-of-network provider, you lose the network savings! The lost savings do not count towards the annual maximum. In addition, your plan may have higher deductibles and co-insurance percentages for non-participating dentists.

Therefore, consider the network when comparing quotes.

Deductible

Full coverage dental insurance with instant benefits may also have larger deductibles in order to keep the premiums low. However, a very large deductible means that your total costs for extensive oral care may be less affordable overall.

A deductible is a minimum amount the member must pay every year before the company begins to honor claims. For example, a plan with a $500 deductible will not begin paying claims until the member covers the first $500 out-of-pocket each year.

Plans may have individual and family deductibles to meet every year. Therefore, forecast the annual premiums plus these out-of-pocket expenses when evaluating your quote.

Co-Insurance

Full coverage dental insurance with immediate benefits may also have higher co-insurance percentages in order to keep the premiums low. Once again, higher co-insurance percentages mean that comprehensive oral care may be less affordable than at first glance.

The dental co-insurance is the percentage of the allowed charge that the member must cover out-of-pocket for each service. For example, a plan with a 50% co-insurance feature will pay $500 on a $1,000allowed charge. The member owes the other $500.

Expect each plan to vary the co-insurance percentages by treatment category. It could follow a pattern similar to this example.

Category Treatment In-Network Out-of-Network
Preventive
Exams 100% 100%
Cleaning 100% 100%
X-Rays 100% 100%
Fluoride 100% 100%
Sealants 100% 100%
Basic
Fillings 80% 70%
Extractions 80% 70%
Endodontics 80% 70%
Periodontics 80% 70%
Oral Surgery 80% 70%
Major
Crowns 60% 70%
Restorations 60% 70%
Bridgework 60% 70%
Dentures 60% 70%
Orthodontics 60% 70%