You might think that buying dental insurance with no waiting periods would be the best way to reduce your oral care costs.

After all, paying a small monthly premium and getting an enormous immediate benefit in return should be the ideal way to make dental work more affordable.

Guess again. The issuing companies have no interest in trading hundreds of dollars in exchange for thousands in instant claim payments. Would you?

Therefore, be prepared to practice delayed gratification – although a new policy could pay off in the end if you need significant dental work in later years.

See how the numbers work for a real-world PPO policy. Then, explore other designs and alternative approaches to making dental work economical.

Full Coverage Dental Insurance without Waiting

Full coverage dental insurance with no waiting periods may not make oral care more affordable initially – but could reward you handsomely over the long-term. Follow along as we break down and review the numbers for an example plan covering everything from A to Z.

Below is a real-life quote from a leading provider with a monthly premium of $180 for family coverage.[1]

Year 1Year 2Year 3

Preventive

100%

100%

100%

Basic

50%

60%

80%

Major

25%

30%

50%

Orthodontic

25%

25%

50%

Annual Max

$1,200

$2,500

$5,000

Shortest Wait

Dental financing programs have the shortest waiting period for every type of treatment and often represent the best option for people in a hurry or with preexisting conditions.

The first thing you should notice from our example is the time it takes for your premium investment to breakeven – if you hit the maximum every year and your provider is out-of-network with the plan (see PPO below).

YearCostBenefitReturn

1

$2,160

$1,200

-$960

2

$2,160

$2,500

$340

3

$2,160

$5,000

$2,840

In other words, you could have to delay gratification for at least two years before your investment proves slightly economical. Borrowing money could provide a faster route.

PPO Savings

Our example of full coverage dental insurance without waiting periods is a PPO (Preferred Provider Organization) plan, which includes hidden savings that are the key to your oral care’s overall affordability.

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

For example, suppose our family of four (two adults and two children) reaches the annual maximum every year when utilizing a PPO in-network dentist and the allowed charges are 30% lower than what the provider charges otherwise.

YearMax BenefitRetail ChargeNetwork Savings

1

$1,200

$1,714

$514

2

$2,500

$3,571

$1,071

3

$5,000

$7,143

$2,143

Did you notice the oddity in the math? The retail charge is a proxy for the total value received in return from the PPO plan (benefits paid plus savings). The total return reaches breakeven at some point in year two and could snowball after that.

YearPremiumsValueReturn

1

$2,160

$1,714

-$446

2

$2,160

$3,571

$1,411

3

$2,160

$7,143

$4,983

Preventive Services

Our example full coverage dental insurance plan starts paying right away for preventive services at 100% of allowed charges, without any preexisting condition exclusions. In this illustration, recommended exams and cleanings alone make the new policy cost-effective.  

Suppose our family has two children and every member (four in total) takes full advantage of the preventive benefits.

ServiceYearly LimitBenefitTotal

Oral Exam

2

$38

$304

Cleaning

3

$75

$900

As you can see, our family of four people achieves two critical milestones just by going to the dentist for routine checkups and getting their teeth cleaned regularly.

  1. Offsets $1,200 of the year one premium investment even when every family member has perfectly healthy teeth
  2. Consumes the entire year one annual maximum of $1,200, leaving zero claims capacity for basic and or major services until year two

Basic Services

Our example full coverage dental insurance also pays for basic services instantly with graded benefits that scale higher with time. The plan could also reduce your out-of-pocket costs for simple fillings.

Suppose each of your family members (4) has one cavity every year, and the allowed amount for an amalgam filling in a back molar is $100.

YearBenefitPaymentYour Cost

1

50%

$200

$200

2

60%

$240

$160

3

80%

$320

$80

The payout of basic services claims is unlikely to exceed your annual premium investment of $1,800 because the expenses are so small. Below are other treatments that fit into this category.

  • Space maintainers
  • One bite-wing X-ray annually
  • Sealants under age 16
  • Topical fluoride treatment under 16

Major Services

Our example full coverage dental insurance also pays for major services immediately with graded benefits that scale higher over time. However, a critical exclusion and the annual maximum combine to limit the plan’s cost-effectiveness for certain treatments.

First, a missing tooth exclusion clause could exclude benefits for major restorative services such as dentures and implants. The plan will not pay for prosthetic devices under three common scenarios, with caveats that rarely apply.

  1. Teeth lost before the effective date unless the device replaces natural teeth lost or extracted while covered under the policy
  2. Teeth extracted within the first six months of the plan start date unless the policy replaces a prior plan with no gap in coverage
  3. Congenitally missing teeth, unless you are replacing a current fixed bridge or denture

Second, major restorative services can leave you with enormous left-over bills in addition to your premium investment. For example, suppose one family member has a single dental implant installed each year for teeth that do not set off the exclusion clause, and the allowed amount is $3,000.

Extractions – $150 Allowed Charge

YearBenefitPaymentYour Cost

1

25%

$38

$112

2

30%

$50

$100

3

50%

$75

$75

Implants – $3,000 Allowed Charge

YearBenefitPaymentYour Cost

1

25%

$750

$2,250

2

30%

$900

$2,100

3

50%

$1,500

$1,500

In other words, this plan could save you lots of money on implants in year three. However, you must extract teeth while covered by the policy, and you have the resources to cover left-over expenses and have the patience to delay gratification that long.

Orthodontic Braces

Our example full coverage dental insurance includes claim payments for orthodontic braces right away with graded benefits that scale over time. However, other restrictions limit the ability of this plan to make treatment of malocclusions more affordable.

  • The orthodontic coverage applies only to children age nineteen or younger while receiving treatment. Adults do not qualify for benefits.
  • The plan contains a separate lifetime benefit maximum per child of $1,200.
  • The most expensive treatment steps occur in the beginning when the orthodontist diagnoses and installs the braces.

Suppose two teenagers in our family of four begin orthodontic treatment in years one and four as each reaches age 12 and opts for metal braces. The allowed charge is $3,000 spread unevenly over three years.

YearChargeBenefitPaymentYour Cost

1

$1,500

25%

$375

$1,125

2

$750

25%

$188

$562

3

$750

50%

$375

$375

4

$1,500

50%

$750

$750

5

$750

50%

$375

$375

6

$750

50%

$75

$675

As you can see from this illustration, our family does not hit the $2,400 combined lifetime for braces but must invest in six years of premiums totaling $10,800. Yikes – good thing they need other treatments in the interim and benefit from in-network provider savings.

Immediate Dental Insurance Designs

Our example dental insurance with no waiting periods is just one of many different possible plan designs. Each form of coverage will impact the overall affordability of oral care in unique ways.

Individual

Our example of dental insurance without waiting periods is meant for the individual marketplace instead of group coverage designed for employer groups.  Two significant factors make private options less economical than group plans that you enroll in at work.

  1. Individual plans cannot pool risks with other co-workers without urgent needs for expensive oral care. Therefore, the issuing companies build in the limiting features noted in the sections above (exclusions and graded benefits).
  2. Individual coverage loses the first-dollar tax savings associated with pretax payroll deductions. You can deduct the premiums on plans bought privately using Schedule A. However, you must meet two difficult thresholds before realizing any savings.
    1. Itemized deductions must exceed your personal deduction to qualify
    2. Medical and dental expenses must top 7.5% of Adjusted Gross Income (AGI)

Cosmetic

Dental insurance covering cosmetic procedures right away is either a bait-and-switch, leans on a medically necessary reason rather than improved appearance, or has an optional rider design.

In general, insurance does not honor claims for procedures performed for aesthetic reasons only. Do not expect to find bargains for cosmetic work unless you can support a legitimate claim reason.  

  • Crowns are sometimes medically necessary (although they enhance appearance) because they can prevent a week tooth from splitting or breaking and can secure bridges in place.
  • Porcelain veneers are laminates that adhere to the front tooth surface to improve the appearance and are rarely medically necessary unless associated with acid reflux disease.
  • Tooth whitening improves the aesthetic appeal of discolored or stained incisors and bicuspids with few medically necessary cases

Optional riders attach to a base policy and cover specific cosmetic treatments after a delay: labial veneers, occlusion adjustment, enamel microabrasion, odontoplasty, and bleaching of a discolored tooth.

The bait and switch that you find online often come from companies touting discount plans for cosmetic procedures, which are not insurance (see alternatives).

No Maximum

Dental insurance with immediate benefits will have more restrictive features baked into an offering with no annual maximum. If you open the valve on one limiting factor, another has to close to make the deal reasonable for both parties.

A plan with unlimited benefits each year might include one of these two tradeoffs.

  1. Dental Maintenance Organizations (DMO) could have a tiny network of participating providers with few available appointment slots
  2. Indemnity plans could include hefty copayments that leave patients to self-fund unreimbursed charges

Supplemental

Supplemental dental insurance with instant benefits could be one of two distinctly different plan designs. Therefore, make certain you are researching the form of inexpensive coverage that fits your situation best.

  1. Senior citizens and disabled workers buy supplemental coverage because Medicare Part A and Part B do not honor claims for oral care that is not medically necessary.
  2. Younger people buy supplemental plans that fill holes in their primary plan by paying a fixed amount for each ADA procedure code billed by a licensed dentist.

Secondary

Secondary dental insurance that covers oral care right away is unlikely to prove economical because having dual coverage doubles your premiums while lowering out-of-pocket costs just a little.

A secondary plan could limit benefits in one of two ways.[2] 

  1. Pay the lesser of the normal benefit for a specified treatment or unreimbursed expenses from the primary plan
  2. Include a “non-duplication of benefits” clause, which means the plan will not honor claims if the primary plan paid more than the allowed amount

Instant Dental Insurance Alternatives

Sometimes, dental insurance with no waiting periods is not the best answer for making your oral care more affordable. You have alternatives that might prove more cost-effective in narrowly defined circumstances.

Emergency Services

Private health insurance is an option that might cover emergency dental work immediately without graded benefits, annual maximums, or preexisting condition exclusions. Most people already have this coverage in force, a huge difference-maker when you are in pain and need urgent care.

Plus, the federal government could provide two subsidies.

  1. Premium subsidies make the premiums cheaper
  2. Cost-sharing subsidies reduce unreimbursed expenses

However, you must have a medically necessary reason for any emergency or scheduled oral care, such as non-biting accidents that dislodge or break teeth or treatment for diseases deemed integral to the plan.

Pediatric

Low-income families are more likely to find a pediatric dental insurance alternative they can use right away through Medicaid. The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program mandates minimum oral care standards for children.[3]

  • Relief of pain and infections
  • Restoration of teeth
  • Maintenance of dental health

The Medicaid pediatric coverage is cheapest as the government funds most of the premiums. Plus, new enrollees can file claims for up to three months retroactively.

Discount Plans

Dental discount plans are the only design alternative that offers immediate coverage without limiting features or exclusions for preexisting conditions hidden in the fine print. However, they are not insurance, which means the alternative is a better bargain in the short-term, but less budget-friendly over a decade.

Dental discount plans drive patient traffic to providers from members paying a small monthly subscription fee. In turn, the dentists agree to charge members bargain rates for treatment.

However, discount plans do not make claim payments.

Final Thoughts

Full coverage dental insurance without waiting periods could prove affordable for people willing to delay gratification. However, buying a policy does not instantly put extra money in your pocket.

If something sounds too good to be true, it probably is false. And such is the case for people looking for immediate payback on their oral care.

We walked you through a PPO example where the premium outlay matched the returned value: benefit payments plus in-network savings in year one. Only after twelve months in the life of the policy does it break into the black.

Plus, many people searching for instant gratification find that missing tooth exclusion clauses mean that they do not qualify for any benefit for implants or dentures.

Other design elements such as individual, supplemental, secondary, no maximum, and cosmetic riders all have a unique impact on any choice’s cost-effectiveness.

Finally, health insurance and Medicaid might help with emergencies and pediatric dentistry. Discount plans help everyone else. 

Footnoted Sources:

[1] Spirit Dental All Plans NJ

[2] Delta Dental Dual Coverage

[3] Medicaid EPSTD