You probably do not want to delay treatment if you need wisdom teeth removed because of the pain.
However, waiting periods (how long after getting the coverage before you can begin using it) might stand in your way. Insurance companies do not like trading a small monthly premium for an expensive claim followed by a quick cancellation.
Health insurance covers medically necessary wisdom teeth extractions. You might already have the coverage, meaning you can start treatment immediately!
Or, you can buy dental insurance with instant benefits, but the issuing company will include limitations that could erase much of the cost savings.
Medical Insurance With No Waiting Period
Health insurance has no waiting period for medically necessary (bone-impacted) wisdom teeth extractions because most people already have this coverage. Furthermore, your medical plan might cover more of your expenses.
Not only might your health insurance cover medically necessary wisdom teeth extractions with no waiting period, but your out-of-pocket costs might be considerably lower than any alternative.
Nearly free wisdom tooth removal is a reasonable expectation because healthcare plans’ cost-sharing components are more affordable.
- No additional monthly premiums to pay
- The annual deductible may have been satisfied
- Copayments and coinsurance are typically smaller
- Maximum out-of-pocket limits yearly expenses
- Annual benefits limitations rarely restrict claims
While your medical insurance might cover medically necessary wisdom teeth removal with no waiting period, you save even more money by choosing an in-network oral surgeon charging the lowest prices.
Find local oral surgeons accepting your health insurance by searching the online find a doctor tool at the issuing company’s website. In-network providers accept the allowed amount as full payment and will only balance bill for the deductible, copayments, and coinsurance, if any.
The allowed amount is a negotiated discount. The provider sees more patients by lowering prices for members, and the insurance company gets to tout the savings.
Because medical insurance often covers medically necessary wisdom teeth extraction with no waiting period, you might want a definition and process.
Health insurance covers dental work when medically necessary: care arising from non-biting accidents, certain diseases, and treatments considered integral to other services included in the plan.
Wisdom teeth extractions fitting this definition include the following:
- Bone-impacted (most common)
- After non-biting accident
- Before cancer treatment
Have your oral surgeon compose a letter of medical necessity and submit it to your insurance company for pre-authorization. Your provider should have plenty of experience and know what to do.
While the Affordable Care Act requires health insurance to cover pre-existing conditions without a waiting period, you may face a delay if you do not already have coverage.
Apply for medical insurance at healthcare.gov. You can sign up during the annual open enrollment period (November 1 through January 31). However, coverage will not begin until January 1 of the following year.
The coverage can begin outside of open enrollment if you experience a qualifying life event.
- Loss of other medical insurance
- Changes in household composition
- Changes in residence location
Dental Insurance With No Waiting Period
Dental insurance with no waiting period for gum-impacted wisdom teeth removal, the extractions your healthcare will not cover will sometimes save money, other times not.
Medicaid sometimes behaves as dental insurance with no waiting period for wisdom teeth removal. Medicaid is a government program providing health (nationwide) and dental (state-by-state) coverage to low-income families and individuals receiving Supplemental Security Income (SSI).
Medicaid covers wisdom teeth removal differently in every state for adults and children, reflecting its dual nature as health and dental insurance.
|Children under 21||Bone-impacted nationwide||Gum-impacted nationwide|
|Adults over 21||Bone-impacted nationwide||Gum-impacted in 25 states|
You can purchase individual dental insurance with no waiting period for gum-impacted wisdom teeth extractions, but the savings come from a surprising source. The issuing company wants to make a profit.
Apply for Spirit Dental Plans online, understanding that the savings come from in-network providers offering significant discounts while graded benefits and annual maximums limit claim payments.
PPO dental insurance with no waiting periods has a hidden feature making gum-impacted wisdom tooth extractions more affordable. A PPO (Preferred Provider Organization) charges discounted fees to plan members needing treatment.
In-network dentists cannot charge more than insurance allows in its contract for covered services. While most plans with immediate benefits pay only a tiny percentage (see next section), the provider cannot set higher prices as they can when other exclusions apply.
- Average retail provider charge: $1,900
- Typical insurance allowed amount: $1,300 (32% discount)
Individual dental insurance often includes graded copayments to offset the immediate claim payments for wisdom teeth extraction. The percentage of the allowed amount paid might be smaller in the early years.
- Year 1: 25%
- Year 2: 30%
- Year 3: 50%
The cost to remove gum-impacted wisdom teeth drops in half ($975/$1,900) from the retail price, even though your copayment percentage is minuscule initially.
- The plan pays 25%: $325
- The patient pays 75%: $975
Individual dental insurance often includes annual benefit maximums to offset the immediate claims payments for wisdom teeth extraction and other covered services. As with copayments, the limits might start small in the early years.
- Year 1: $1,200
- Year 2: $2,500
- Year 3: $5,000
If your dental insurance is maxed out, consider postponing treatment until the next plan year. Spreading services over time is the best way to overcome the maximum annual benefit. Plus, the limits may grow the longer you pay premiums.