Picture this scenario: For months, or even years, you’ve struggled with a dental problem. Maybe you had persistent tooth pain. Perhaps your jaw ached and made clicking sounds. Maybe your gums bled frequently and showed signs of obvious recession. Whatever the problem, you were putting off the solution because you couldn’t afford a visit to the dentist.
But then one day you obtained dental insurance. Finally, dental visits are more affordable! Now that you’re insured, you can finally treat those persistent dental problems, right? Well, maybe not. Let’s take a look at how “pre-existing conditions” can affect your dental care.
What are Pre-Existing Conditions?
Pre-existing conditions are dental problems which existed before the policy was purchased. Typically, dental insurance either doesn’t cover or places restrictions on many of these dental issues.
Different dental policies have different restrictions. Generally, larger and complex procedures are more likely to be excluded from coverage. For example, replacing a missing tooth is typically not covered. But a minor procedure like a filling might be covered. However, even then restrictions might apply.
What are Common Dental Insurance Limitations?
Dental insurance might not provide instant relief for dental problems. Before purchasing a policy, you’ll want to understand when and if your specific dental issues will be covered.
There are three categories of dental coverage limitations:
- Procedure Limitations: Aside from limitations on pre-existing conditions, certain services are excluded from coverage entirely. While policy restrictions vary, generally cosmetic procedures such as tooth whitening and veneers are not covered by dental insurance. (Special insurance policies exist which provide coverage specifically for braces and other orthodontic care.)
- Time Restrictions: Many insurance plans place waiting periods on certain procedures. For instance, many policies limit you to just cleanings and check-ups during the first six months. After six months, coverage expands to include more basic procedures like fillings and root canals. After one year, coverage opens up further to include major procedure such as implants and oral surgery.
- Financial Restrictions: A deductible is the amount of money the insured person must first pay before the insurance company will cover the rest. Dental insurance deductibles will vary by type of procedure. In most cases, the insurance company will cover 100% of preventative procedures such as checkups and cleanings. Basic procedures such as fillings are covered at about 70% to 80%. Major procedures such as oral surgery, dentures, and bridges are usually covered at 50%.
Annual benefit limits are another restriction. Insurance companies won’t pay for an unlimited number of procedures in a year. The exact dollar limit will vary based on the type of policy. Usually, the higher your monthly premiums are, the higher the policy’s annual limit. Be careful when selecting a policy with a low annual limit. The cost of major procedures might exceed what insurance will pay for.
Why Does Dental Coverage Have Limitations?
Dental insurance typically only covers treatments which are medically necessary. These are treatments used to diagnose or treat illness, injury or disease. Unfortunately, most insurance companies don’t consider discolored teeth and many other cosmetic procedures to meet the definition of a medical necessity. However, certain types of jaw damage and bite misalignments can be considered both cosmetic and medically necessary.
Another reason for coverage limitations is, at the end of the day, insurance is a business. Without wait limits, people might sign up for a policy, undergo a bunch of expensive dental procedures and then drop coverage immediately after. While that would work great for that individual, the insurance company likely wouldn’t be able to offer affordable rates for everyone else.
Can Dental Insurance Limitations Be Avoided?
Waiting for dental care you need right now isn’t an ideal situation. Without treatment, dental problems are likely to grow worse over time. Plus, your current dental issue might be uncomfortable or even painful! Fortunately, options are available if you need treatment right away
Some dental policies will waive the waiting period if you were previously covered by a different dental insurance plan. Typically, this applies if you had dental insurance within 60 days of purchasing your new policy. Not all insurance companies provide this option, so be sure to ask.
Sometimes local and state laws mandate certain types of coverage. For instance, suppose you lose your dental insurance while you’re in the middle of a dental procedure which requires multiple trips to the dentist’s office. The insurance company might still be legally required to complete the procedure if you’ve undergone a which is the first appointment for a multi-visit procedure. Note that this typically requires a specific set of circumstances, often involving transferring coverage from government programs to private insurance, or vice-versa.
What if Dental Insurance Isn’t an Option?
For many people, limitations on care mean dental insurance can’t help them save on certain procedures. If you’re looking for an alternative to dental insurance, consider a dental discount plan.
A dental discount plan is a membership club which offers savings of 15% to 50% on many different preventative, basic and major procedures. Savings don’t apply to just medically necessary procedures, either. You can find savings on many different cosmetic procedures, too.
Dental discounts cards have no waiting periods. After purchasing a membership in a dental savings plan, your discount card will be ready to use in about two to three days. Once activated, you simply present your card to any of the 100,000+ participating dentists in the discount network. Discounts are applied instantly with no paperwork required. Even better, you can use the card as often as you like. Dental discount plans have no annual limits.
Don’t want to think about “pre-existing” conditions at all? They’re not a factor with a dental discount card. Regardless of how long you’ve had the issue, if a discount is available for treatment, you’re eligible for immediate savings.
Dental insurance can be a great choice if your needs meet the requirements found in the policy. But if you need help for an issue which dental insurance won’t cover, consider a dental discount plan. In many cases, a discount plan can help you save big on the care you need today.
Save 15% to 50%* at the Dentist
With an Aetna Dental Savings Plan.