Marketplace Dental: What's with the Waiting Periods?

You're in the market for dental insurance, and you want to check out the dental insurance marketplace. You browse through a number of plans based on your needs and, of course, which plans provide the most bang for your buck and then--you find him--the plan that was meant for you. Great coverage with a reasonable monthly premium. Attractive to both your brain and your wallet. 

You purchase the plan for you and your family and wait with excitement for the next opportunity to visit the dentist. You go to your dentist and, as always, they are happy to see you. You update your insurance information with the lovely receptionist at the front desk, and everything is working perfectly. During your checkup, your dentist informs you the tooth that's been bothering you is a troublemaker and recommends a shiny new crown.

"No worries," you think to yourself, "my loving new insurance plan covers crowns."

But then reality hits like a bulldozer smashing your phone screen. There's a waiting period for crowns. In fact, that waiting period is upwards of a year. 

What happened? Your relationship with your new insurance plan started out so perfectly. He said all the right things and promised to be there for you. He even complimented your smile! You feel betrayed and can't understand why your dental insurance would put a waiting period on something you need right now.

Alright, let's snap out of this dream-turned-nightmare scenario for a second.

Why are there waiting periods on marketplace dental plans?

There are several reasons why waiting period are in place, but we're going to talk about five of the main reasons why dental plans have waiting periods and what you can do if you need work done now.

1. Profitability. Yes, we started with that, can you believe it? Well, believe it or not, dental insurance isn't very profitable for insurance companies. I know, I know, you're thinking, "That's absurd! Insurance companies are evil!" Go with me for a second. The next items on our list will explain what we mean.

2. People use it. Dental insurance almost always gets used, and in many cases, all the way to the max. This is not the case with other types of insurance. Other types of insurance are built on a profit model that banks on people not using it. Medical insurance companies plan on a significant number of the enrollees not getting sick. Auto insurance companies bank on the fact that the vast majority of drivers will avoid crashing into things on a regular basis. Dental insurance? Most people with it will use it at least twice a year.

3. Pre-existing conditions. Dental problems often fester for years, and those with several issues stockpile their problems until they get insurance, like a squirrel bracing for winter. Then they want to go cash in on their display of patience--four root canals, a couple of crowns, and let's throw in a bridge to top it all off. This happens so often, in fact, that most dental insurance providers have a waiting period of at least one year for any major work.

4. Teeth are tough to manage. There is an extremely small population of people out there that never need any dental work done. We're talking, never had a cavity and never needed braces, no gum issues, nothing. They brush regularly, floss daily, use mouthwash, and never have that sneaky cavity show up. That pool of people is itsy bitsy spider small. Similar to point #2, people need dental work done, and they use dental insurance more often.

5. Overall dental costs are relatively low. Compared to major medical care, which can bankrupt an individual, dental costs are relatively low. This means that it is difficult for an insurance company to charge a high enough rate to cover the people using the benefit, but also keep the rate low enough for the average person to find value.

What can you do about waiting periods?

Now we know the "why," so let's talk about what you can do about waiting periods.

1. Preventive services. Most dental plans do not have waiting periods for preventive services like exams, cleanings, x-rays, and fluoride. All of EMI Health's dental exchange plans offer preventive services with no waiting period. As long as your teeth have no problems, you're covered 100 percent.

2. Discount dental plan. If you need major work done immediately, discount dental plans have no waiting periods, and you can get a good discount on major services. If you are in Arizona or Utah, you can find a great discount plan through EMI Health here. Discount dental plans are not insurance plans. Instead, the organization providing the discount plans has negotiated lower prices with participating dentists in the organization's network. You don't have to worry about an annual maximum, and you can access these dentists and their lower rates as often as you need.

3. Wait. While probably the most difficult, waiting is the last option on how to deal with a waiting period. After that waiting period is up, your benefits are considerably better than the discounts offered by providers or a discount dental plan. Remember, if you are on a plan with a waiting period, and you switch to a different plan, you will have to start over on the new plan's waiting period.

There you have it! Hopefully, this helped clarify why your exchange plan has a waiting period and a few things you can do in the meantime. Check out our other article: How Dental Coverage in the Federal Marketplace Works to learn more about...well, the title of the article says it all.

Contact EMI Health today if you want to learn more about our Federal Marketplace dental insurance. As always, EMI Health offers Federal Marketplace dental insurance suited to your needs. These plans are not only affordable, but they also cover the basic but important care. In addition to Federal marketplace plans, we also provide senior dental plans and a wide variety of health plans. Whatever your need may be regarding insurance, we've got you covered. Contact us today by calling 1-800-662-5851 or by visiting www.emihealth.com

Sources:

https://www.nadp.org/Dental_Benefits_Basics/Dental_BB_1.aspx

https://www.colgate.com/en-us/oral-health/basics/brushing-and-flossing/ada-10-survey-finds-shortcomings-in-americans-dental-health-habits

https://www.thebalance.com/dental-insurance-waiting-period-2645722

https://www.huffingtonpost.com/thomas-p-connelly-dds/why-is-dental-insurance-s_b_842186.html

https://www.investopedia.com/articles/personal-finance/122315/6-dental-insurance-plans-no-waiting-periods.asp