Would you, as a private insurance company, pay thousands in claims now for a vague promise of hundreds in future premiums?
You wouldn’t stay in business long if you paid out claims this way.
Patients want dental insurance that covers wisdom teeth removal without a waiting period. The issuing company finds this request unprofitable.
Expect problems unless the insurance company has one of three reasons to offer money-losing features: the government requires it, supports it, or large employer groups insist on it.
Learn about the three ways to get immediate insurance benefits for wisdom tooth extractions.
Medical Insurance Has No Waiting Period
The Affordable Care Act requires medical insurance to pay for treatment of pre-existing health conditions immediately. Some wisdom tooth extractions qualify under this rule.
If you already have coverage, you can begin medically necessary treatment now. If you are uninsured, you may have to schedule the procedure after open enrollment.
Medically Necessary
Health insurance covers medically necessary dental care without a waiting period. Wisdom teeth extractions that fit this definition include:
- Bone-impacted (most common)
- After non-biting accident
- Before cancer treatment
My daughter had her bone-impacted third molars pulled several years ago. Our medical insurance covered most of the bill because she chose an oral surgeon in-network with our plan.
Open Enrollment
Health insurance covers medically necessary wisdom tooth extraction without a waiting period. However, uninsured patients cannot start coverage anytime without a qualifying life event.
Apply for medical insurance at healthcare.gov during the annual open enrollment period (November 1 through January 31). Group plans purchased at work may have different dates. Schedule the procedure after your new coverage begins.
You might qualify for a special enrollment period with a qualifying life event, meaning coverage can begin sooner. Qualifying events include:
- Loss of other medical insurance
- Changes in household composition (marriage)
- Changes in residence location
Medicaid Has No Waiting Period
Medicaid often covers wisdom tooth extraction without a waiting period. This government program provides health insurance nationwide and dental insurance state-by-state to low-income families.
Third molars typically begin erupting between 17-24 years of age. Timing is crucial because Medicaid benefits may shrink after your 21st birthday.
Adults Over 21
Medicaid sometimes covers wisdom tooth removal for adults over 21 without a waiting period. However, patients in some states may not have coverage for removing gum-impacted third molars.
Medicaid covers wisdom tooth removal for adults differently from state to state because it is medical and dental insurance.
- Medically necessary extractions of bone-impacted third molars are covered nationwide under health insurance.
- Removing gum-impacted third molars is not medically necessary and is covered by the dental insurance component. However, only twenty-five states provide this dental benefit.
Age 17 to 20
Medicaid usually covers wisdom teeth extraction for teenagers aged seventeen to twenty without a waiting period. The federal government requires comprehensive dental benefits for children across the country.
The Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program requires Medicaid to cover dental services to relieve children’s pain or infection.
- Gum-impacted wisdom teeth cause pain and infection, so dental insurance should cover their removal.
- Bone-impacted wisdom teeth cause severe health problems, so medical insurance should cover their necessary extractions.
Dental Insurance Without Waiting Periods
It is harder to find private dental insurance that covers the extraction of gum-impacted wisdom teeth without a waiting period. Business logic prevails when the government does not require the benefit.
However, group plans at large employers have better benefits than individual programs because issuing companies can pool risks.
Employer Groups
Your large employer is the best place to find dental insurance without waiting periods to remove gum-impacted wisdom teeth. Issuing companies might incur losses on a few patients, but thousands of other co-workers paying premiums help offset these costs.
The Blue Cross Blue Shield Federal Employee Program is one example. The federal government employs millions of workers, and their voluntary dental insurance programs have no waiting periods for major services like wisdom tooth extractions, implants, and dentures.
Additionally, the BCBS plans offer unlimited yearly benefits, no missing tooth exclusions, extensive networks, and other features rarely found elsewhere.
Individual Plans
Individual dental insurance without waiting periods for gum-impacted wisdom teeth removal does exist. However, issuing companies often include graded benefits to protect their profits, so patients must look closely to find the value.
The Spirit Dental Insurance Company offers individual plans without waiting periods for major services. However, graded benefits limit the value to patients needing immediate treatment for pre-existing conditions.
| Year | Copayment | Annual Maximum |
|---|---|---|
| 1 | 25% | $1,200 |
| 2 | 30% | $2,500 |
| 3 | 50% | $5,000 |
Do the math. You will find that the yearly premium costs exceed the first year’s maximum benefit by a wide margin. However, you might still want to buy the coverage.
In-network dentists must accept the insurance-allowed amount. Insurance companies negotiate discounts with providers, often lowering retail costs by 50%. Choose an in-network provider to take advantage of these savings.
