Avoid The Missing Tooth Clause

Updated: May 22, 2019 at 6:42 pm

missing tooth clauseYou put off purchasing dental insurance for awhile now. But, your bicuspid fell out. Now you need to get that fixed. You just purchased dental insurance and go to the dentist. Your dentist is in the plan’s network, and that makes you feel good. However, you turn upset when the office manager informs you that your partial bridge won’t be covered. The reason, she tells you, is because of a “missing tooth clause” with your dental insurance. You’ll have to pay 100% of the cost of your tooth replacement. In this article, we discuss the missing tooth clause and how to avoid it.

What Is The Missing Tooth Clause?

Essentially, dental insurance has a clause that states that it won’t pay for the replacement of any missing tooth before your insurance begins. So, if you have a missing tooth or teeth, the cost to replace these teeth with a crown, bridge, implant, or some other device won’t be covered IF…

…the missing tooth or teeth occurred BEFORE the insurance begins.

Think of this as a pre-existing condition in dental insurance.

So, to recap, if you have a missing tooth or teeth prior to dental insurance coverage, the cost to replace those teeth won’t be covered.

Of course, if the missing tooth or teeth occurred AFTER the insurance begins, you have coverage according to your plan’s provisions.

Ways To Avoid The Missing Tooth Clause

There are many ways to avoid the missing tooth clause within your dental insurance policy. We discuss these next.

Get Dental Insurance Before “Now”

We receive a lot of phone calls from people needing major services done “now”. Like, tomorrow. They need a crown put in or are missing teeth. They put off purchasing dental insurance. Now, they have a dental problem. They decided to go to the dentist. And, they don’t have any dental insurance.

Honestly, if this is you, this is a self-inflicted problem. It could have been avoided.

A simple way to avoid the missing tooth clause is to purchase dental insurance before you need it. Really, this is the easiest solution. If you have a missing tooth or teeth after you purchase the policy, the insurance covers the replacement of your tooth.

For seniors, the best time to purchase dental insurance is a year before you go off your company’s dental insurance plan as you enroll in Medicare.

It may seem like a waste of money to pay premiums for insurance you don’t need right away. But, many dental insurance plans have waiting periods of 12 months for major services. Moreover, if you do lose any teeth, the plans cover replacement your teeth.

The cost of NOT having dental insurance is potentially greater than having it.

Discount Dental Plans

A discount dental plan might help. There is no missing tooth clause as a discount plan is not dental insurance. It is simply an agreement that the dentist will charge you less than their “retail” price.

I like discount dental plans. I think they can work if you find the right dentist who accepts them. That leads me to my point. Many dentists do not accept discount dental plans. If you really want a discount plan, be prepared to switch dentists or go out of your way to find one.

Moreover, dentists who accept dental insurance already agree to a discount from their retail cost.

Nevertheless, a discount dental plan is an option. We outlined several ways a discount dental plan is better than dental insurance. The moral of our article, however, is finding that right dentist for you who accepts the discount plan. If he or she is great and knowledgeable, then likely the discount plan and your situation are a great fit.

Purchase Dental Insurance That Avoids The Missing Tooth Clause

Many dental insurances have missing tooth clauses. Even if you had the dental insurance for years…if you had a missing tooth prior to coverage, the insurance won’t pay.

Sure, you can try to have your dentist submit the claim to your insurance. Chances are, for something like this, the carrier will request your dental records. In those dental records will be a note of your missing tooth or teeth. So, there is no getting around it.

We only know of one dental insurance that does not have a missing tooth clause. That is right. It will cover the replacement of missing teeth for any teeth missing PRIOR to coverage starting.

However, the replacement of missing teeth is a major service. This policy has a 12 month waiting period on major services.

Nevertheless, it will cover the replacement of a missing tooth or teeth once this 12 month period is met.

The carrier offers two dental insurance plans – a basic plan and a more robust plan.

The basic plan has an annual benefit of $1,000 while the robust plan has an annual benefit of $1,500.

Likely, the $1,500 will provide more coverage for the replacement of your missing tooth. If you go to an in-network dentist, which we generally recommend, the plan immediately covers cleanings at 100% (excluding any deductibles). The plan also covers basic services such as fillings immediately as well.

The $1,500 annual plan also covers out of network dentists costs much better.

Most importantly, you will have a decent annual benefit to cover or help cover the replacement of your missing tooth.


I hope you are now more knowledgeable about the missing tooth clause common in many dental insurance plans. Do you have a missing tooth? Do you want to know your options? Or, do you want to get started and simply figure out the right plan for you? Contact us or use the form below. Unlike other agencies you read about, we only have your best interest first. That means if there is a plan available that better fits your situation, we will tell you that. We will also do our best to put you in contact with them.

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