Are Braces Covered by Insurance: Understanding Your Options

Orthodontic care is a vital aspect of maintaining overall dental health, yet many people are uncertain about whether their insurance will cover the cost of braces. Braces, which are used to correct alignment and bite issues, come in various types, each with its own set of features and costs. The expenses associated with orthodontic treatments can be significant, making it crucial to understand insurance coverage and alternative payment options. This guide aims to shed light on the nuances of insurance coverage for braces, helping you navigate the complexities and make informed decisions.

What are braces?

Braces are orthodontic devices used to correct misaligned teeth and jaws, improving both functionality and aesthetics. They work by applying continuous pressure over time to gradually move teeth into the desired position. There are several types of braces available, each suited to different needs and preferences.

When reviewing a dental insurance plan, it’s essential to understand which types of orthodontic services are covered, as policies may vary based on the type of braces chosen and the specific dental care needs of the patient.

Traditional metal braces

Traditional metal braces are the most common type of braces, known for their durability and effectiveness. These braces consist of metal brackets glued to the teeth, connected by a wire, and periodically adjusted to move teeth into place.

Pros and cons of metal braces

One of the main advantages of metal braces is their effectiveness in treating a wide range of orthodontic issues. They are also typically more affordable than other types of braces. However, they are quite noticeable, which can be a concern for some individuals. Additionally, metal braces can cause discomfort and require careful maintenance to avoid food getting stuck.

Ceramic braces

Ceramic braces are similar to traditional metal braces but use clear or tooth-colored brackets, making them less visible. This aesthetic advantage makes ceramic braces a popular choice among adults and older teens. Some dental insurance plans may offer partial coverage for ceramic braces, though they may be considered a cosmetic option under certain policies. It’s worth checking your plan for specifics.

Pros and cons of ceramic braces

Ceramic braces are less noticeable than metal braces, which is their primary advantage. They are effective in treating most orthodontic issues. However, they can be more expensive and are also more prone to staining if not properly cared for. Additionally, ceramic brackets are more brittle than metal ones, making them more susceptible to damage.

Clear aligners

Clear aligners, likeInvisalign, are a popular alternative to traditional braces, using a series of clear, removable aligners to straighten teeth. These aligners are custom-made for each patient and are changed every few weeks to gradually move the teeth. For patients considering clear aligners, it’s important to check whether your dental insurance plan includes dental coverage for these treatments, as not all plans provide full benefits for this type of orthodontic service. Most dental savings plans, on the other hand, do provide savings on clear aligners and most other types of braces.

Pros and cons of clear aligners

The main benefit of a clear aligner is its near invisibility, making it an attractive option for those concerned about the appearance of braces. The aligners are also removable, allowing for easier eating and cleaning. However, Invisalign may not be suitable for severe orthodontic issues and can be more expensive than traditional braces. Additionally, it requires a high level of patient compliance, as the aligners should be worn 23-hours a day and only be removed to eat, brush your teeth, or to clean them.

How to find dental insurance that covers braces

Understanding whether braces are covered by insurance involves looking at several factors, including the type of insurance plan, the age of the patient, and the specifics of the policy. A dental insurance plan may offer an orthodontic benefit that covers part of the cost of braces. However, it’s important to check whether your policy includes specific coverage for adult orthodontics or different types of braces, like ceramic or clear aligners. Dental savings plans are another option for saving on braces.

Understanding dental insurance orthodontia benefits

Dental insurance plans vary in terms of coverage, particularly for orthodontic treatments. Some plans offer comprehensive orthodontic benefits, while others may provide limited or no coverage. Look for “Orthodontia benefit” when reviewing dental insurance to see if braces are covered. Understanding the specific orthodontic benefits in a dental insurance plan will help you better prepare for the financial aspects of the treatment, especially if you’re considering orthodontic services that may be classified as cosmetic. Cosmetic treatments are typically not covered by traditional dental insurance, but are included in most dental savings plans.

What is an orthodontia benefit?

Dental insurance orthodontia benefits are specific provisions within dental insurance plans that cover orthodontic treatments, such as braces. These benefits are designed to help offset the cost of orthodontic care, which can be substantial. Understanding the details of orthodontia benefits is essential for maximizing your insurance coverage and managing out-of-pocket expenses. It’s also important to understand how much of the orthodontic treatment is covered under your dental insurance plan, especially if you’re looking at adult orthodontics, which may have different coverage terms compared to treatment for children.

Orthodontia coverage percentage

Orthodontia benefits typically cover a percentage of the total cost of orthodontic treatment. This percentage can vary widely, ranging from 25% to 50% or more, depending on the insurance plan. For example, if your treatment costs $6,000 and your plan covers 50%, your insurance will pay $3,000, and you will be responsible for the remaining $3,000.

Lifetime maximum orthodontia benefit

Many dental insurance plans have a lifetime maximum benefit for orthodontic treatments. This is the maximum amount the insurance will pay for orthodontic care over the lifetime of the policy. Common lifetime maximums range from $1,000 to $3,500. Once this limit is reached, you will need to cover any additional costs out-of-pocket. Reviewing your dental plan’s lifetime maximum benefit can help you gauge whether you’ll have enough dental coverage to cover both orthodontic services and other necessary dental care. If it does not meet your needs, you can consider adding a dental savings plan which does not impose lifetime or annual limits.

Age restrictions

Insurance coverage for orthodontic treatment often includes age restrictions. Many plans primarily cover orthodontia for children and teenagers, usually up to age 18 or 19, though 16 can be the cut-off limit in some plans. Coverage for adult braces may be limited or not available under some plans. It’s important to check your policy for specific age-related provisions if this matters to you.

Generally, orthodontic treatment can be more expensive for adults than for children. Adults may require longer treatment times or more specialized care, both of which can increase costs. Additionally, adults are less likely to have orthodontic coverage in their dental insurance, potentially leading to higher out-of-pocket expenses. If your dental insurance plan limits coverage for adult orthodontics, exploring alternative payment options, such as dental savings plans, could be beneficial to reduce the cost of braces for adults (and children). These plans often provide discounts on orthodontic services without the age-related restrictions that some dental insurance policies have.

Waiting Periods

Dental insurance plans often impose waiting periods for orthodontic benefits, meaning you must be enrolled in the plan for a certain period before you can begin using your orthodontic benefits. Waiting periods can range from several months to over a year. During this time, you will need to pay for orthodontic services out-of-pocket. Check your plan’s orthodontia benefit to see if there is a waiting period and check the plan’s overall details. If you’re facing a waiting period, a dental savings plan can provide more immediate discounts for orthodontic services, helping you begin treatment sooner.

In-network vs. out-of-network providers

Most dental insurance plans have a network of in-network (preferred) providers. If your dental insurance is a PPO plan, you can see any dentist that accepts the plan but using in-network orthodontists typically results in lower out-of-pocket costs because these providers have agreed to charge reduced rates to plan members. Out-of-network treatment is often more expensive and may not be covered to the same extent. If you have HMO dental insurance, you must stay in network.

Dental insurance for braces – common clauses and exceptions

Pre-existing conditions

Some dental insurance plans have clauses that exclude coverage for pre-existing conditions, which can include orthodontic issues diagnosed before your policy start date. Understanding this clause is crucial if you or your child have already been diagnosed with an orthodontic condition. Talk to your insurance provider or dentist to understand if your insurance will cover your orthodontic treatment.

Types of braces covered

Not all types of braces are covered equally. Traditional metal braces are usually covered, but coverage for other types like ceramic braces, lingual braces, and Invisalign may vary. Some plans may provide partial coverage or none for these alternatives, so it’s important to verify this with your insurance provider. Make sure your dental insurance coverage applies to the specific type of braces you’re interested in, as some orthodontic services, such as clear aligners, may not be fully covered.

How to maximize orthodontia benefits

Review Your Policy Thoroughly

Before beginning any orthodontic treatment, review your dental insurance policy carefully. Look for details on the coverage percentage, lifetime maximum, age restrictions, waiting periods, and in-network requirements. This will help you understand your financial responsibilities and coverage limits.

Consult with your orthodontist

Discuss your insurance coverage with your orthodontist. They can provide a treatment plan and cost estimate, which you can use to verify coverage with your insurance provider. Orthodontists often have experience dealing with insurance companies and can help ensure that necessary documentation is correctly submitted.

Submit Claims Promptly and Accurately

Ensure that all claims are submitted promptly and include all required documentation, such as the treatment plan, itemized bills, and proof of payment. Keeping copies of all documents and maintaining a record of communication with your insurance provider can help resolve any issues that arise.

Stay in-network

Whenever possible, choose an orthodontist within your insurance plan’s network. This can significantly reduce out-of-pocket costs and simplify the claims process. Verify that your orthodontist is in-network before beginning treatment.

Alternative payment options for braces

Dental savings plans

Dental savings plans are a great alternative to traditional dental insurance, especially for orthodontic treatment. You pay an annual fee to join a dental savings plan, and then gain access to discounts on virtually all dental services, often including braces for adults and children. Unlike insurance, there are no deductibles or maximum caps. Many patients find that dental savings plans provide substantial savings on orthodontic treatments – on average, orthodontia discounts can save plan members 20% off the usual cost of braces. These plans are particularly helpful for adult orthodontics, where traditional dental insurance coverage may not apply.

The quickest way to find a plan that can save you money on orthodontics is by using the calculator at the bottom of this page. You’ll be shown the plans in your area, and see how much each plan can save you on braces and more.

Common misconceptions about insurance coverage for braces

There are several misconceptions about insurance coverage for braces that can lead to confusion and unmet expectations. One common misconception is that all dental insurance plans cover orthodontic treatments, which is not always the case. Another is that coverage amounts are standard, whereas they can vary significantly between policies and providers. Understanding the specifics of your plan is crucial for accurate expectations.

Dental insurance and braces – final thoughts

Understanding whether braces are covered by insurance involves navigating various factors, including the type of braces, the specifics of your insurance plan, and alternative payment options. By thoroughly reviewing your insurance policy, exploring financing and discount programs, and working closely with your orthodontist, you can make informed decisions and maximize your benefits. Regularly reviewing your policy and utilizing preventive services can also play a significant role in managing the costs of orthodontic care. Ultimately, being proactive and informed is key to ensuring you receive the necessary treatment without undue financial burden.

For those whose dental insurance plan does not fully cover orthodontic treatment, dental savings plans can be a valuable alternative. These plans offer discounts on a wide range of dental services, including adult orthodontics, without the limitations often found with insurance, such as annual limits or waiting for certain procedures to be covered.

The quickest way to find out which plan is best for you is to use our online dental plan finder. Answer a few quick questions and receive a personalized recommendation. Want a quick peek at how much you can save with a dental savings plan? Use our calculator below to find out now.

All cost averages obtained from DentalPlans.com procedure search tool, and independent research.

*Discount health program consumer and provider surveys indicate average savings of 50%. savings may vary by provider, location, and plan.