Millions of Americans wear braces but hardly do they grin over the cost of them — the price tag starts at around $3,000 and goes up to $10,000. Luckily, some dental plans do cover braces and other orthodontic care.
To avoid paying thousands of dollars that your dental insurance policy could otherwise cover, you have to choose the right policy in the first place. Read on to learn everything you should know about orthodontic insurance.
First, it’s worth understanding what orthodontics is and what services it comprises.
Orthodontics is a branch of dentistry that diagnoses, prevents, and treats teeth and jaw irregularities, such as misaligned teeth, crowded teeth, overbite, and underbite. Orthodontic procedures include initial evaluation (x-rays of the jaw and teeth, etc.), teeth removal, putting on braces/aligners/space maintainers/jaw repositioning devices/etc., and routine treatment visits.
What Is Dental Insurance for Braces?
Dental insurance for braces, also called orthodontic insurance, is a special treatment that includes putting on braces (among other appliances and procedures) to fix the alignment of your teeth and jaw.
Orthodontic coverage may or may not be included in your dental plan. Most children’s dental plans include orthodontics coverage, whereas most adult plans exclude it. Some plans may include metal braces while excluding expensive braces like Invisalign.
If you don’t have orthodontic coverage in your dental plan, you can buy it as a standalone plan or an addendum (rider) to your policy. The point is to get orthodontic coverage to safeguard yourself from paying a lump sum for orthodontic treatment.
In addition to braces, orthodontic coverage usually includes retainers and other orthodontic appliances, as well as exams, imaging, and treatment. However, braces will not be free because of the deductible you will have to pay before your policy kicks in.
Some appliances and procedures may be excluded from dental coverage, but a bigger concern is the limit of orthodontic coverage. Most plans have lifetime coverage much smaller than the amount of money required to cover braces. It’s common that the orthodontic coverage limit is exceeded long before dental treatment goals are met.
To avoid being underinsured, you can purchase a discount plan* on top of your dental insurance. It will provide a substantial discount for orthodontic services, but won’t completely cover costs.
Discount plans do not include any coverage but allow you to get a discount from your orthodontist.*
The average cost of full dental coverage is around $200 per month for a family and $30 per month for an individual. Group plans for employees are cheaper. Discounted plans cost around $15 per month.
There are several ways to save on orthodontic insurance other than purchasing a discount plan and lowering the amount of coverage or increasing the deductible. You can research dental programs for low-income families (Smiles Change Lives, Dental Life Line, Donated Orthodontic Services, etc.), enroll in a plan through your employer, try aspiring dentists from dental schools, look for regular discounts (for example, a discount for paying upfront), or negotiate.
Children’s dental plans usually include orthodontics coverage, but this is the only substantial difference. The cost of orthodontics coverage for children is the same as for adults, and the same exclusions apply.
In the United States, parents of children under 18 can buy dental insurance by meeting the criteria of the Affordable Care Act (ACA) when they purchase health insurance. However, the choice is optional – no fines apply for children not having dental insurance – and braces coverage may not be included in this dental plan.
The extent of coverage also varies depending on the state. Some states require all licensed dental insurers to provide braces coverage for children, but the coverage may only apply to braces used for medical purposes, not improving a child’s appearance.
To understand whether orthodontic insurance is worth it in your particular case, consider your needs, budget, teeth condition, risk tolerance, and the full cost of orthodontic services. The cheapest metal braces cost around $3,000, whereas Invisalign and lingual braces may cost up to $10,000.
To choose the best braces coverage, compare the parameters of the available plans: the type/amount/cost of coverage, the amount of deductible, and the waiting period.
To find a policy that suits you, research at least a few major dental insurance providers. Among the big names are Aetna, Aflac, Cigna, Delta Dental, Dental Plans, Humana, and USAA, each of which provides various dental plans and caters to different needs (for example, USAA caters exclusively to the military, whereas Humana has no waiting period).
Orthodontic coverage is not too expensive – around $30 per month for an individual – but it covers only a part of your expenses (for example, $1,500 out of around $5,000 that you may need to spend on braces).
Some plans have a waiting period of up to 24 months, so take this into account.
Your eligibility and coverage can be checked by the medical office staff via your online portal or by calling the number on your ID card.
Braces for adults cost just as much as for children. However, while braces coverage is usually included in children’s dental plans, adults usually have to buy supplemental orthodontic insurance for adults as a standalone policy or rider.
There are several ways to reduce your spending on orthodontic services. If you cannot afford orthodontic treatment, try the following:
Enroll in a dental program for low-income families: Smiles Change Lives, Dental Life Line, Donated Orthodontic Services, etc.
Enroll in a dental plan through your employer.
Try aspiring dentists from dental schools.
Look for discounts (for example, a discount for an upfront payment).
By applying these tactics, you will likely find affordable orthodontic insurance.
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Oleksandr is an expert in deep research. He covers various insurance topics across verticals, adopting to every local law.
Date added: September 15, 2022