Orthodontic Insurance Plans For Adults - Understanding orthodontic benefits can be more confusing than traditional dental or medical insurance coverage. Dr. Harris is committed to providing affordable care to all of our patients, and part of that promise is helping you understand your insurance coverage. Check out some FAQs to help you understand your benefits.
Some do, some don't. It just depends on your policy. Be sure to ask if your plan covers general dentistry and orthodontics. Another important question to ask is whether orthodontic coverage is only for children/teens or do you have orthodontic coverage for adults.
Orthodontic Insurance Plans For Adults
Again - it depends on your plan. Different policies and insurance companies have higher premiums for orthodontic coverage, but often do not charge extra. If you pay more precisely for orthodontic coverage, make sure your premiums don't exceed the cost of treatment. Our team can help you figure this out if you're not sure.
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We hate to be the broken record, but every policy is different. Here are some basics that make a good rule of thumb:
No, not normally. Generally, orthodontic benefits are provided throughout treatment. The insurance company pays the initial payment and then the retainer in monthly, quarterly or annual installments.
Some plans require a waiting period, but not all are guaranteed. Be sure to ask your insurance company if there is a waiting period before braces are covered.
In most cases, yes! There are certain rules that insurance companies must follow for primary and secondary insurance. You should check if your plan allows this
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The brace is difficult to match the driving force of the tooth. They are more studied and more effective than most other options. But this effectiveness comes at a price. Braces are one of the most expensive orthodontic options, and many people wonder if dental insurance can help lower the overall cost. The answer is yes, but only sometimes.
Dental insurance plans sometimes cover braces treatment, although this depends on the provider and your specific plan. This guide will help you navigate your insurance details and know what to expect.
Financial & Insurance Options
How much you actually pay for braces depends on many factors, especially the severity of your condition, your orthodontist fees, and even your location. But on average, that price drops to about $4,000 to $6,000. However, some cases may fall outside this range.
For example, a very mild overbite can be closed in a few months and for less money, while a complex overbite can take longer and cost more. And the price depends on the type of braces you choose. In addition to traditional metal brackets, there are several other types:
Clear/Ceramic Brackets: A less visible alternative, these use clear or tooth-colored brackets and wires. These are often slightly more expensive than traditional braces, ranging from $4,000 to $8,000. They are not as durable as metal braces.
Lingual braces: These braces are placed in front of your teeth, not behind them. They are less visible, but more expensive, sometimes as much as $8,000 - $10,000. Because of their location, tongue braces cannot handle the same range of conditions.
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Self-locking brackets (Damon): These brackets use special clips to hold the archwire rather than small elastics in each bracket, making it easier to adjust. The manufacturers of Damon wires claim that they can move teeth faster. Like other specialty braces, these are somewhat more expensive, usually around $4,000 - $8,000.
Six Month Smile Braces: Six Month Smile is a brand of short-term orthodontic treatment that offers clear parallels and clear retention. These braces are best suited for mild to moderate deformities, but they are a bit more expensive, averaging $3,500 to $5,000.
If you're looking to avoid high prices and a slight inconvenience, you might consider at-home teeth whitening services like SmileDirectClub instead. They will ship a set of clear aligners to your door, making it cheaper than in-office treatments. Check out our guide to the top 5 home lining options or learn more about our #1 pick, Byte, in this in-depth review.
It's natural to think that every dental insurance plan covers orthodontics, but that's not always true. Some dental insurance plans have orthodontic benefits and some do not. Even plans that include orthodontics can come with limitations.
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You can enroll in a dental insurance plan through your employer or on your own. Once you have insurance, you can use it for any treatment it covers (unless there's a waiting period, but more on that later). Often, orthodontic benefits cover a certain percentage of your orthodontic treatment or pay up to a certain amount.
Most dental insurance companies have a plan or plans that include some form of orthodontic benefits. These benefits often include braces, Invisalign, and (sometimes) at-home aligners. But if you want more information about specific insurance providers, take a look at our specific provider guides:
Often, orthodontic benefits include braces, but it depends on the plan. Typically, the most basic plans do not include conservative coverage, while more comprehensive and expensive plans do. Each of the insurance companies described above has a plan (or multiple plans) that covers braces or clear aligners.
This coverage may extend to other types of braces (see above), but you should double check with your dentist/orthodontist and insurance provider to be sure.
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Many plans with orthodontic benefits cover only a portion of your treatment. Sometimes they will cover up to 50% of your treatment, other times the lifetime coverage limit is $1,000 - $3,000 (on average), sometimes both. Rarely, if ever, will a plan offer 100% unlimited coverage.
Additionally, there are certain limitations that you should keep in mind when purchasing dental insurance and enrolling in a plan.
Each dental plan has a network of dentists who are approved to submit claims for coverage. If you choose an in-network dentist or orthodontist, you will receive coverage for the treatments described in the plan. If you don't like any of the in-network dentists, you can always go to an out-of-network dentist. You won't get the same level of coverage.
Most insurance providers have very large networks, especially if you have a PPO plan, so you can find a good fit. However, if you are convinced of an out-of-network dentist, you may need to find other ways to control costs.
Are Adult Braces Affordable?
This is one of the most common limitations of orthodontic benefits. In most cases, age-restricted plans will cover orthodontic treatment for people up to age 19, but not for adults. You should always check the age limit when considering your insurance plan.
Many plans offer a maximum amount for orthodontic treatment during your lifetime. These limits are often between $1,000 and $3,000, but can be higher or lower depending on your plan. For example, if your plan covers orthodontics up to a lifetime maximum of $2,000, and your braces cost $4,500, you'll pay the $2,500 difference.
Also, some plans may have a waiting period before using their benefits. These waiting periods can range from a few months to a year. So if you enroll in a plan, be aware of any possible waiting periods before you can get braces, or you may have to stop your treatment for a few months.
Orthodontic coverage isn't something you have to purchase separately—it's included in some plans. There are two ways to enroll in a qualified dental plan: through your employer or by purchasing an individual plan.
The Ins And Outs Of Orthodontic Insurance Coverage — Cuozzo Orthodontics
About half of US adults get dental insurance through their (or their spouse's) employer. Enrolling in dental insurance through an employer plan has many advantages. For one thing, insurance premiums are deducted directly from your pre-tax paychecks, reducing what you owe in taxes. Another is that employers often contribute to the cost of their plans, resulting in lower premiums.
However, employer-sponsored dental plans also have some significant drawbacks. First, you are limited to the plan options offered by your employer. This is especially problematic if you are interested in braces or clear aligners, as many dental insurance plans do not cover orthodontics, or offer very limited coverage.
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