DOES INSURANCE COVER BRACES? Here’s What You Need To Know

does insurance cover braces

Braces can be quite expensive to obtain and maintain. But these expenditures can be broken down with insurance. Ordinarily, dental insurance can cover braces for your child, but what about adults? This article is a guide on when and how dental insurance will cover braces. Read on.

What Is Dental Insurance For Braces?

Orthodontic insurance, often known as dental insurance for braces, is designed specifically for orthodontic treatment. This includes braces, retainers, and other procedures used to correct your teeth and jaw.

Orthodontic insurance is not typically sold separately. Orthodontics, on the other hand, may be covered by dental insurance or a dental discount plan. Many dental insurance policies exclude orthodontia coverage, so you may need to purchase an additional policy, discount plan, or rider to assist pay for orthodontic treatment.

The cost of braces or other treatments can vary depending on the type. Traditional metal braces, for example, may be less expensive than modern, removable Invisalign. If you have a certain treatment in mind, carefully study what is covered and what may incur additional costs when selecting orthodontic insurance.

When Does Dental Insurance Cover Braces?

Orthodontic insurance typically offers discounts and some amount of treatment coverage, such as exams, imaging, braces, retainers, and so on. However, just because you have orthodontic insurance does not imply your braces will be free.

When orthodontics is covered by dental insurance coverage, there will most likely be a waiting period before benefits begin. Once they do, you will most likely be required to achieve a minimum deductible before insurance will begin to pay. Depending on your plan, you may still be responsible for 50% or more of the treatment costs.

You can save money on braces and other treatments by using a discount plan. While they may not cover a percentage of the procedure, as regular insurance does, they can reduce the cost and often charge less per month than traditional dental insurance.

When Will Dental Insurance Not Cover Braces?

When orthodontics is included in dental planning, tight guidelines are usually followed. Lifetime restrictions for orthodontic insurance are typically substantially below the total cost of coverage. Even if you have a good dental plan that covers orthodontics, you may have to pay thousands of dollars out of pocket for braces and other comparable treatments.

Individual limits are used in some policies to keep coverage to a specified amount. If your policy has a lifetime limit, you can run out of coverage before your second child even gets braces.

This is why, in addition to your dental insurance, discount plans might be a smart method to save money on braces. Some clever customers supplement their normal dental insurance with a discount plan. This can provide reductions on braces at a low annual cost without requiring a change in dental policies.

How Much Does Insurance Cover For Braces Cost?

The cost of orthodontic insurance varies greatly based on where you obtain it and the type of coverage you select.

When purchased on your own, full dental coverage typically costs between $20 and $40 per month for individuals and up to $200 per month for families. It is frequently less expensive if you are a member of your employer’s group plan.

Discount plans range in price from $10 to $20 per month and do not include insurance coverage. They simply save you money over what your dentist or orthodontist offers.

Is it worthwhile to pay for dental insurance for braces?

The cost of braces can vary depending on the type of therapy and the amount of treatment required, according to Oral-B:

  • Metal braces (traditional braces) cost between $3,000 and $7,000.
  • Ceramic braces cost between $4,000 and $8,000
  • Lingual braces cost between $8,000 and $10,000.
  • Invisalign costs between $4,000 and $7,400.

Even if you do not have orthodontic coverage, which can be costly on its own, there are still methods to save money on orthodontics. These include using a health savings account or a flexible spending account to save money on taxes, as well as visiting a local dental school to be treated by an orthodontist-in-training.

It is ultimately up to you to choose if insurance is worthwhile. You can meet with a local orthodontist to acquire a cost estimate without insurance to determine whether you can afford treatment out of pocket or if you need to explore other methods to help pay.

Does Insurance Cover Braces For Adults?

Some insurance policies cover braces for adults, but they are rare.

Adult braces can help you realign your teeth for a better smile and to enhance the health of your teeth, mouth, and jaw if you are an adult considering having your teeth straightened. However, without dental insurance, adult braces can be costly.

While many dental insurance policies cover braces for children aged 19 and under, insurance for adults is available but less frequent because it is generally considered cosmetic.

If your dental insurance policy covers adult braces, find out if there is a yearly or lifetime maximum benefit for braces. Some policies pay a percentage of the dentist’s fees, whilst others pay a fixed price. The most prevalent limitation for braces is a lifetime maximum benefit amount.

Adult braces dental insurance can help you save money on what would otherwise be a highly expensive surgery. According to a 2015 report, the typical cost of braces for adults is expected to be between $3,000 and $7,0002.

What Does (and Doesn’t) Dental Insurance Cover?

Because there are so many different types of dental plans, what your insurance covers will vary depending on which one you have:

  • Services for prevention. Routine cleanings, checkups, and bitewing X-rays are among the services provided. Teeth whitening is sometimes incorporated as well.
  • Fundamental services. Basic dental services include cavity fillings and minor tooth extractions.
  • Important services. Major dental services include crowns, bridges, root canals, wisdom teeth extractions, periodontic deep cleanings, oral surgery, dentures, and partial dentures.
  • Orthodontia. This type of coverage includes both braces and retainers. However, most insurance companies do not pay for braces for people over the age of 18.

Obtaining Dental Insurance That Covers Braces

You should engage with a broker who can help you shop for the finest dental insurance plan for you. In general, you should opt for a plan that covers ‘orthodontia,’ and look into the plan’s limitations or exclusions.

Saving Money on Dental Insurance

Dental insurance costs can quickly add up, but remember that paying for it monthly may end up saving you money in the long run if you need a major procedure or braces. That being stated, here are a few pointers to keep in mind when shopping:

  • Enroll in a plan offered by your work. 
  • Individual dental insurance should be avoided. 
  • Look for a membership-based practice. 

Do not despair if your current policy does not cover adult braces. There are various solutions available to assist you in paying for braces:

#1. Individual dental coverage

You can enroll in an individual dental insurance plan if your employer-sponsored dental insurance plan does not cover adult braces. Many businesses provide separate dental coverage. Simply ensure that the plan covers braces without regard to age.

#2. Orthodontic clinics

Look to your local dentistry school for a source of affordable braces for adults, especially if you do not have insurance. Many states have open-to-the-public dental schools. Those that provide orthodontist training have specific prerequisites that students must complete under the supervision of faculty dentists before graduating. If this is an option in your area, the fees may be lower than in a private clinic.

#3. Planned payments

Because orthodontic treatment often takes two to three years, most orthodontist clinics provide payment options. This could range from in-house financing to credit card plans tailored specifically for dentists. Spreading the costs over a few years with a low-interest financing plan may help you decide to pursue the necessary treatment.

#4. Credit cards and personal loans

Although these solutions are more expensive, they can provide a way to pay for adult braces. The majority of dentists accept credit cards as payment. If you have an excellent working connection with your local bank, a short-term loan from that institution could be the solution to your financial needs.

#5. Accounts for Flexible Spending

If you have an employer-sponsored health plan, you can usually utilize a Flexible Spending Account (FSA) to cover some of the out-of-pocket costs of braces that your dental insurance does not cover. FSAs can also be used to cover insurance copayments and deductibles for various medical, dental, and orthodontic procedures.

#6. Plans for dental savings or discounts

Dental savings programs are not insurance policies in the traditional sense. A company providing dental discount plans contracts with a network of dentists who agree to reduce their dental fees3. Joining the plan entitles you to discounted dental services, including braces, from member dentists. Read the tiny print and specifically ask if you may use the plan for adult braces.

Is there no-waiting-period dental insurance for braces?

Almost all dental insurance policies that cover braces have a waiting period. This means that even if you find a terrific plan that covers braces to enroll in, you’ll most likely have to wait at least a year before receiving orthodontic coverage. Waiting periods are primarily determined by your state of residence and the type of dental insurance you have, among other considerations. So, if you’ve been thinking about getting braces for yourself or your children, buy dental insurance that covers braces as soon as possible to save money on orthodontic treatment a year or more from now.

Even if your dental insurance for braces has a waiting period for orthodontic treatment, you may still be able to enjoy certain dental benefits from the start of coverage. There are no waiting periods for preventative care, such as oral exams, cleanings, and X-rays, in any Guardian Direct dental plan. Furthermore, depending on the plan*, some operations may be covered to the tune of 50%-100%. This might help you take good care of your teeth in the year before you get braces.

Changing dental insurance coverage while wearing braces

Orthodontic therapy is usually done in stages. Braces can take up to 1-3 years to place the teeth in an optimum bite, and in the interim, regular exams and adjustments are required. It can be difficult to switch dental insurance policies while wearing braces, but it is feasible.

If you have dental insurance through your employer and that employer changes insurance while you are undergoing orthodontic treatment, your new insurance company will typically pick up where the previous company left off, taking into account how many months the previous company paid and how many months of treatment remain.

If you have individual dental insurance, you may be subject to waiting periods and other restrictions while switching carriers. Furthermore, when you switch insurance companies, your deductible, maximums, and premiums are all reset. Changing dental insurance during braces is usually not a good idea if you can avoid it.

Is it necessary to have dental insurance to obtain braces?

It is possible to obtain braces without dental insurance, but the cost will be higher. The Guardian Direct Achiever plan may cover braces up to 50% with a maximum benefit amount—if you don’t have dental insurance, you’ll have to pay the entire balance yourself.

You can try going to an orthodontic school to help drive down the cost, or see if your orthodontist offers payment plans to make the cost more manageable if you don’t have dental insurance. However, if you do not have dental insurance that covers braces and intend to undergo orthodontic treatment in the future, acquiring dental insurance may be the best approach to save money.

In Conclusion,

Insurance will most certainly cover braces for a child, but it isn’t as easy for adults. While some insurance policies may cover braces for adults, certain conditions must be met. Ensure that you understand the conditions before choosing the plan that works best for you.

Frequently Asked Questions

How can adults get free braces?

Adults can get free braces if they qualify for Medicaid and have a condition treatable with braces.

Who is entitled to free braces?

People under the age of 18 who have a demonstrable medical need for braces can get them for free.

How much do braces cost a month?

Your braces treatment could cost anywhere from $1,200 to $13,000 in total, and as little as $80 to $650 per month, depending on where you reside, how long the treatment lasts, and the style of braces you get.

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