Orthodontic Insurance: Is It Necessary? How to Get it
Table of Contents
- When to Get Orthodontic Insurance
- Orthodontic Insurance Coverage
- Orthodontic Insurance Cost
- Orthodontic Care Cost
- Pros and Cons
- How to Choose
The average cost of braces in the United States without insurance is between $3,000 and $7,350, per surveys conducted by CostHelper. People who have insurance, on the other hand, can save money. CostHelper says people with insurance pay as little as $1,500 out of pocket for their braces.
Orthodontic insurance is highly variable. Your savings will depend on your plan, where you live, and the coverage options.
Not all dental insurance covers orthodontic treatment. Braces are often considered cosmetic and not medically necessary, which can impact insurance coverage specifics.
Orthodontic insurance can help to offset the overall expense of orthodontic treatment, although you can still expect to pay some of the costs on your own.
What is orthodontic insurance?
Orthodontic insurance is a type of insurance that covers orthodontic care, such as braces or aligners. Some companies (such as Cigna) call this type of plan full coverage dental insurance. Others might call it something like orthodontic coverage.
Orthodontic insurance isn’t the same as the following types of plans:
Standard dental insurance: A standard dental insurance plan will cover preventive care (such as cleanings) and some restorative care (such as fillings). A plan like this might exclude orthodontic care altogether.
Dental discount plans: A dental discount plan will help you save money on orthodontic care through something like a coupon or membership card. It’s not insurance. It’s a savings tactic.
Health insurance: A health insurance plan typically covers care provided by a doctor, not services delivered by a dental professional.
When to Get Orthodontic Insurance
Most of the time, health insurance does not include dental coverage. Even dental insurance does not regularly cover orthodontic treatment. Some plans will cover orthodontic treatment for children under the age of 18, but usually only partially.
For children, the ACA (Affordable Care Act) requires that dental coverage is offered, but orthodontic treatment is only covered if it is deemed medically necessary. Most of the time, braces are not considered to be medically necessary and instead are classified as cosmetic.
Braces and orthodontic treatment can cost thousands of dollars on average, and orthodontic insurance can help to cut the final bill. On average, orthodontic insurance covers about 50 percent of your costs with a lifetime maximum of $1,500.
Orthodontic Insurance Coverage
When looking for insurance coverage for orthodontic treatment within dental plans, be sure to check that orthodontia is included. Many dental plans do not cover this specifically.
Dental discount plans that specify orthodontic treatment can provide discounts for these services to offset the costs. When getting orthodontic treatment, there are typically going to be limits on what insurance plans will cover.
Orthodontic insurance and discount plans frequently offer discounts on coverage, but they will not generally cover the full amount. Coverage does not always include braces either. Some plans will require that you stay in-network and use a contracted provider in order for any of the costs to be covered.
Typically, coverage will include help with a down payment (usually between 35 percent and 50 percent off). Then, it will include discounts on the monthly payments.
Most orthodontic insurance plans have a lifetime maximum amount, and they will only cover up to that amount. You will also be responsible for copays and costs up to the deductible amount, depending on your plan and provider.
Your costs for orthodontic care
With insurance, expect to pay as little as $1,500 for braces out of pocket, says CostHelper. This chart can help you understand what orthodontic care typically costs, along with what insurance might pay:
Type of Treatment | Average Cost Without Insurance | Average Out-of-Pocket Cost With Insurance |
Metal braces | $4,937 | $3,407 |
Self-ligating braces | $4,572 | $2,570 |
Invisalign | %5,000 | (Not reported) |
Additional costs associated with orthodontic care can include the following:
Initial consultation visit: $100-$200
Dental x-rays: $10-$250
Retainers: $200-$1,000
Replacement retainers: $100-$500
Your Cost for Orthodontic Insurance
An orthodontic insurance plan can save you money, but it will usually also cost you more per month than a traditional dental insurance plan. These plans are often separate, and you will need to ensure that the plan you are getting includes the services you need.
For example, Delta Dental of Washington charges a monthly premium of $57.10 for its Plus Ortho Plan, which covers braces and aligners. That’s much more expensive than the $35.50 monthly fee you’d pay for their clear plan, which doesn’t have ortho coverage.
These are other details to keep in mind:
Waiting periods
Some orthodontic insurance plans have waiting periods. For example, the Delta Dental plan we mentioned above requires people to pay premiums for 12 continuous months before using their orthodontia benefits. However, if you had another plan with orthodontic coverage right before you signed up for Delta Dental, this wait could be waived.
Deductibles
Some orthodontic insurance plans require you to pay a specific amount of money (a deductible) before the plan benefits will kick in. In the Delta Dental plan we mentioned, that deductible is a low $50. Other plans charge more.
Copayments
Some orthodontic insurance plans require you to make a small payment (a copayment) each time you connect with your provider. You’d pay this fee for things like wire adjustments or bracket removals. In the Delta Dental plan we mentioned, there are no copayments required. Not all plans work this way.
Maximums
Some plans come with plan-year caps, meaning you can’t spend more on treatment than the plan will cover. In the Delta Dental plan we mentioned, your plan year maximum is $1,500.
Orthodontic coverage
Plans are highly variable, and so is the amount covered. Some plans don’t cover your entire cost of orthodontic care. The Delta Dental plan, for example, covers 50% of your costs.
Weighing the pros and cons of orthodontic insurance
Should you purchase orthodontic insurance? Is paying for treatment out of pocket the better choice? The answer depends on your oral health and your bank balance.
Let’s use our Delta Dental example. To use this plan, you’ll pay about $57 for 12 months before you can tap into your benefits. In other words, you’ll be $700 down before you even get started. However, when your plan kicks in, you can save 50% on your total orthodontic bill. If your metal braces cost about $5,000, you could save $2,500. The insurance premiums seem small by comparison.
Full-coverage dental plans also help with expenses such as cleanings, x-rays, and extractions. All of these services are crucial for keeping your mouth healthy. If you don’t have any kind of dental insurance, you’ll have to pay all of these fees out of pocket, and that’s not easy for everyone.
How to choose orthodontic insurance
Seek out full-coverage dental plans and ask for detailed quotes. Compare them to the cost of the orthodontic treatment you’re considering. You could find that you’ll save much more than you spend.
Good questions to ask include the following:
How much will I pay every month?
How long is the waiting period?
How much of my orthodontic treatment is covered?
What other types of care are covered?
How much is my copayment?
How much is my yearly maximum?
Ask every potential partner the same questions, and keep track of the answers they provide. In time, you could find just the right plan for you.