Orthodontic Insurance: Is It Necessary? How to Get it

Orthodontic Insurance: Is It Necessary? How to Get it
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Orthodontic Insurance: Is It Necessary? How to Get itClinical Content Reviewed by Dr. Jay Khorsandi, DDS
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Table of Contents

  1. When to Get Orthodontic Insurance
  2. Orthodontic Insurance Coverage
  3. Your Costs
  4. References

The average cost of braces and orthodontic treatment in the United States is between $5,000 and $6,000, but it can be much higher than this in some areas of the country. Orthodontic insurance can help to save you money and often cut your out-of-pocket expenses in half.

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.

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.

The cost of orthodontic insurance can range from as low as $10 per month up to over $200 a month in premiums. Cost depends on several factors, including the following:

  • Level of coverage
  • Plan and provider
  • Where you live since plans and prices can vary from state to state
  • Whether or not you have a discount dental plan or dental insurance

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

Even with insurance, you are still going to pay around $3,500 for braces out of pocket on average. The cost for orthodontic services can vary widely, and the quote you are given for braces does not always tell the whole story. You will often have to pay for additional services and products outside of this initial cost and cost for the appliances.

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.

Orthodontic insurance plans regularly have waiting periods. You must have the plan for a certain amount of time before you can access certain services. Be sure to get the insurance plan early enough so you can start orthodontic treatment when you want.

Typically, orthodontic services are split into payments over the lifetime of the treatment. For example, most treatments last about 24 months, and payments will be monthly after a down payment.

Plans are highly variable and so is the amount covered. Most of the time, you can expect about a 50 percent discount on services, up to a lifetime maximum.

While orthodontic insurance will cost you every month in terms of monthly premiums, it can ultimately save you money in the long run if you need braces or other substantial orthodontic treatment.

References

The Average Cost of Braces and How to Save. (June 2020). U.S. News & World Report. Date Fetched: June 23, 2021.

How Much Do Braces Cost? (2021). Oral-B,  Procter & Gamble. Date Fetched: June 23, 2021.

How Much Are Braces With Insurance? (2021). Colgate- Palmolive Company. Date Fetched: June 23, 2021.

Medical Necessity and Orthodontics. (September 2016). Pediatric Dentistry Today. Date Fetched: June 23, 2021.

Orthodontic Coverage: What Dental Insurance Plans Cover Braces? (July 2018). Cigna. Date Fetched: June 23, 2021.

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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