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Does Dental Insurance Cover Braces


Dental Insurance and Braces, What’s the deal?

Braces can be expensive. Averaging from $3000 to $7500, the fix to straighter teeth is no walk in the park for your wallet. If you’re needing braces to fix any irregularities in your teeth, you may require dental insurance covering orthodontia. Orthodontia deals with the prevention or correction of tooth irregularities. 

If you have dental insurance, you might have benefits covering orthodontia. Orthodontic benefits are paid over the course of the treatment. A 2018 study found that the average treatment time for braces is about 19.9 months. 

What are the most common orthodontic appliances?

  1. Braces: These consist of brackets, bands and wires that are continually tightened over time to straighten teeth. Braces are metal and come in ceramic, clear and colored brackets.
  2. Aligners: Like braces, these help to straighten and align teeth. A recognizable brand of aligners is Invisalign. They are clear trays which fit around the teeth in order to mold them.
  3. Removable Retainers: Metal or plastic appliances that are molded to fit the mount to either move the teeth or keep the teeth from shifting back to their original position after braces/aligners are removed. 

How much are orthodontic procedures after insurance?

Type of braces Before insurance After insurance
Metal braces $3,000 to $7,500 $1,500 to $3,750
Ceramic braces $2,000 to $8,500 $1,000 to $4,750
Invisalign braces $3,000 to $7,000 $1,500 to $3,500
Lingual braces $5,000 to $13,000 $3,500 to $9,250

Dental insurance plans can help to cover some of the cost for braces. You will also need to consider your out-of-pocket costs as well. These may include:

  • Premiums: the monthly rate you pay for dental insurance
  • Deductibles: The amount you pay for services before your insurance begins paying a portion of the expenses.
  • Co-pays: The cost-share amount you have to pay for covered dental services. This is typically a flat dollar amount or a percentage of the cost of the service.

How do these benefits actually work?

Orthodontic benefits typically work in these different ways:

1. Payable at a percentage with a lifetime maximum of a certain amount
For example, 50% payable with a maximum of $2000 per person. If your braces are costing you $6000, the insurance will cover 20% right off the bat ($1200) which is covered at 50%. So the insurance company will pay $600 (50% of $1200) and you’ll pay the remaining $600 or 50%. 

The remaining $4,800 is paid over the course of the treatment which the insurance company will pay at 50%. So if the treatment is $200 per month for 24 months, you will be responsible for paying the remaining $100. You will have to start paying the full $200 once your lifetime maximum of $2000 runs out. So in this case, your benefits run out after 9 months.

2. Orthodontic benefit as a percentage
The most common percentage is 50%. Using the previous example, this will be calculated as a $6000 total charge, 20% down ($1200), and $200 per month. In the orthodontic benefit as percentage’s scenario, the insurance company pays $600 down and $100 per month for 24 month.

3. Fixed copay
The most common co-pay is $1000 or $1200. You will have to pay your copay and the insurance company pays the remaining of the full charge over the course of treatment (typically 24 months). For example, if braces are $6000 and your fixed copay is $1000, then you can expect the insurance company to pay the other $5000 in installments. 

4. Percentage
An example of this is if the insurance company covers 75% of the total fee. You are then responsible for the remaining 25% of the fee. The 25% is also considered your co-pay like in the previous section. 

What plans cover orthodontics? 

Private individual and family plans often offer dental insurance for orthodontia. Employers sometimes also offer dental insurance plans. 

Many dental plans may include these following services for adults and childrens: 

  • Examinations
  • Treatment
  • Retainers
  • Pre and post orthodontic treatment

Medicaid coverage varies state to state but there are some standards set at the federal level. For example, all states must at least cover for children: 

  • Dental treatment to relieve infections 
  • Teeth restoration
  • Medically necessary orthodontic services (such as braces) 

Some states also may provide braces coverage for adults who are in need of them to treat a medical condition including overbite, underbite, open bite, and too little or too much teeth space. 

Conclusion

There are those at risk for a medical condition such as gum disease due to having too much teeth space. And then there are also the ones who aren’t suffering from a medical condition but are just wanting a straighter smile. Whatever the case, having straight teeth can do wonders for people. Having a great smile helps to boost self esteem and confidence. 

Braces serve as a catalyst in helping those who want a nicer smile achieve this goal in as little as 24 months with the average time actually being 19.9 months. Finding a dental plan with the ideal benefit will prove very beneficial for you in the long term. 

Summerlin


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Sat - Sun: Closed

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Sat - Sun: Closed

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