How Does Orthodontic Insurance Work? - Wiewiora & Dunn Orthodontics
Orthodontic Insurance Policies

How Does Orthodontic Insurance Work?

April 12, 2024

Although expensive, people continue to invest in orthodontic treatment, whether for themselves or their children. In some cases it is to improve image, while for others it is medically necessary. In either scenario, people strive to find the most affordable avenue to achieve the optimal desired outcome. Keep reading to learn about your options to obtain a healthy, attractive smile.


Are Braces Covered Under Dental Insurance?

More often than not, there is an age limit with your orthodontic benefits. Therefore, it is ideal that you seek orthodontic treatment at an earlier age. This is important as treatment time often increases with age, which inflates the cost. Only one percent of plans will fully cover the cost of braces, while most will pay a partial amount. You may determine your coverage by contacting your insurance carrier directly with information regarding the procedure, and – if possible – an estimated cost.

Although plans vary, there are a few points to understand about dental insurance that often carry across policies and providers. If braces are covered under your plan, there is likely a lifetime maximum to your insurance. Take note of this max, as the cost of braces may reach or exceed it. In some cases, there are waiting periods that require enrollment prior to treatment. Finally, if you have recently switched insurance carriers, you should wait until the effective date of the policy. Otherwise, your braces will not be covered.


Different Types of Dental Insurance

Braces or other orthodontic treatments, such as Invisalign, can be expensive. There are several dental insurance options that may help you afford the treatment you or your child needs.

Employer-Sponsored Dental Insurance – Dental insurance is often a part of an employee’s healthcare package, which determines the plan and level of coverage. Speak to your human resources department regarding an age limit, lifetime maximums, waiting periods and other details.

Individual Dental Insurance – If your employer does not provide dental insurance, some companies may offer it independently. Unfortunately, these may not provide orthodontic coverage at all, and if they do, they may not include coverage for adults.

Discount Plans – While discount plans are not considered dental insurance, they allow you to obtain services at a lower cost. These plans are increasing in popularity, and many offer reduced prices for adults, including orthodontics and cosmetic procedures. It can be purchased in addition to dental insurance, or if you have already capped your payout.


Orthodontic Benefits Payment Plan

If you have dental insurance, you may have orthodontic benefits. Separate from dental insurance, these benefits are paid by your insurance carrier to the orthodontist over the course of your treatment. Some benefits are paid at a percentage, up to a set maximum. After the maximum is reached, you pay the remaining balance throughout treatment. Some orthodontic plans have a co-pay, and the insurance company pays the rest. However, in some cases the benefit is still covered at a percentage.

At Wiewora and Dunn Orthodontics, we accept many HMO and PPO dental insurance plans, and we offer a variety of payment options to meet your needs. We also offer an interest-free, no money down in-house financing plan. Contact us today to learn about our orthodontic treatment options, or to book an appointment.

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