Does Insurance Cover Orthodontic Treatment?

Long Beach, CA – Orthodontic treatment is important not only for aesthetic reasons but also to ensure a lifetime of good oral health. If you require orthodontic treatment, you may wonder what your options are to pay for treatment. Will your dental insurance cover braces or Invisalign treatment?

As with any medical care, you need to understand the type of insurance you have. While many dental plans do cover orthodontic treatment, not all do. And even for those who do, there may be limitations or conditions to what your insurance may cover. Here are some things to look for in your dental plan.

Key Factors to Consider in Your Dental Insurance Plan

1. Coverage limits. Most dental plans have a lifetime maximum orthodontic benefit for each beneficiary. This means that your insurance will only pay a certain amount for the lifetime of the policyholder.
2. Amount covered. The typical coverage will be on a percentage basis up to a maximum amount (your coverage limit, as defined above). For instance, your insurance may cover 50% up to a $2,000 maximum, so if your fee is $3,000 you will only get $1,500 coverage. It is important to understand what your insurance will cover and what will be left for you to pay out of pocket.
3. Age restrictions. Some plans may only pay for orthodontic treatment for patients under the age of 18, while others are capped at age 26. As treatment for adults is becoming more popular, many insurance plans cover adult orthodontic treatment, but it is important to read the fine print and make sure there are no age restrictions when you enroll.
4. Waiting period. Some dental insurance plans may have a waiting period before your coverage starts. Therefore, if you just started a new job, be sure you understand what your waiting period may be prior to starting treatment.
5. Frequency of payments. Some insurance companies pay monthly, while others pay quarterly or annually. You may wonder, why is this important? The frequency of payments matters, because if your insurance terminates for any reason (i.e. change in employment, age limit reached, etc), your insurance plan may not pay the full maximum. An annual plan may pay half when treatment is started and the other half a year later, so make sure that your insurance plan remains active during the duration of your treatment to ensure you receive your full benefits.
6. Provider. Every insurance plan will have in-network and out-of-network providers. With a PPO insurance plan, you can choose whichever provider you would like to go to, whether they’re in- or out-of-network. However, it is important to check whether your benefits are the same, as there may be different coverage limits for in-network and out-of-network providers.
7. Type of treatment chosen. There are many different options for treatment today, so it is important to know what treatments are covered under your plan. Some may only cover traditional metal braces while others may include options such as Invisalign, ceramic, or lingual braces. Some insurance plans still have Invisalign listed as a cosmetic treatment and may not cover the whole treatment. The good news is that most orthodontic offices will allow you to pay the difference in fee with a payment plan, so you can still choose the best treatment option for your lifestyle.  
8. Cost considerations. Metal braces are typically the most cost effective, so if you are looking at a different option, such as Invisalign, you’ll want to take into account any price differences.
9. Pre-approval. Your insurance may require pre-approval. This is because your insurance company may need to determine if your treatment is actually medically necessary. Remember this before beginning treatment, because it is possible that your claim could be denied.

Maximizing Your Insurance Benefits

It is important for you to go into your treatment understanding your insurance policy. Getting the most of your insurance benefits is important, and your orthodontic office’s financial coordinator can work with you to help ensure you receive your maximum benefits. Fortunately, if your insurance doesn’t provide adequate coverage or doesn’t cover orthodontics at all, there are still many ways you can afford orthodontic treatment.

Additional Payment Options for Orthodontic Care

• HSA/FSA accounts. Flexible Spending Accounts and Health Savings Accounts are pre-taxed dollars that can be used to cover medical expenses.
• Supplemental insurance. If your coverage is inadequate, consider looking into supplemental orthodontic insurance. Many companies can provide this, including Aflac.
• Payment plans. Our financial coordinator can help create a payment plan that can fit comfortably into your family’s budget so that you can afford orthodontic treatment. She will be happy to work with you to ensure you can begin your desired treatment.

Choosing the Right Orthodontic Provider

Dental insurance can help you manage the cost of orthodontic treatment. However, even with the best insurance, there will most likely still be out-of-pocket costs for you, so it is important to understand all of this before beginning treatment. At the end of the day, you want to make sure you choose a provider that you’re comfortable with, is board-certified, and will work with you to ensure you receive the smile you deserve. Choosing an orthodontic practice solely based on your insurance plan can result in unhappy patients and undesirable results. Do your research to find an orthodontic team who will create a treatment plan that meets all of your needs, both orthodontic and financial.

Call HD Orthodontics today at 562-283-6590 to learn more about starting your orthodontic journey.