Dental Insurance That Cover Braces

This article will explore dental insurance that covers braces. If you wish to know more about this topic then keep reading. Having braces can be quite expensive, often costing thousands of dollars.

Dental Insurance That Cover Braces

If you or your child needs orthodontic treatment but don’t want to pay completely out-of-pocket, then finding health insurance that covers some or all of the costs of braces is a good option to consider.

Dental Insurance That Cover Braces

Braces are considered an elective dental procedure, so they may not be fully covered by basic dental plans. However, many insurance providers do offer plans with orthodontic coverage.

Whether you have employer-provided coverage, are shopping on the individual marketplace, or have children on your plan, learning about insurance policies with braces benefits can help make this important treatment more affordable.

By the end of this article, you’ll have a better understanding of what plans are available and how to leverage them to get the straight smile you want at a more reasonable price.

Exact Dental Insurance That Covers Braces

Dental insurance plans that cover braces can vary depending on the provider and the specific policy details.

However, some common types of dental insurance that may include coverage for orthodontic treatment, such as braces, include:

Traditional Dental Insurance Plans: Many traditional dental insurance plans offer coverage for orthodontic treatment, including braces.

Orthodontic Insurance Plans: Some insurance providers offer specialized orthodontic insurance plans that focus specifically on covering the costs of braces and other orthodontic treatments.

Employer-Sponsored Dental Plans: Many employer-sponsored dental plans include coverage for orthodontic treatment, including braces, as part of their benefits package.

Health Maintenance Organization (HMO) Dental Plans: Some HMO dental plans may include coverage for orthodontic treatment, but it’s essential to check the specific policy details.

Preferred Provider Organization (PPO) Plans: PPO dental plans often include coverage for orthodontic treatment, but the extent of coverage can vary.

Supplemental Dental Insurance Plans: Supplemental dental insurance plans are designed to complement existing dental coverage by providing additional benefits or filling gaps in coverage.

Direct Purchase Dental Plans: Individuals who do not have access to employer-sponsored dental insurance or who prefer to purchase coverage independently can explore direct purchase dental plans.

What is Dental Insurance?

Dental Insurance is an insurance policy that pays for the cost of dental services in exchange for a monthly premium.

Dental insurance is similar to medical insurance however it cannot be termed insurance as it is a discount plan with a limited benefit.

This means your dentist will give you a fee different from the office fee as your insurance coverage

The fee you will be given is typically 20 to 40& cheaper, this is because your dental insurance coverage pays a part of the fee.

However, the fee paid depends on the specific plan you are on and the benefits offered to you.

Dental insurance doesn’t always cover your entire bill but it is quite helpful for dental procedures as well as preventive care.

It is important to note that dental work is quite expensive and being a part of it helps to alleviate the financial burden of your medical bills.

The Different Kinds of Dental Insurance Plans

There are different kinds of dental insurance and they are listed and explained below:

Traditional Dental Insurance Plans

Traditional dental insurance plans are the most common type of dental coverage. These plans typically involve a monthly premium paid by the individual or employer, along with copayments or coinsurance for dental services.

Coverage may include preventive care, such as cleanings and exams, as well as basic and major dental procedures.

However, coverage for orthodontic treatments like braces may vary or require additional riders.

Preferred Provider Organization (PPO) Plans

PPO dental plans offer a network of dentists who have agreed to provide services at a discounted rate for plan members.

While individuals can choose to see out-of-network providers, they usually receive the most significant cost savings by staying within the network.

PPO plans often include coverage for orthodontic treatment, but the extent of coverage can vary.

Health Maintenance Organization (HMO) Dental Plans

HMO dental plans typically require members to choose a primary dentist from a network of providers and obtain referrals from that dentist to see specialists.

These plans often have lower premiums and predictable copayments but may have limited provider options.

Orthodontic coverage may be included but may require pre-authorization and have coverage limitations.

Dental Discount Plans

Dental discount plans, or dental savings plans, provide discounts on dental services in exchange for an annual membership fee.

Unlike traditional insurance, there are no copayments or deductibles; members simply pay the discounted rate directly to the dentist at the time of service.

While these plans can offer savings on orthodontic treatment, they do not provide coverage in the traditional sense.

Supplemental Dental Insurance

Supplemental dental insurance plans are designed to complement existing dental coverage by providing additional benefits or filling gaps in coverage.

These plans may offer enhanced coverage for specific services like orthodontics or higher annual maximums.

Individuals may choose to purchase supplemental orthodontic insurance if their primary plan has limited coverage for braces.

Indemnity or Fee-for-Service Plans

Indemnity dental plans, also known as fee-for-service plans, allow individuals to visit any dentist without being restricted to a network.

After receiving services, the individual pays the dentist directly and then submits a claim to the insurance company for reimbursement based on a predetermined fee schedule.

While these plans offer flexibility, they may have higher out-of-pocket costs and limited coverage for orthodontic treatment.

Employer-Sponsored Dental Plans

Many employers offer dental insurance as part of their employee benefits package.

These plans may vary widely in terms of coverage and cost, depending on the employer’s contributions and the insurance provider.

Orthodontic coverage may be included in employer-sponsored dental plans, but the extent of coverage can vary, and waiting periods may apply.

Direct Purchase Dental Plans

Individuals who do not have access to employer-sponsored dental insurance or who prefer to purchase coverage independently can explore direct purchase dental plans.

These plans are available for purchase directly from insurance companies or through health insurance marketplaces.

Orthodontic coverage options and costs may vary among direct purchase dental plans, so it’s essential to compare options carefully.

Dental Health Maintenance Organizations (DHMO)

Here, the plan allows dentists access to a certain amount of money for each month.

This money is allocated to each patient assigned to them while services are offered to these patients at reduced or no costs.

DHMO plans have unlimited benefits but also tend to have more restrictions while lacking coverage for higher-end procedures.

Table or Schedule of Allowances plan

Here the users of this plan are required to pay a certain amount for every procedure.

This means patients pay the difference between the main fee and the discounted price.

What Dental Insurance Covers

Understanding what dental insurance covers is key to making informed decisions. Below is a breakdown of what dental insurance covers:

Preventive Care: Most dental insurance plans cover preventive services, including routine exams, cleanings, and X-rays.

Basic Restorative Procedures: Dental insurance typically covers basic restorative procedures such as fillings for cavities and simple extractions.

Major Restorative Procedures: Some dental insurance plans provide coverage for major restorative procedures like crowns, bridges, and root canals.

Periodontal Care: Many dental insurance plans cover periodontal care, including treatments for gum disease such as scaling and root planing.

Orthodontic Treatment: Some dental insurance plans include coverage for orthodontic treatment, including braces, for both children and adults.

Emergency Dental Care: Dental insurance often covers emergency dental care, including treatment for dental injuries or sudden severe pain.

What Dental Insurance Typically Doesn’t Cover

Understanding what dental insurance doesn’t cover will guide you toward making an informed choice.

Below is a breakdown of what dental insurance doesn’t cover:

Cosmetic Procedures: Most dental insurance plans do not cover purely cosmetic procedures that are not deemed medically necessary.

Elective Procedures: Dental insurance generally does not cover elective procedures that are not essential for maintaining oral health.

Pre-existing Conditions: Some dental insurance plans may exclude coverage for pre-existing dental conditions that were present before enrolling in the plan.

Certain Specialty Treatments: While dental insurance covers many specialty treatments, such as endodontics and periodontics, coverage for certain specialized procedures may be limited or require pre-authorization.

Annual Maximums and Coverage Limits: Dental insurance plans often have annual maximums and coverage limits, which cap the amount of benefits that can be received within a policy year.

Out-of-Network Providers: Some dental insurance plans have networks of preferred providers, and coverage may be limited or nonexistent for services obtained from out-of-network dentists.

Coverage Levels for Braces

When it comes to coverage for braces, dental insurance plans typically offer varying levels of benefits to help offset the costs of orthodontic treatment.

Understanding these coverage levels is essential for individuals considering braces.

Here’s what you need to know:

Typical Coverage Percentages

Dental insurance plans often cover a percentage of the total cost of braces, typically ranging from 50% to 80%.

For example, if the total cost of braces is $5,000, and your insurance plan covers 50%, you would be responsible for paying $2,500 out of pocket.

However, it’s crucial to review your specific plan details, as coverage percentages can vary.

Annual and Lifetime Maximum Benefit Limits

Dental insurance plans may impose annual and lifetime maximum benefit limits on orthodontic coverage.

The annual maximum is the maximum amount that the insurance plan will pay toward orthodontic treatment within a policy year.

Once this limit is reached, any additional costs are the responsibility of the individual.

Similarly, the lifetime maximum is the maximum amount the plan will pay over the lifetime of the policy for orthodontic treatment.

Factors That Impact Coverage

Several factors can impact coverage for braces under dental insurance plans and they are listed below:

Age Requirements: Some dental insurance plans have age requirements for orthodontic coverage.

For example, coverage for braces may only be available for children and adolescents up to a certain age, typically 18 years old.

Adults seeking orthodontic treatment may have limited coverage options or may need to explore supplemental orthodontic insurance.

Waiting Periods: Many dental insurance plans impose waiting periods before orthodontic coverage becomes available.

This means that individuals may need to wait for a specified period after enrolling in the plan before they can receive coverage for braces.

Waiting periods vary among plans and can range from a few months to a year or more.

Copays and Deductibles: Copayments and deductibles may apply to orthodontic treatment under dental insurance plans.

Copayments are fixed amounts that individuals must pay out of pocket for each visit or service, while deductibles are the amount individuals must pay before the insurance plan starts covering costs.

It’s essential to understand these cost-sharing arrangements when estimating out-of-pocket expenses for braces.

Popular Insurance Carriers and Plans

Some popular dental insurance carriers and plans that offer coverage for braces include:

  • Delta Dental
  • Aetna
  • Cigna

Choosing a Plan

When choosing a dental insurance plan for braces, consider the following factors:

  • Coverage Details
  • Provider Network
  • Cost


What Are the Tips for Maximizing My Braces Coverage?

To maximize coverage for braces under your dental insurance plan, consider the following tips:

  • Plan Ahead
  • Stay In-Network
  • Understand Policy Details

Does dental insurance cover braces for adults?

Dental insurance coverage for braces for adults can vary depending on the specific dental insurance plan.

While many dental insurance plans provide coverage for orthodontic treatment, including braces, there are factors to consider when seeking coverage as an adult.

First, it’s essential to review your dental insurance policy to determine if orthodontic coverage is included and what the coverage entails. Some dental insurance plans may have age restrictions or limitations on orthodontic benefits for adults.

What Are the Other Ways In Which I Can Pay For My Braces?

In addition to dental insurance, there are other ways to help pay for braces and they are listed below:

  • Flexible Spending Account (FSA) or Health Savings Account (HSA): If available, contribute pre-tax dollars to an FSA or HSA to cover eligible medical expenses, including orthodontic treatment.
  • Payment Plans: Many orthodontic practices offer flexible payment plans that allow you to spread out the cost of braces over time, making them more affordable.
  • Orthodontic Discount Programs: Some orthodontic practices offer discount programs or promotions to help make braces more affordable for patients without insurance coverage.

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