Getting braces can be a significant financial commitment. Orthodontic treatments, such as braces, are often costly, and dental insurance that covers orthodontic care can be essential in helping you manage those expenses. In this article, we’ll explore the steps you need to take to get dental insurance that covers braces, what to consider when choosing a policy, and the specific methods for ensuring you maximize your benefits. We will also cover how dental insurance works for braces, what to watch out for, and how to find the right plan.
1. Understand How Dental Insurance for Braces Works
Before looking for dental insurance, it’s important to understand how most dental insurance plans work when it comes to braces. Traditional dental insurance typically covers preventive care (such as cleanings and exams) and basic procedures (like fillings and root canals), but not all plans cover orthodontic treatments, including braces. When they do, there are limitations on how much they’ll cover, waiting periods, and eligibility criteria.
Orthodontic coverage limits: Most dental insurance plans have a cap on how much they’ll pay for braces. This cap could range from $1,000 to $3,000, depending on your plan.
Waiting periods: Some plans have a waiting period of 6 to 12 months before orthodontic treatments are covered. This means you must hold the policy for this period before receiving coverage for braces.
Eligibility: Some insurance policies only cover braces for children under the age of 18. However, adult orthodontic coverage is becoming more common, so be sure to check the details.
2. Assess Your Current Dental Insurance Plan
If you already have dental insurance, the first step is to review your current policy. Check whether it includes orthodontic care and, if so, what the specifics are. Look for the following details:
Does it cover braces? Many basic plans do not, but you may have an optional rider (an add-on to your policy) that covers orthodontic treatments.
What are the annual or lifetime maximums? Dental insurance often has a limit on how much it will pay out for orthodontic care. This is usually a lifetime maximum, meaning it’s the total amount your insurance will pay for orthodontic treatment over your lifetime.
Is there a waiting period? Some policies require you to wait several months or even a year before they’ll pay for braces.
Age restrictions: Many policies only cover braces for children or teenagers, while others have no age limit.
If your current plan does not provide sufficient coverage for braces, you may need to look for alternative options.
3. Look for Dental Insurance Plans That Cover Orthodontic Care
If you don’t already have dental insurance, or your current policy doesn’t cover braces, the next step is to find a plan that does. There are several ways to do this:
Employer-sponsored dental insurance: Many employers offer dental insurance as part of their benefits package. If you’re unsure whether your employer’s plan covers orthodontic treatment, speak with your HR department or benefits manager.
Individual dental insurance plans: You can purchase dental insurance independently if you’re self-employed or if your employer’s plan doesn’t cover orthodontics. Look for plans specifically designed to cover braces.
Family dental plans: Some family plans offer orthodontic coverage for children and adults, so if you’re looking for coverage for both yourself and your children, this could be a good option.
When comparing plans, make sure to check the following:
Premiums: The monthly cost of the plan. Higher premiums might offer better orthodontic coverage, but make sure it fits within your budget.
Coverage levels: Look for how much the plan will cover for braces, both in terms of percentage and dollar amount.
Deductibles: This is the amount you need to pay out-of-pocket before the insurance starts to cover treatments.
Copayments and coinsurance: Understand how much you’ll be responsible for paying for each orthodontic visit.
Out-of-pocket maximum: Some plans limit the total amount you’ll have to pay before the insurance covers the rest, which can help if your orthodontic treatment is expensive.
see also: How to Get Insurance to Cover Dental Implants?
4. Consider Orthodontic Discount Plans
If dental insurance isn’t an option or doesn’t provide enough coverage, orthodontic discount plans are an alternative. These plans aren’t insurance, but they offer discounts on braces and other orthodontic treatments at participating dentists and orthodontists.
How they work: You pay an annual or monthly fee to enroll in the discount plan, and then you receive a reduced rate on braces and other treatments from providers in the plan’s network.
No waiting periods: Unlike dental insurance, discount plans often don’t have waiting periods, so you can start saving immediately.
No maximums: Discount plans typically don’t have a cap on how much you can save, so you can use them throughout your treatment.
Popular discount dental plan providers
include Careington, DentalPlans.com, and Aetna Dental Access. Be sure to check if the plan covers orthodontics, as not all discount plans do.
5. Combine Payment Options for Maximum Savings
To reduce out-of-pocket costs, consider combining different payment methods. If your dental insurance only partially covers braces, here are a few ways to cover the remaining expenses:
Health Savings Account (HSA): If you have an HSA, you can use the funds to pay for braces tax-free. HSAs are available with high-deductible health insurance plans and allow you to save pre-tax dollars for medical expenses.
Flexible Spending Account (FSA): If your employer offers an FSA, you can also use it to pay for orthodontic treatment tax-free. FSAs are typically part of employer-sponsored benefits packages and work similarly to HSAs.
Financing plans: Many orthodontists offer financing options that allow you to spread the cost of braces over several months or years. This can make paying for braces more manageable, even if your insurance doesn’t cover the full amount.
CareCredit: CareCredit is a healthcare credit card specifically for medical and dental treatments. You can use it to pay for braces and then make monthly payments.
6. Check for Special Orthodontic Plans for Children
If you’re seeking dental insurance for your children’s braces, look for plans specifically designed to cover pediatric orthodontic treatments.
These plans are often more generous in their coverage of braces, especially for children under 18. Some tips to follow include:
Pediatric dental benefits under the ACA: If your child is under 18, pediatric dental benefits are an essential health benefit under the Affordable Care Act (ACA). Many ACA plans include orthodontic coverage for children if medically necessary.
Children’s Health Insurance Program (CHIP): If your family qualifies for CHIP, it might provide coverage for braces if deemed medically necessary.
Make sure to read the fine print of any pediatric plan to understand what’s covered and what’s not.
7. Ask About In-Network vs. Out-of-Network Providers
When choosing dental insurance for braces, it’s essential to understand the difference between in-network and out-of-network providers:
In-network providers: These are orthodontists who have agreed to work with your insurance company and provide services at a reduced rate.
Using an in-network provider will save you the most money.
Out-of-network providers: If you go to an orthodontist who is not in your insurance plan’s network, you may have to pay higher costs, and your insurance might not cover as much of the treatment.
Before starting treatment, ask your insurance company for a list of in-network orthodontists and compare their rates with out-of-network options.
8. File a Claim for Braces Coverage
Once you’ve chosen a dental insurance plan and selected an orthodontist, the next step is to file a claim for your braces.
Your orthodontist’s office will typically handle this, but here’s what you need to know:
Submit the necessary paperwork: The orthodontist will likely submit a pre-treatment estimate to your insurance company to determine how much of the cost will be covered.
Wait for approval: After submitting the estimate, you’ll need to wait for your insurance company to approve the claim. This could take several weeks.
Understand your payment responsibility: Once the claim is approved, you’ll receive an explanation of benefits (EOB) outlining how much your insurance will cover and how much you’ll owe out of pocket.
Conclusion
Finding dental insurance that covers braces requires careful research and planning. Start by reviewing your current insurance policy, and if necessary, explore additional options such as employer-sponsored plans, individual insurance, or orthodontic discount plans. Be mindful of premiums, deductibles, coverage limits, and whether your orthodontist is in-network. Consider using an HSA, FSA, or financing options to cover any remaining costs.
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