Your Dental and Orthodontic Insurance Plan

Do You Have Coverage for Braces and Orthodontic Dental Care?

Person Having Teeth Checked While Smiling at Orthodontist
••• mediaphotos / Getty Images

Dental insurance is not an essential benefit, so health insurance plans do not automatically cover dental and orthodontic care. Orthodontic health insurance is usually a supplemental health plan which you add to your health insurance or purchase separately.

Depending on the type of orthodontic care or services you are looking for, different plans might work better for you. Learn more about dental insurance and orthodontics coverage.

Key Takeaways

  • Some dental insurance programs can help you pay for orthodontics for anyone in your family.
  • Not all dental insurance cover orthodontics, so you should make sure your plan does before starting any treatments.
  • You can choose between two types of plans: a dental discount plan and a dental insurance plan.
  • Dental discount plans take a percentage of costs, while dental insurance plans can act like normal insurance with deductibles and co-pays.

Orthodontics Insurance Coverage 

Orthodontic insurance can provide many benefits aside from braces to align your teeth when you're young. In addition, many adults turn to orthodontics to correct problems that come up later on in life.

Some adults might get braces or a retainer to align their teeth; some might need mouth guards for night-time teeth grinding. The field of orthodontics has made incredible advances, so people can take advantage of orthodontics insurance at all stages of life.

Unfortunately, you might not have orthodontics coverage even if you have dental insurance. If this is the case, you'll have to find a supplemental dental coverage plan for orthodontics that offers what you and your family need. You should also note that orthodontics coverage and costs are usually different for adults and kids, so look at plans that are affordable for both if an adult needs treatment.

Orthodontics care is very expensive, so it helps to have financial assistance to pay for treatment.

What Should I Look for in Orthodontics Insurance?

As you're looking for orthodontics insurance, there are some questions you should ask the providers:

  • Is there a yearly or lifetime maximum benefit limit?
  • Does coverage apply to adults or only children under 18?
  • Is there a waiting period before coverage can begin?
  • If treatment has begun before the plan starts, will it still be covered after the waiting period? Are there any restrictions?
  • Are there any non-covered types of braces?
  • Are there any restrictions on orthodontists? For example, do they have to be within a specific health network?
  • Is there a deductible or copay for orthodontic work?
  • Does your plan cover orthodontic care?

If you're not comfortable with any of the answers they give, you may want to look at a different provider. Every provider will offer slightly different options, so don't stop looking until you find the right plan.

Where Can I Find a Plan?

Not all health plans cover orthodontics or even dental. If you're covered under an employee health benefits package, it does not mean your plan sponsor chose to include orthodontics in their dental package. Check under the dental section of your benefits package or ask your human resources representative or benefits manager to help you figure out if it is covered.

There are several other places you can look to find orthodontics coverage. Here are a few to help you locate plans:

  • The National Association of Dental Plans is a great resource to help you find a plan. It is a dental insurance marketplace that offers you options and information on the various dental plans available. You can choose your state and search based on what you are looking for.
  • Another great place to look is at dental and orthodontic doctor's offices to see if they have any recommendations. Knowing what insurance certain doctors accept is especially important if you would like to go to a specific doctor. 
  • If you have a health insurance broker or agent, they can help you find a plan that meets your needs and what you are looking for. Also, if you find the research to be overwhelming, the agent may save you some time.
  • Your spouse or domestic partner might have insurance with dental, so you should also find out if there is a possibility of coordinating benefits or supplemental insurance on their plan. It is also very important to specifically ask about the coverage for orthodontic work.
  • Healthcare plans on the Healthcare marketplace have dental insurance for your kids, but you'll more than likely need to buy additional adult dental insurance. You can find dental plans with orthodontics coverage on the the marketplace.

One caveat for buying dental insurance on the marketplace is that you're required to buy a healthcare plan simultaneously.

Dental Discount Plans vs. Dental Insurance

Dental discount plans provide you with discounted services. Most discount plans use annual premiums that equate to less than the combined monthly premiums of insurance plans. You then pay reduced costs for every visit to your dentist. Depending on how much you use the dentist, you could save money—if you go to the orthodontist and dentist more, you might spend more with a discount plan.

With a dental discount plan, you will get a certain percentage off your dental visits and orthodontic care. Discount plans may restrict you to certain doctors who accept the discount plan. However, they provide the advantage of not having a maximum limit on services—this could come in handy if you're going to have a lot of work done.

A dental insurance plan is used similar to health insurance. You might have a co-pay for some services or a deductible depending on what you choose and pay premiums for. There also may be waiting periods before you can use the services.

 Dental Discount Plan Dental Insurance Plan 
Get a percentage off every treatment 100% covered annual cleanings and exams
No limit to the amount of visits or services Annual limit on other visits and services
No monthly premiums Monthly premiums
Lower annual amount paid in premiums High annual amount paid in premiums
Best for people who don't visit the dentist often Best for people who go to the dentist often

How Much Does Orthodontic Care Cost?

Dental insurance plans or dental discount plans can help you get access to the orthodontic care you need. Therefore, it is important to research what orthodontic care is covered in the plans you're looking at and how much you'll be paying. Depending on the coverage you select, you might pay less than $20 per month or hundreds of dollars per month.

Four areas relate to orthodontic services and treatments that are essential to the costs you'll pay and coverage you'll receive:

  • Premiums
  • Deductibles
  • Co-pays
  • Exclusions

You'll find that the more you pay upfront (monthly premiums), the less you'll pay at treatment time. First, however, you'll have to determine how often you or your family will be visiting the orthodontist and what kind of treatments might be needed. Then, once you have an estimate, you can decide how much you might need to pay for supplemental insurance based on prices from different providers.

The Bottom Line

If you're looking into having some work done on your teeth, take a close look at your individual or employer-sponsored dental insurance plan to see what coverage you have for braces and orthodontic care.

If you don't have any coverage, can't afford coverage, or don't have the coverage you need, you'll need to look for other dental or health insurance plan options.

Not all health insurance plans carry dental benefits. Not all of those that do cover orthodontic work; however, more health plans are starting to cover it. The level of coverage varies, and some plans only cover orthodontics for children. Make sure you know what you're getting when you sign up for a dental plan and consider whether you'll need orthodontic work done in the future before you decide.