Dental insurance isn't an essential benefit, so health insurance plans don't automatically cover this type of care. Orthodontic health insurance is often a supplemental health plan. You can add it to your health insurance or purchase it separately.
Some plans might work better for you than others, depending on the type of orthodontic care or services you're looking for. Learn more about dental insurance and orthodontics coverage.
- Some dental insurance programs can help you pay for orthodontics for anyone in your family.
- Not all dental insurance covers orthodontics. 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. Dental insurance plans work like normal insurance with deductibles and copays.
Orthodontics Insurance Coverage
Orthodontic insurance can provide many benefits aside from braces to align your teeth. Many adults turn to orthodontics to correct problems that come up later 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 huge advances. People can take advantage of orthodontics insurance at all stages of life.
You might not have orthodontics coverage even if you have dental insurance, and you might have to find a supplemental dental coverage plan for orthodontics that offers what you and your family need. Orthodontics coverage and costs often vary for adults and kids, so look at plans that are affordable for both if an adult also needs treatment.
Orthodontics care can be very expensive, so it helps to have financial assistance to pay for treatment.
What Should I Look for in Orthodontics Insurance?
Ask the providers certain questions when you look for orthodontics insurance:
- 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?
- Will treatment still be covered after the waiting period if it began before the plan started? Are there any restrictions?
- Are any types of braces not covered?
- Are there any restrictions on orthodontists? Do they have to be within a certain health network?
- Is there a deductible or copay for orthodontic work?
You may want to look at another provider if you're not comfortable with any of the answers they give. Each will offer their own options, so don't stop looking until you find the plan that works for you.
Where Can I Find a Plan?
Not all health plans cover orthodontics or even dental work. It doesn't mean that your plan sponsor chose to include orthodontics in their dental package if you're covered under an employee health benefits package. Check under the dental section of your benefits package, or ask your human resources representative or benefits manager to help you figure out whether this type of treatment is covered. There are many other places you can look to find orthodontics coverage.
The National Association of Dental Plans is a great resource to help you find a plan. It's a dental insurance marketplace that offers you options and information on the various plans available. You can choose your state and search based on what you're looking for.
Ask dental and orthodontic doctors' offices whether they have any recommendations. Knowing what insurance certain doctors accept is key if you'd prefer to go to a certain doctor.
Your health insurance broker or agent can help you find a plan that meets your needs. The agent may save you some time if you find the research to be more than you care to handle on your own.
Your spouse or domestic partner might have insurance that covers dental care. Find out whether there's a possibility of coordinating benefits or supplemental insurance on their plan. Ask about the coverage for orthodontic work.
Healthcare plans on the Healthcare Marketplace offer dental insurance for your kids. You'll no doubt have to buy additional adult dental insurance. You can find dental plans with orthodontics coverage on the Marketplace.
One catch to buying dental insurance on the Marketplace is that you're required to buy a healthcare plan at the same time.
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. You could save money, depending on how much you use the dentist. You might spend more with a discount plan if you often go to the orthodontist and dentist.
You'll get a certain percentage off your dental visits and orthodontic care with a dental discount plan. These plans may restrict you to certain doctors who accept the discount plan, but 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 copays or a deductible for some services, depending on what you choose and pay premiums for. There may also 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 number 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. Research what orthodontic care is covered in the plans you're looking at and how much you'll be paying. You might pay less than $20 per month, or you might pay hundreds of dollars per month, depending on the coverage you select.
Four areas relate to orthodontic services and treatments that are essential to the costs you'll pay and the coverage you'll receive: premiums, deductibles, copays, and exclusions.
You'll find that the more you pay upfront in the way of monthly premiums, the less you'll pay at treatment time. First, you'll have to decide how often you or your family will be visiting the orthodontist and what kind of treatments might be needed. Then you can decide how much you might need to pay for supplemental insurance based on prices from different providers when you have an estimate.
The Bottom Line
Take a close look at your individual or employer-sponsored dental insurance plan to see what coverage you have for braces and orthodontic care. You'll have to look for other dental or health insurance plan options if you don't have any coverage, can't afford coverage, or don't have the coverage you need.
Not all health insurance plans carry dental benefits. Not all of those that do carry them cover orthodontic work, although more health plans are starting to cover it. The level of coverage varies. Some plans only cover orthodontics for children. Make sure you know what you're getting when you sign up for a plan. Think about whether you'll need orthodontic work done in the future before you decide.
Cigna Health and Life Insurance Company. "Orthodontic Coverage: What Dental Insurance Plans Cover Braces?" Accessed Feb. 15, 2022.
National Association of Dental Plans. "Search Membership Directory." Accessed Feb. 15, 2022.
HealthCare.gov. "Dental coverage in the Marketplace." Accessed Feb. 15, 2022.
Humana. "The Scoop on Dental Discount Plans." Accessed Feb. 15, 2022.