Your Dental Insurance Plan - Orthodontic Insurance

Getting Coverage for Braces and Orthodontic Dental Care

Woman 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 covered by a supplemental health plan which you will have to add on to your health insurance or purchase separately. If you are interested in orthodontic insurance or a good dental plan that will provide you with orthodontic care, there are a few things you should consider to make your choice. Shopping around is always a good way to save money, but you should also consider that the orthodontic insurance has different coverages for adults vs. kids. Depending on the type of orthodontic care or services you are looking for, there are different plans that will work better for you.

Orthodontic Insurance for Adults and Kids

Orthodontic insurance used to be something that people only thought about for their kids, but these days if your health insurance can help you get that smile you always dreamed of, it is definitely worth shopping around for and finding the best supplemental health plan with a dental coverage that will offer what you need including orthodontics.

Orthodontic Coverage in Dental Insurance 

Orthodontic insurance can provide many benefits aside from braces. Many adults turn to orthodontics to correct a number of problems that may only come up later on in life. For example, sometimes teeth move as you get older shifting previous orthodontic work. Cases like this might need a retainer. Invisalign treatments are very popular for adults. The field of orthodontics has a lot to offer people at all stages of life, finding affordable coverage for yourself and your family can be important.

7 Questions to Ask to Get Good Orthodontic Dental Insurance Coverage:

  1. Are there yearly or lifetime maximum benefit limits?
  2. Does coverage apply to adults or only children?
  3. Is there a waiting period before coverage can begin?
  4. If treatment has begun before the plan starts, will it still be covered after the waiting period? Are there any restrictions?
  5. Are there any non covered types of braces?
  6. Are there any restrictions on orthodontists, for example, do they have to be within a specific health network?
  7. Is there a deductible or copay for orthodontic work?

Does Your Dental Insurance Plan Cover Orthodontic Care Such as Braces? 

Many people who currently have dental insurance assume that they have some coverage for orthodontic care but that is not always the case. 

Review Your Current Dental Plan Coverages

The first step in starting your search for orthodontic insurance is to review what you have currently. Take a look at your individual or employer-sponsored dental insurance plan to see what coverage you have for braces and orthodontic care. If you find you have no or little coverage, or if you are unemployed you can research other dental or health insurance plan options.

What Orthodontic Care Is Covered?

Dental insurance plans or dental discount plans can help you get access to the orthodontic care you need, but it is important to research what orthodontic care is covered and how these four areas are covered for orthodontic related services and treatments because many dental insurance plans are very limited.

  • Premiums
  • Deductibles
  • Co-pays
  • Exclusions.

Do Health Insurance Plans With Dental Benefits Cover Orthodontic Work?

Not all health insurance plans with dental benefits cover orthodontic work, although more health plans are covering orthodontic work, the level of coverage varies, and some plans only cover orthodontics for children.

If I Have Dental Insurance in My Employee Benefits Plan, Does This Cover Orthodontics?

All health plans do not cover orthodontics, just because you are covered under employee health benefits package, it does not mean your plan sponsor chose to include orthodontics. Check under the dental section of your benefits package or ask your HR person or benefits manager to help you figure out if it is covered.

If you have a spouse or domestic partner who also has dental insurance, you should also find out if there is a possibility of coordination of benefits or supplemental insurance on their plan.

It is very important to specifically ask about the coverage for orthodontic work using our checklist above, and if the coverage is for all plan members or if it only covers children under 18.

How to Find a Dental Discount Plan

You have a few options on how to go about getting a dental plan. You may want to decide if you want a dental insurance plan or a dental discount plan first.

Dental Discount Plans vs. Dental Insurance

  • With a dental discount plan, you will get a certain percentage off of your dental visits and orthodontic care. Discount plans may restrict you to certain doctors that accept the discount plan, but they provide the advantage of not having a maximum limit on services which could come in handy if you are having a lot of work done.
  • With a dental insurance plan, you use it as you would health insurance. You can have a co-pay for some services or a deductible depending on what you choose. There also may be waiting periods before you can use the services. Learn more about dental insurance waiting periods here.

4 Places to Help You Find Dental Insurance

  1. The National Association of Dental Plans is a great resource to help you find a plan, it is a dental insurance marketplace that can offer you options and information on the various dental plans available. You can choose your state and do a search based on what you are looking for. It can really save you the time of searching aimlessly online. Here's a link to their Facebook page where they share info and will respond to messages.
  2. As you are doing your research to find a plan that covers orthodontics, besides associations and membership health plans (which can save you money) you should also check with your employer.
  3. Another great place to look is by speaking to 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. 
  4. If you have a health insurance broker or agent, you can get their help to find a plan that will best respond to your needs and what you are looking for, if you find that all the research is overwhelming, they may be able to save you some time.