When most people think about orthodontics, they think braces. And this is one of the most common orthodontic procedures. But, it’s often not covered by health insurance or even regular dental insurance.
And when braces cost $3,000 to $5,000, it’s easy to see why people want the better orthodontic insurance.
What Is Orthodontic Insurance?
Orthodontic insurance is a special type of insurance designed to fill in the gaps left by most dental and health insurances.
Regular health insurances only cover dental and orthodontic procedures if the overall problem is caused by or made worse by a problem that originates in the mouth. Even then, it could be tricky to get full coverage for the work done by a dentist or orthodontist.
We aren’t sure why health insurance doesn’t cover dental work. So many problems start in the mouth and so many problems could be avoided with good and regular dental check-ups.
Dental insurance covers most dental procedures. It’s designed for general check-ups, cavities, and minor procedures. Basically, it covers things that can be fixed in one session and require few, if any, surgical tools.
For most people, this insurance is enough. Most people don’t need more complex orthodontic procedures. But for the few who do, the insurance will more than pay for itself.
Most often, it is children who need orthodontics. They are the ones that require braces and teens may require the removal or adjustment of wisdom teeth. Many dental plans will cover children up to the age of 18 for braces and other orthodontic work. They know that fixing a problem in a child is significantly less costly than fixing the same problem in an adult.
You should contact your health insurance and dental insurance companies to find out exactly what they cover. You should also ask your regular dentist what kind of problem you are likely to see in your life to help you prepare for the eventuality of needing orthodontic insurance.
Why Do I Need Orthodontic Insurance?
If you check, you are probably among the 80% of the population that are not covered for braces and other orthodontic procedures. If you need braces or serious work, you are paying for it out of pocket.
There is a huge growing trend in adults to fix their teeth. They want white, straight smiles. Braces, retainers, and whitening treatments are not normally covered under regular dental plans for adults.
Of course, most of the time, these are voluntary procedures. You may not require them, but life is better with them.
For example, a good friend of mine was plagued by a poor dentist growing up and stopped visiting one as a late teenager until her mid-20s. At that time, she found a good dentist and discovered she was grinding her teeth so hard, it was wearing them away and she had one or two stress fractures.
Her dental insurance covered fixing the stress fractures, but not the night retainer to prevent future reoccurrences. She chose to purchase the night retainer on her own, at a cost of $4,000.
Types of Orthodontic Insurance
Unlike health insurance plans and even dental plans, orthodontic insurance is considered a specialty insurance and not covered by regular plans. Employers, those that still offer plans, rarely include orthodontics in their plans.
In the world of changing insurance coverage, it is unclear whether any of us will have insurance tomorrow or not. Fortunately, paying for your own insurance improves your chances of having it when you need it.
Individual Orthodontic Insurance Plans
If you don’t have a good dental plan, seeking out a full coverage orthodontic insurance plan is the way to go. These plans include all dental and orthodontic work. They will take you through day to day cleanings right up through getting braces.
These plans are more complicated to find. Only a handful of insurance companies is choosing to handle full orthodontic insurance that covers everything. Most of the time, they want you to purchase two separate plans: one for regular dental and a supplemental one for orthodontics.
Supplemental Orthodontic Insurance Plans
Most people will actually only need supplemental insurance for orthodontics. This is coverage only for certain procedures and works to be done, like braces, retainers, and wisdom teeth.
It can be highly beneficial if you have on-going dental issues. For people with multiple cavities, weak teeth, or are thinking about adult braces, we recommend getting this insurance as soon as possible.
The problem with supplemental insurances like these is that they require you to be on the plans for several months, sometimes as long as a year, before they will cover voluntary orthodontic work. They want to make sure they get enough income to justify the payout.
How Does Orthodontic Insurance Work?
Orthodontic insurance pays out like most insurances. When the dentist or orthodontist chooses work, they will check with the insurance companies to see if they actually will pay for the procedure. Some may also check to see what other related services are also covered and then choose the therapies they provide from there.
No medical practitioner should behave this way, but far too many have done procedures, expensive procedures, only to find the insurances won’t pay and the person cannot afford it. Now, they doctor may be out tens of thousands of dollars.
So, the insurance companies are more in control of the procedures they are paying for and what the doctors do. They dictate what is paid for and what is not.
Once the orthodontist knows what procedures are covered, they will do the work. Then, they will submit their bill to the insurance company. And then, months later, they will get a check to pay for the work they did for you.
Is Orthodontic Insurance Worth the Cost?
For most people, it will be a big YES. For some, it will be a waste.
If you find your dental plan does not cover orthodontics and your dentist has determined it is a possibility you will need more extensive work in the future, we highly recommend getting the insurance. But, if the opposite is true, then we feel it would be a waste of money.
Young adults wanting braces and older adults beginning to have dental issues are the best candidates for needing supplemental orthodontic insurance. Medicare does not cover most orthodontic procedures.
The insurance itself is not overly expensive. The cost per month is much less than what you would pay out of pocket for many procedures.
Last year, a gentleman discovered the past bridgework in his mouth came loose. Fortunately, he had purchased supplemental insurance years ago, even though he had never used it (the bridge was covered by his regular dental insurance). Upon trying to replace the bridge, covered by regular dental insurance, the dentist discovered that several other teeth were in serious need to repair and that the bridge would cause further damage.
This gentleman was referred to an orthodontist to discover what his options were. It turned out, he needed several teeth removed, a new bridge, and a partial denture created. In order to preserve the remaining teeth, special crowns were needed.
Had he not had supplemental insurance, his regular insurance would only have covered the removal of his teeth. He would have been on his own to replace the teeth and take care of the ones that were still good. At a cost of nearly $6,000, this gentleman feels the small monthly cost of his orthodontic insurance more than paid for itself.
What Does Orthodontic Insurance Cover? How Much?
You can find coverage for as little as $7 per month. But, it doesn’t cover much.
Generally, you’ll find full orthodontic insurance for $50 to $100 per month. Smaller supplement plans are often $20 to $40 per month. The level of coverage dictates what is covered and how much your plan will be.
We definitely recommend using a broker rather than searching yourself for a plan. Websites are notoriously hard to navigate and a plan you may like now could be gone when you go to purchase it.
With a broker, they do all the work for you and present you with a plan that will fit your needs. Often times, they can find a plan that will be lower cost than what you could find yourself.
Of all the problems orthodontics covers, there are certain ones that stick out.
This often occurs when the mouth is too small for the teeth. Many times, the wisdom teeth push the other teeth together. Removal of the wisdom teeth helps to relieve this stress.
In other cases, braces are needed to help straighten out the teeth.
In general, crowded teeth are not a problem to eating or talking. In adults, adjusting crowded teeth is considered a cosmetic procedure. Orthodontic insurance usually covers this case, but be sure to verify it before you have the procedure done.
Minor over and under bites are not considered a detriment to health. Moderate to major over and under bites are. When the bite is off significantly, it can be considered a hazard to health and many dental insurances, and a few health insurances will cover the braces or retainers to adjust the bite.
This is often done in children and young adults. Once you reach adulthood, your insurance company may consider this a cosmetic procedure and deny coverage. Again, you will need to see what your current plan covers and what your dentist suggests before any work is done.
Closing a minor gap is a cosmetic procedure and more often than not is denied under insurances. It is not harmful and many gaps close on their own.
When a gap affects your eating or talking patterns, your dentist or orthodontist will recommend braces or retainers. As a child, your dentist will recommend this, rarely as an adult.
Since gaps in your teeth are the most common reason for adult braces, orthodontic insurance often covers this reason.
This is the second most common reason for adult braces. While many dentists will believe crooked teeth will straighten with time, many people don’t. They find that the crooked teeth are a detriment to their job prospects and relationships.
Oftentimes, braces are covered under orthodontic insurances to fix crooked teeth.
As a child, your dental insurance will have full coverage for braces. But, as an adult, this is rarely the case. Orthodontic insurance will cover braces that are to fix problems, such as gaps or overbites. But, they may balk at covering braces for cosmetic reasons. You would need to check with your plan or potential plan to see.
The actual cost of the braces for adults should be fully covered by the insurance, but you may have an additional cost of the insurance. Some insurances will pay 100% or may only cover a certain time frame.
If your insurance doesn’t cover braces complete, you can work out a payment plan with your dentist to make up the difference.
More often than not,
Be sure to check with your insurance company to know when and how your coverage applies to retainers.
This is a retainer system that is rather controversial within the insurance industry. Some companies love the system, and will cover all the costs. Others find it to be too weak and unproductive and will not cover it at all.
If your orthodontist recommends Invisalign, be sure to check with your insurance company to find out if you are covered or not. Don’t be surprised by a huge bill of a couple thousand dollars when you expect your insurance company to provide coverage.
How To Get Orthodontic Insurance
Once you decide you need orthodontic insurance, the skill is to get it. We recommend using a broker to navigate the system and to get the best deal.
Orthodontic insurance for adults
Your dental insurance most likely does not cover orthodontic work. Things like braces, wisdom teeth removal, night retainers, and much more will be out of pocket expenses for you.
Your orthodontic insurance is best obtained early before you ever need it. It is available through various independent insurance companies, usually for reasonable rates.
Be sure to check with your current insurance provider(s) to know what exactly is covered and not. Most insurance plans will allow you to dictate what coverage you actually will need, so you are not wasting money paying for things that will never come up.
Orthodontic insurance for college students
As a college student, you have many more options. First, more and more health and dental plans are being extended to college students under the age of 25. You may be able to stay on your parent’s plan through college. Your broker or agent will have these details for you.
Some colleges have insurance plans for those students who are not on their parent’s plans. These insurance coverages vary widely and you really need to talk to an agent to know what is covered and not.
Rarely are voluntary procedures covered under these plans. Your dentist would need to know a necessity to have braces or other work covered, and even then it can be argued whether the insurance plan will cover it.
Fortunately, many independent insurance companies are extending coverage to college students and recent graduates at a reduced price. You can check with many of these companies to see what is covered and what isn’t, plus what discounts they offer.
Orthodontic insurance for children
Most regular dental plans will cover orthodontics for children. You would need to check with your own plan to know what is covered and what is not.
If your plan does not cover orthodontics for children, then you will need to see out supplemental or full coverage.
These plans vary widely in cost and requirements for the parents to be on the plan or not. Some companies feel that if a child is on the plan, then the whole family unit should be on the plan. This can get very expensive if only one child needs it.
Other plans allow you to just cover one child. A good broker would be able to help you navigate the various plans and requirements.
Many of the plans for children do require coverage for a year or more before they will pay for services. They may also require a contract of several years, with stiff penalties for canceling the plan early. Be sure to read the fine print.
Because of this, we do recommend getting supplement insurance for children as soon as you know you don’t have coverage. Children compose over 75% of all orthodontic work.
Orthodontic insurance for veterans
As a veteran, you may be eligible for discounted supplemental coverage. But, here’s the conundrum: independent insurance is not often accepted by the VA hospitals and could cancel your VA coverage altogether. So, now the choice is difficult.
You need to know what you are facing and what your future may hold. A good dentist will help you determine what you may need for the future.
Then, you need to do some digging on what is truly covered and what isn’t. In an ideal world, our vets would have any and all necessary health and dental related costs covered. But, politicians got in the way.
Once you know what you face and what is covered, you can talk to various brokers to determine what insurances are available and what discounts there are for veterans. It is then up to you to determine what is most important.
Orthodontic insurance for military
Active military rarely is allowed extensive dental work as what orthodontic insurance would cover. What is allowed is mixed up in various regulations and insurances.
We really don’t know what to recommend in your case. We suggest discussing what is possible with your regular dentist and then find out what would be covered and allowed in your present situation.
Orthodontic insurance for senior citizens
Orthodontics for seniors is the second highest use of dental and orthodontic insurance. The need for tooth removal, extraction, dentures, bridges, and another work is extensive and frequent.
Most dental plans for seniors is not adequate for the work that often needs to be done. Medicare does not cover many of the regular procedures that would be cosmetic.
This leaves a huge hole in coverage that is too often left to seniors and paid out of pocket.
Fortunately, most insurance companies offer discounts to seniors for their dental and orthodontic insurances. It will help offset many costs that could come up.
We recommend that you obtain this insurance in the years prior to needing any work and going onto Medicare. This way, you know you are covered and when you need the coverage, you have it.
Orthodontic care for low income families
Low income has several options. For children, the state programs will provide 100% the cost of necessary dental and orthodontic work. For adults, there are supplemental programs that help reimburse you for the cost of additional insurance.
What most of these coverages won’t cover are cosmetic procedures. Adult braces are considered luxuries and are often not covered. In these cases, you would be on your own to cover the costs.
Where Can I Buy Orthodontic Insurance
Before you just buy your insurance plan, you may want to make sure it fits into your budget. Check out this really good orthodontic insurance calculator to know your true costs.
Each orthodontic insurance provider covers different things. You really need to know your potential issues and compare your issues with what the insurance will cover.
You don’t want to purchase insurance that covers braces primarily only to find out that you need surgery. Also, some will have variable rates for different ages. Be sure to check out various plans to know what will work best for you.
We recommend you start your search of what orthodontic insurance coverage with the following provider. This one we trust to give you accurate information with minimal hassle.