To know how orthodontic insurance works, you need to first be aware of what orthodontic insurance is, what orthodontic insurance covers, and whether or not orthodontic coverage is an extension of dental insurance.

What is orthodontic Insurance and what does it pay for?

Orthodontic coverage is a benefit plan or a coverage plan under dental insurance. It covers orthodontic services and exceptional dental treatments that deal with the positioning of misaligned or mispositioned teeth or jaw. The services provided include; 

  • Positioning and aligning misplaced or overcrowded teeth
  • Treating malocclusions caused by crossbite, underbite, or overbite. 
  • Providing lip and cheek bumpers
  • Providing Braces, retainers, space maintainers and palatal expanders when needed.

Orthodontic insurance can be bought under a health care or dental insurance plan either individually, as a family or through your employer- if your workplace offers dental insurance. It is important to note that not all dental plans offer orthodontic coverage benefits.

How does orthodontic Insurance work?

At times, orthodontic coverage is treated as a different insurance plan when really it is a benefit plan under dental insurance. Though it may be purchased separately from your dental insurance, it does not change the truth that orthodontic treatment still falls under general dental care and is treated as such. However, orthodontic treatment is extra special dental care, meaning costing, payment plan, waiting periods, plan limitations, and so on, differ from regular dental care.

Here are a few things you need to know about how orthodontic insurance works;

  1. Coverages:  Most insurance coverages have a waiting period whereby an individual waits before that coverage is made active. For orthodontic coverage, you may need to follow up on your dental plan to know whether or not there is a waiting period. Also, a coverage -depending on your dental plan- may cover just children, adults, or both. It is important to note that in the case of loss in coverage, unpaid benefits will be transferred to your balance and the billing parties will take up the responsibility of payments.
  2. Lifetime maximum: Lifetime maximum benefit is the paid benefits of orthodontic coverage that you are entitled to. However, these LTM benefits have a paid limit; this means that for every orthodontic coverage, your LTM only covers a percentage (maybe more or less than 50%). Some orthodontic treatments may require that you use your LTM full benefits at once while others may require your insurance company pays 50% of your LTM benefits.
  3. Work in Progress: Work in progress is a term used not only for new coverages but in case your dental insurance changes during your orthodontic treatment. Not all dental insurances or plans cover work in progress. Work in progress may also cover orthodontic benefits you didn’t have before until maybe after a change of employer or dental plan.
  4. Dual coverage: For dual coverages, it is necessary that insurance companies determine the primary and secondary plan. There are rules that must be followed before you can be eligible for a dual coverage
  • Standard coordination of both benefits
  • Non-duplicating clause
  • The birthday rule
  1. Qualification: In most cases, if you are able to qualify for healthcare insurance then you can also qualify for orthodontic coverage. However, some policies may have terms and conditions that apply before you can qualify for orthodontic coverage. It is important to discuss with your insurance company to know if you are eligible for orthodonticcoverage.
  2. Benefit Duration: Orthodontic benefits do not last for a lifetime. As a matter of fact, you are limited to how much orthodontic treatment you can get in your lifetime. Usually orthodontic benefits can only be used once and covers only a percentage of your orthodontic treatment.
  3. Payments: Orthodontic payments are never in lump sum. Depending on your insurance company, payments mode or method can be customized. However, your coverage must always be active to receive full benefits.

Difference between orthodontic coverage and Dental coverage

Orthodontic CoverageDental Coverage
Orthodontic coverage pays out benefits at once initially, then in installments over a customized period.Having a dental insurance does not mean you have orthodontic coverage.
Braces are tax-deductible especially if they are considered a medical necessity.It is often included as part of an employee’s healthcare insurance package






How much does Orthodontic Insurance cost?

Orthodontic benefits are not your regular dental benefits hence, it will reflect in the amount of premium you pay. In most cases, orthodontic benefits are paid in installments over a customizable period that best suits you.

Orthodontic services are quite different from general dental services hence your insurance company –depending on your plan- may decide to cover a part or all of your or child’s orthodontic treatment. Most insurance plans cover up to 50%

Factors that affect the costing in orthodontic treatment

While cost of orthodontic coverage depends on the dental insurance company you are purchasing from, a few other factors are worth considering;

  • The types of braces you’re purchasing has a large influence on the costing
  • How long you receive orthodontic treatment or wear your braces for.
  • Encouraging your dentist to join a network of dentists.
  • Coverages

Other things to know about Orthodontic Insurance

  1. If you are purchasing orthodontic coverage under a family dental insurance plan, be sure to confirm if it covers adults or children, or both.
  2. If you do not understand the details of your coverage plan, you may end up with unexpected costs.
  3. Depending on your dental plan, you may be qualified for discounts. 
  4. Every dental plan has a planned material that must be reviewed to identify covered and uncovered services.
  5. Most dental insurance plans include orthodontic coverage specifically for braces.
  6. There is what is referred to as a coverage limit that is the maximum amount your company can cover for your orthodontic treatment. Also, this coverage limits maybe annually or bi-annually.
  7.  There are waiting periods between orthodontic treatment and before orthodontic care is activated. 

References

  • Cigna, (2022) Orthodontic coverage| Learn about dental insurance that covers braces. Retrieved from https://www.cigna.com
  • Best Orthodontics NYC, (2021) What services do orthodontists provide? Retrieved from https://www.bestorthodontistnyc.com
  • (2019) Understanding your orthodontic benefits. Retrieved from https://www.mardagaortho.com
  • Dr Carrie, ( 2020,February 11) Understanding your orthodontic Insurance. Retrieved from https://chtortho.com
  • Colgate-Palmolive company, (2022) How to find dental insurance that covers braces for adults. Retrieved from https://www.colgate.com