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Does Dental Insurance Cover Braces?

Does dental insurance cover braces? Break down different types of braces, coverage variations, payment options, and an affordable solution here.

Last updated on

December 20, 2023

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Does Dental Insurance Cover Braces?

Braces can correct improper bites, overcrowding, and alignment issues, contributing to your overall oral health. While most of us focus on the aesthetic enhancement braces bring, they serve a much more significant purpose.

When it comes to maintaining your oral health, understanding your dental insurance plans and coverage is imperative. Often, orthodontic care like braces is a vital part of this health journey. 

However, the looming question is: does dental insurance cover braces? It's essential to know this information to prepare for any out-of-pocket expenses. This article aims to answer that question and more, so let's dive in!

How Do Braces Work?

Braces work through a combination of direct pressure and shifting the teeth gradually. The orthodontist usually places brackets on each tooth and runs a wire through them. The purpose of the wire is to guide the teeth in a specific direction, correcting the alignment or bite. 

Over time, the pressure from the wire moves the teeth into their proper positions. Braces are not a one-size-fits-all treatment plan; the orthodontist tailors the type, application, and length of treatment to individual patient needs.

During the course of the treatment, you may also need to wear aligners or retainers. These are custom-made devices designed to hold, adjust, or stabilize your teeth and jaw position. It's crucial to understand that braces and their auxiliary elements, like aligners or retainers, are all parts of orthodontic treatment to enhance your oral health.

What Different Types of Braces Are There?

Several types of braces are available, and each comes with a different price tag, aesthetics, and functionality.

Traditional (Metal) Braces

These are the most common types of braces. They consist of metal brackets that are attached to each tooth and connected by a wire. Traditional braces are efficient and cost-effective; usually, they are the least expensive option but still can number to the thousands.

Ceramic Braces

Ceramic braces are similar to metal braces in shape and size but are tooth-colored or clear, making them less noticeable. However, they can cost more than metal braces, but not as much as the following two options.

Invisalign

These are clear, custom-made, removable aligners that gradually shift your teeth into place. They are less noticeable and easier to clean than braces.

Lingual Braces

Lingual braces are attached to the back (lingual side) of your teeth, making them invisible when you smile. However, they are harder to clean and are generally more expensive than traditional braces. Lingual braces tend to be one of the priciest treatments. 

Understanding the various types of braces can help you make an informed decision about which would be best for your orthodontic treatment and budget. However, the cost of braces can still be daunting, so it's crucial to understand whether your dental insurance coverage includes orthodontic care.

Orthodontics vs. Dentists: What's the Difference?

While both orthodontists and dentists work to improve oral health, their focus is quite different.

Dentists cover a broad range of oral health issues. They're experts in general dental care and maintenance, performing tasks such as cleanings, fillings, crowns, root canals, and whitening treatments.

Orthodontists, on the other hand, are dental specialists focused on the alignment of teeth, bites (overbite, underbite, crossbite, etc.), and jaws. They use appliances like braces, retainers, and aligners to help move teeth and jaws into proper alignment.

Think of it this way: All orthodontists are dentists, but not all dentists are orthodontists. An orthodontist requires additional years of training beyond dental school, focusing specifically on orthodontia.

Does Dental Insurance Cover Orthodontic Services?

The coverage of orthodontic services, such as braces, varies significantly among dental insurance plans. 

Some plans may include full orthodontic coverage for individuals under a certain age, while others may provide a certain amount of coverage for individuals of any age. Some insurance plans cover a portion of the orthodontic treatment cost up to a lifetime maximum, which is a cap on the benefits your insurance provider will pay over the course of your life.

There are also plans that might not cover orthodontic services at all, especially if it's deemed as "cosmetic" and not medically necessary. Before considering orthodontic treatment, it's vital to thoroughly review your insurance coverage and clarify what portion of the cost will be covered by your insurance company and what will be your out-of-pocket responsibility.

While this can seem overwhelming, understanding your dental insurance coverage is crucial before starting orthodontic treatment. 

Can I Get Braces With Dental Insurance?

The answer to this question is, unfortunately, pretty nuanced. Whether your dental insurance will cover the cost of braces largely depends on your specific insurance plan.

Dental insurance plans vary greatly, with some providing coverage for orthodontic care and others not. Furthermore, even within plans that do cover orthodontic care, the extent of that coverage can vary significantly. Some may cover only a small percentage of the cost, while others may cover a significant portion.

Most dental plans focus on preventive care, such as regular cleanings and exams, to keep your oral health in check. These plans might only offer limited coverage for orthodontic procedures if any at all. But don’t panic. We’re here to help break down what factors can affect your coverage and highlight payment options outside of insurance that can help reduce braces' costs. 

What Factors Can Affect Insurance Coverage?

The cost of braces can vary widely depending on your specific situation, and several factors can influence your dental insurance coverage. 

Age and Type of Braces Required

The cost of braces can fluctuate significantly depending on your specific situation, such as the type of braces you need. Additionally, your age plays a crucial role, with some insurance plans only covering orthodontic treatment for individuals under 18.

In-Network Providers and Plan Policies

Whether your orthodontist is in-network with your insurance provider can also affect the overall costs. Many PPO (Preferred Provider Organization) health insurance plans provide a higher level of coverage if you opt for an in-network provider.

Focus of Insurance Plan: Preventative Care vs. Orthodontic Care

Most dental insurance plans prioritize preventative care, such as cleanings and X-Rays. However, these insurance policies also extend some coverage to orthodontic care, although the percentage of coverage typically varies from plan to plan.

Waiting Periods and Lifetime Coverage Limitations

Insurance providers often implement waiting periods. This means that they won't cover braces or other orthodontic services until you've been on the plan for a specific amount of time. Also, many insurance plans specify a maximum lifetime coverage limit for orthodontic services, beyond which you'll be responsible for the costs.

Exclusions and Cost-Sharing Policies

Insurance plans typically list exclusions or services not covered under the plan. Cosmetic orthodontics, like invisible aligners such as Invisalign, often fall under these exclusions, especially when cheaper alternatives are available. Furthermore, even when orthodontic treatment is covered, insurance plans often require the patient to share the cost, typically through deductibles or copays.

Navigating these factors can make understanding your insurance coverage quite challenging, underscoring the importance of exploring other ways to pay for orthodontic treatment.

How Else Can I Pay for Braces?

While dental insurance is one way to help shoulder the cost of braces, it is by no means the only option. There are other paths you might consider:

  • Health Savings Accounts (HSA): These accounts allow you to contribute pre-tax dollars for medical expenses. The funds in an HSA roll over from year to year, and you can use the money for qualified medical expenses, including orthodontic treatment.
  • Flexible Spending Accounts (FSA): Like HSAs, FSAs allow you to contribute pre-tax dollars for medical expenses. However, FSA funds do not roll over to the next year, so it's a use-it-or-lose-it situation.
  • Medicaid: This is a state and federal program that provides health coverage for some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Some Medicaid programs offer coverage for orthodontic services.
  • Dental Schools: Many dental schools offer high-quality, supervised dental work at a reduced cost as part of the training experience for graduate students. This can be a cost-effective way to get braces.
  • Discount Plans: Another viable option is dental discount plans. They are not insurance but offer discounted rates for dental services from select providers. Discount plans can be used alone or in conjunction with traditional insurance coverage to offset the cost of orthodontic treatment.

Each of these options has pros and cons. For instance, while HSAs offer a tax-efficient way to save for medical expenses, you may be limited by how much you can contribute each year. On the other hand, Medicaid could offer low-cost or free coverage, but eligibility requirements can be strict.

Flossy: An Affordable Dental Solution

In this complex landscape of dental care and orthodontics, Flossy emerges as an affordable dental health solution. Our mission is to make dental care, including orthodontic services, accessible and affordable to everyone. 

By working with a network of trusted dental professionals to provide top-quality care at reduced prices, we can help save you up to 50% on dental care. With Flossy, you can enjoy immediate discounts, transparent pricing, and the convenience of paying with your smartphone.

Your oral health is a critical part of your overall wellness, and understanding how to manage the financial aspects of dental care can help ensure you and your family get the treatments you need without undue financial stress.

So why wait? Download the Flossy app and connect with our network of dental professionals today.

Sources:

Types of Dental Plans | American Dental Association

Adults Braces: Types, Costs and How they Work | U.S. News

Health Savings Account (HSA) | HealthCare.gov

Cost-sharing reductions | HealthCare.gov

Braces: Types & How They Work | Cleveland Clinic

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