Does insurance cover orthodontic care?

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insurance

Having the perfect teeth are not just for children anymore; many adults are searching for that fantastic smile also. However, orthodontia is an expensive cosmetic choice and finding a plan to cover these braces can be challenging.

Employer-Sponsored Dental Insurance

Dental Insurance is often a part of every employer’s health care package. Even though your employer is the one who decides the plan and level of coverage, you may get lucky and have orthodontic treatment covered under your policy. With this being said, most plans are limited to children under the age of 18, but it is becoming more popular for employers to opt-in for adult coverage also. 

If you are unsure of your current coverage, you should check with your human resources department. Make sure you clarify whether you have limitations. Ask if there are yearly or lifetime maximums or any waiting periods before you can begin treatments. The amount of coverage varies from company to company, but it is common to see about a 50% coverage with a $1500 lifetime maximum. You also need to clarify the types of braces that are covered and if you are required to visit a dentist or orthodontic specialist within your insurance network.

Stand-Alone Dental Insurance

Individuals who are looking to have affordable dental coverage without purchase individual health plans can look at opting-in to a stand-alone policy. These plans tend to reimburse you or will pay your dentist directly. 

Like group plans done with an employer, you can expect stand-alone dental coverage to have similar benefits. With stand-alone plans, you have the flexibility to choose the policy that is best for you and your family. Orthopedic care coverage will depend solely on the company and program you decide to purchase. Make sure to ask all the essential questions as you would if you had employer-sponsored dental coverage. Subjects should include topics such as cost, limitations and network.

As an example, DeltaCare USA PAA48 is an example of a stand-alone dental program that includes the treatment of orthodontics for adults. Their premium is around $105 and includes an expense coverage of $2500 for a two-year treatment, which is approximately 50% less than the average cost of a orthodontic treatment.

Discount Plans

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Also recognized as dental savings plans, discount plans allow you to buy dental services at lower prices. These plans are NOT considered dental insurance, but with their increasing popularity, patients can find significantly discounted rates given by network dentists that provide adult orthodontic procedures. These plans can be a great choice if you have either no coverage for orthodontic treatment or if you have reached your maximum payout for both yearly or lifetime coverage.

Does Medicaid cover braces?

If you qualify for Medicaid only your children may be covered. The procedure must be deemed medically necessary for them to approve your application. Make sure to ask about the percentages covered and their lifetime maximums.

Dental coverage for Low Income

Your state/province or local health departments are quite knowledgable and can provide information on programs in your area. These offers can include free or reduced-cost dental care. Call your local or state/province health departments to acquire more information about their assistance programs. 

Shopping for Your Orthodontic Coverage

When we are trying to find the right coverage we must consider what is best for both yourself and your pocketbook. There are many options available. Not all plans are created equals; therefore, finding a plan that meets your needs can make a huge difference. There are databases such as Dental Plans which represent over 40 discount programs and allow you to compare the important benefits such as yearly fees, discounts and networked dentists. The NADP (National Association of Dental Plans) is also a great place to search for all types of coverage whether it be group, individual, or discount. 

Discovering dental insurance that encompasses coverage for adults may take some due diligence. Still, with more programs and expanded networks surfacing today, there is no doubt you will be able to find coverage for your needs.

Alternatives to braces

If you are not eligible for or have no interest in wearing braces, you may want to look at alternatives. Your orthodontist may recommend options to braces allowing you to achieve the results you are wanting. 

One of these alternatives may be Invisible braces. This option tends to be more expensive but many dental insurance policies will cover a portion of the cost. Even if not specifically covered under your plan, some insurance companies will payout a fixed amount toward the cost of the treatment.

Making braces more affordable

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Payment Plans

Many dental practices offer payment plans. Make sure to check with your orthodontist to see if you are eligible.

HSA/FSA/HRA

A HSA (Health Savings Account) can assist patients with plans that involve high-deductible health insurance plans. These are primarily used to cover their out of pocket expenses when it comes to qualified healthcare.

A FSA (Flexible Spending Account) is set up by an employer for an employee. These are also referred to as flexible spending arrangements. The account allows you to take part of your earnings and contribute towards the purchase of qualified expenses related to medical and dental costs.

A HRA (Health Reimbursement Arrangement) is also an employer-funded plan. These plans are used to reimburse employees for their qualified medical expenses. In some cases, this also can cover insurance premiums. Generally, these plans are tax-free, and employers are allowed to claim a deduction for their reimbursements.

Orthodontists in Training

Check to see if a university near you has a dental or orthodontic school. These schools can offer services that are conducted by students in the dental apprenticeship program. A trained and experienced orthodontist fully supervises these sessions. These services tend to come at a reduced cost.

Plan Ahead

The cost of braces can be quite expensive, and without the proper coverage, it can result in spending quite the penny. These are some rough costs of braces:

Metal: $3000-$7000

Ceramic: $4000-$8000

Invisalign: $8000-$10000

Lingual: $4000-$7400

 

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