Insurance

How to Find Dental Insurance that Covers Orthodontics

Maybe you used your dental insurance to cover routine cleanings and fillings, but now you’re considering something bigger: treatment to straighten your teeth.

If you’re not familiar with your insurance plan, you might think it will cover orthodontia like any other treatment, but that’s not always the case. The fact is that orthodontic benefits are not included in all dental insurance plans.

Reading: What kind of dental insurance covers braces

Luckily for you, there are ways to find dental insurance plans that include coverage for adult braces, invisalign, and even clear aligners online like smiledirectclub. What? with a few simple steps.

step one: understand the basics of dental insurance

Dental insurance is not a magic card that gives you free health care. Sure, it’ll cover some of your procedures and fees, but there’s a little more involved. Many people sign up for dental insurance through their employers, but you can also sign up for individual or family plans. Either way, you can typically choose from several different plans, each with different benefits and policies.

Some plans include orthodontic benefits, while others do not. Orthodontic benefits may cover braces, invisalign, and even at-home clear aligners like smiledirectclub, but typically won’t cover the full cost (many, for example, cover 50%).

can also include certain restrictions. Some plans will cover orthodontia for children under the age of 19, but not for adults. others may have a lifetime spending maximum, where they will cover up to a certain amount (on average $1,500 to $3,000). Sometimes a plan will also include a waiting period that requires you to wait a few months (or even a year) before using your orthodontia benefits.

important terms to know

As you sift through insurance jargon, you’ll see some recurring terms. Understanding these terms will help you better understand your coverage.

  • deductible: the amount you will have to pay out of pocket before the insurance starts paying the bill. If you have a $100 procedure, but your deductible is $500 and you haven’t paid anything yet, you’ll have to pay for the entire procedure.
    • copayment: abbreviation for copay. a fixed amount you will pay for certain covered treatments. copays may vary by procedure.
      • Coinsurance: The percentage of treatment costs that you must cover after you meet your deductible. it also varies by procedure.
        • In-Network vs. Out-of-Network – Dental providers often partner with insurance companies to provide “in-network” coverage. When your dental provider is in-network with your insurance provider, coverage rates are typically higher and your dental provider will handle the insurance paperwork for you. With out-of-network care, coverage rates are typically lower and you may need to apply directly to your insurance provider for reimbursement.
        • step two: choose a preferred treatment option

          Just because you have orthodontic benefits does not mean you will be covered for all orthodontic treatment. For example, some plans may cover in-office treatments like braces and invisalign, but not remote services like smiledirectclub or byte.

          This is a common scenario, although several large insurance providers have begun offering coverage for certain clear aligner companies online. Here is an overview of the main types of treatment that might be covered:

          invisalign

          Adults are often drawn to invisalign because it provides brace-like power without all the metal. but it can also be quite expensive: $3,000 to $8,000 (on average) before insurance. however, if you have orthodontic benefits, they often cover invisalign. just be sure to check the age limits and lifetime spending maximums. You don’t want to commit to treatment, only to find out that your plan only covers invisalign for people under the age of 19.

          See also: What is Security Bond? How does it work? – Risk Managers

          Tip: For more information, check out our comprehensive guide dedicated to covering the ins and outs of dental insurance coverage for invisalign.

          braces

          braces coverage is usually the same as invisalign. orthodontia benefits will cover braces, but there may be age and expense restrictions. Without insurance, braces are about the same price as invisalign and sometimes a little less expensive. If your insurance plan doesn’t include orthodontic benefits, your braces will probably cost around $4,000 to $6,000. Of course, your bill may be out of that range due to minor or complicated conditions.

          Tip: Learn more about how dental benefits work, whether they’re likely to cover braces, and how to claim your benefits by checking out our complete guide to insurance coverage for braces.

          transparent aligners online

          At-home clear aligners like smiledirectclub are not always included in orthodontic benefits. Some insurance providers have formed partnerships that bring home aligner companies into the network:

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