Orthodontics is a specialized branch of dentistry that focuses on the prevention and correction of irregular teeth. Orthodontic corrections primarily involve the fitting of braces or brace alternatives like Invisalign. Because it is a subcategory of dentistry that is generally, but not always, done for aesthetic purposes, it isn’t always covered by dental insurance plans. The following is a quick look at orthodontic insurance: what it covers and how to get it.
Review Your Current Dental Plan Coverage
The first step is to review your current health care and dental plans. Orthodontic insurance benefits are a subcategory of dental insurance and often do not work like traditional health and dental benefits. Instead of offering annual out-of-pocket maximums, orthodontic benefits typically have a lifetime out-of-pocket maximum.
This means that, unlike your standard health and dental insurance benefits, orthodontic benefits never renew. Once that lifetime maximum has been met, there will be no more benefits to collect. The few plans that have an annual maximum are typically written with a 24-month maximum so that the orthodontic benefit will not exceed, for instance, $2,000 if the annual maximum is $1,000.
When reviewing your current dental plan for orthodontic insurance benefits, check for any age restrictions. Orthodontic insurance benefits that come as part of a dental benefits package often have age restrictions limiting the benefits to members under the age of either 19 or 26. In these scenarios, orthodontic insurance typically ends on the day before the member’s 19th or 26th birthday. Avoid scheduling services close to this date because insurance companies typically will not pay for services received after this termination date.
Research Quality Orthodontic Plans for Adults
Most people who come to us for orthodontic treatment are not teenagers or young adults. Straight, Hollywood-style teeth have become a norm in our society, and many of our patients come to us post-college, seeking to improve their appearance and boost their confidence. Braces are an effective way to straighten teeth that have grown in crooked, realign the jaw, and remedy overcrowded teeth. But to get them at the lowest cost to you will take a bit of research.
Begin by carefully comparing your options. Not all dental plans are created equal, and most of them will have minimal orthodontic benefits unless you specifically request them. Many have red tape frustrations like plan limitations, waiting periods, discounts, and variable copayments. Use a database like DentalPlans—a website comparing over 40 low-cost plans—to get a baseline for annual fees, discounts, and offerings in your area.
What we see most often in our offices are orthodontic insurance plans that offer 50% coverage with maximum lifetime benefits ranging from $1,000 to $2,500. $1,000 is normal, $1,500 is good, $2,000 is great, and $2,500 is outstanding if you’re looking for braces. The 50% coverage is up to the lifetime maximum. So if you get a quote of $5,000 for a 24-month treatment and have a $2,000 benefit, those benefits would pay only that $2,000 to maximize your coverage.
How this is paid out will differ based on the company and plan you choose. Some will pay in full at the start of treatment while others will pay on a monthly or quarterly basis. Depending upon your household insurance plans, you may be able to combine and coordinate benefits to further reduce out-of-pocket expenses.
For more information about orthodontics and getting a personalized treatment quote at Carlyle Orthodontics, contact us today.