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Good dental health is important in one’s overall well-being.  Orthodontics is one way of achieving and maintaining your dental health.

Most medical plans do not provide dental coverage. One notable exception can be for extraction of wisdom teeth or orthognathic (jaw) surgery. However, medical plans do not typically cover orthodontic treatment.

The good news, though, is dental coverage can sometimes provide benefits for orthodontic treatment.  Dental insurance can be offered as a supplemental plan through your employer. Unfortunately, orthodontic coverage is often considered a “rider” on dental plans and the amount of coverage can vary greatly from plan to plan.

What is Dental Insurance?

In general terms, Dental insurance typically covers all or a portion of preventative care (exams), fillings, crowns, root canals and some oral surgeries. Depending on your policy, limited coverage for orthodontics may exist.

What Should I Know about Orthodontic Insurance?

Orthodontic insurance has several differences from any other kind of insurance with which you may be familiar.

Orthodontic coverage usually has a lifetime maximum. This is the amount the plan will pay for orthodontic care over your lifetime. This amount is usually between $1000 and $2000, but some plans are lower and some higher.  There will also be a percentage associated with the benefit – usually 50%, but in some cases, it is higher. If your coverages pays at 50% with a lifetime maximum of $1500, your carrier will pay 50% of the fee up to a lifetime maximum of $1500. For patients who have an early phase of treatment, any amount paid that is less than $1500 for the first phase will be paid during the second phase.

Another very important difference with orthodontic insurance is the way in which the benefit is paid. Most plans do not pay the entire benefit in one lump sum payment.  Instead, they break the benefit into monthly or quarterly payments. This means that even though orthodontic treatment started when the insurance was in effect if the insurance is terminated for any reason, the carrier will stop making the payments.

Waiting periods are another consideration when it comes to purchasing dental insurance with an orthodontic rider. Some plans require you to be covered for a certain period of time before orthodontic benefits become available.

Before purchasing dental insurance or investing in orthodontic treatment, it is important you understand the benefits your plan offers.  Your carrier or Human Resource department should be able to assist you.

Are There Other Ways to Pay for Braces?

Flexible Spending Accounts (FSA’s) and Health Savings Accounts (HSA’s) through your employer can allow you to pay for orthodontic treatment using pre-tax dollars.  Ask your employer for more details.

I Don’t Have Insurance or an FSA – Now What?

We realize orthodontic treatment is an investment that can pay big dividends by way of increased self-esteem and self-confidence for your child or yourself. We work hard to find a payment option that is gentle on your budget.  We offer a pay in full discount, as well as several interest-free payment options.