Does Dental Insurance Cover Orthodontia?

Orthodontic care is important for oral health and overall wellness. However, it often costs several thousand dollars. Understandably, you might have some concerns about the cost of care for your child’s braces — or your own braces! Can you rely on your dental insurance to cover your family’s orthodontia? This blog post explores how your benefits might apply.

Coverage for Kids

Orthodontic coverage is more common for children than it is for adults. Many plans cover up to 50% of the cost of braces for kids, up to the amount of the plan’s lifetime orthodontic maximum. For many families, this can reduce their out-of-pocket costs by hundreds if not thousands of dollars.

Of course, there are a few points that you should keep in mind:

• Age limits for orthodontic coverage can vary between insurance companies. Your child might be eligible for benefits until they are 16, 18, 19, or possibly even 21.
• In most cases, insurance companies require that braces be medically necessary (as opposed to being only for aesthetic purposes).
• Clear aligners and other advanced types of treatments might be excluded from coverage.

What About Coverage for Adults?

Some premium dental insurance plans will cover up to 50% of the cost of braces for adults, up to the amount of the plan’s lifetime orthodontic maximum. Again, there may be some stipulations that apply, such as the condition that the braces be medically necessary.

Maximizing Your Coverage

Here are some tips to help you use your dental insurance for braces:

• Visit an orthodontist who is in-network with your insurance. Often, out-of-pocket costs tend to be lower at in-network providers.
• Get pre-authorization if necessary. Your orthodontic team can help you with this.
• Understand your financial obligation. Ask your orthodontist’s team for an estimate of your out-of-pocket costs so you can prepare your budget to accommodate your care.

What if You Do Not Have Coverage?

If your insurance will not help pay for your braces, or you do not have insurance, there may be other methods you can use to make your treatment more affordable. For example, you might be eligible for a low-interest payment plan. You might also be able to use your flexible spending account (FSA) or healthcare savings account (HSA) to pay for at least a portion of your treatment.

Dental insurance might help you pay for braces! Learn about the details of your unique coverage so you can prepare for the road ahead.

Meet the Practice

Serenity Orthodontics is proud to serve patients throughout the Cumming, GA, area. We provide top-quality treatment for patients of virtually all ages, and we are happy to accept insurance. In fact, we are in-network with many popular plans! To learn more about how we may be able to serve your family, contact our Windermere office at 678-879-3006.