If you're looking to get braces for your kids or even yourself, you probably know how costly orthodontics can be. The average cost of braces can work out to more than $5,000 by the time treatment is over. Fortunately, it is possible to get help through your dental insurance, but not every insurance plan offers full coverage for orthodontics.
Plans Offering Orthodontic Care
Many insurance companies do offer orthodontic coverage as part of their dental plans or as an addition you can add to the policy. In many cases, this is handled as a discount plan rather than full insurance.
You can get an idea of what insurers are available in your area by using a comparison search feature like DentalPlans.com. Below are some of the bigger insurers in the country offering individual dental insurance with orthodontics coverage.
The dental plan associated with Kaiser Permanente, Dominion Dental operates on an HMO basis. This means that you'll need to choose a primary care provider and will pay a flat fee to that provider based on the type of care received.
In the case of braces, you'll pay $3,422 for a child instead of the usual price of $6,863, or a 45% discount. Other types of care have a different fee associated with them.
Aetna is a major health insurer, and it provides several dental plans. Its "ValuePass" and "Vital Savings" plans are discount services, offering discounts between 15-50% off the standard cost for dental work, including orthodontics. Aetna also offers HMO and PPO-based dental insurance, including orthodontic coverage, when an in-network provider is used.
To obtain benefits on one of these policies, you will need to get an estimate and file a claim in advance of the treatment. You'll need to wait for approval before receiving payment and pursuing care.
Dental coverage can be added to your existing Cigna health plan. These plans are handled as PPOs, allowing you to choose a provider and receive care after paying a deductible and coinsurance. Depending on the plan, your orthodontics may be handled as a discount, or you may receive a $1,000 lifetime benefit to use toward braces.
Blue Cross/Blue Shield
People with dental plans through BCBS can add orthodontic coverage to their policies for an additional cost. Coverage is available only to children below age 19, not to adults, and it is capped at 50% of the total cost, or up to a lifetime limit of $1,500.
Humana offers several dental plans, most of which can have orthodontia coverage added. Unlike some providers, Humana does offer orthodontics insurance for adults as well as children.
All Humana customers can also receive a 20% discount on orthodontic procedures even if their plans don't offer any actual orthodontics coverage.
Discount Only Plans
While some insurers offer full orthodontic coverage, most choose to use a discount plan instead. These utilize a partnership with service providers to offer affordable care. These are some of the more well-known discount plans:
A discount dental plan offered by Concordia, iDental offers an affordable alternative to full dental insurance. Instead of an insurance plan with deductibles and copays, this is a discount program that connects customers to service providers who will offer care at a reduced cost. An average discount for orthodontic care is around 25%, depending on the provider.
Another well-known dental discount plan, EDP offers a flat discount of 25% for orthodontic care when you hold a membership with the plan. EDP predominately offers policies in New York, but memberships are available for other areas as well.
Are You Covered?
If you already have dental insurance through your employer or an individual policy, orthodontic coverage may be included. Some insurance companies handle this coverage in the form of discounts that can be redeemed at participating service providers, reducing the overall cost of treatment. Some insurers offer reimbursement or up-front coverage up to a specific dollar value.
Before seeking care, you'll want to check with your insurance company about the way coverage is applied and how claims need to be filed to obtain assistance in paying for your new braces.
Orthodontic treatment is excluded from many insurance policies because it differs from other types of dental care. Orthodontia is an expensive and ongoing treatment, requiring regular upkeep. This introduces additional costs that many dental policies are not prepared to handle.
Some insurance companies may view braces as a purely aesthetic treatment rather than a medically beneficial one, leading orthodontia claims to be denied on this basis.
Saving Money on Braces
Braces can be expensive, but they're well worth the investment when they protect your children's oral health for years to come. By understanding how orthodontic coverage works, you can make an informed decision about purchasing insurance for your family. If your current insurance doesn't cover orthodontic care, work with your insurer or another provider to obtain a discount plan or other type of insurance to help offset these costs.