Does Dental Insurance Cover Braces? Braces can be a significant investment, and many people wonder if their dental insurance will help cover the cost. To find out if your dental insurance plan covers braces, it’s essential to understand your plan and know your coverage options.
Different dental insurance plans offer varying levels of coverage for braces, and some may not cover them at all. Before starting treatment, it’s a good idea to check with your insurance provider to see what’s included. This can help you avoid surprises and ensure you’re prepared for any out-of-pocket costs.
What Is Dental Insurance?
Dental insurance is an insurance policy that helps with the cost of dental care, such as check-ups, cleanings, and treatments like fillings. You pay a regular premium to get coverage for these services.
Also, you’ll have a deductible, which is the amount you pay before insurance helps. After that, you might pay a part of the costs through copayments or coinsurance.
However, it is important to know that dental insurance is not typically part of medical insurance coverage. Instead, it is an optional plan that you can purchase differently. And it doesn’t necessarily work the same way as medical insurance.
Furthermore, while dental insurance may not cover your entire bill, it can significantly reduce costs for preventive care and necessary procedures. Since dental work can be expensive, insurance helps ease the financial burden.
Types Of Dental Insurance
There are several types of dental insurance. So, if you’re looking to get coverage, it is important to know the difference. These types of insurance coverage include:
Indemnity Plans
These plans are most similar to traditional health insurance, as the insurance company reimburses claims based on the procedures performed and typically allows patients to choose their own dentists.
Direct Reimbursement (DR) Plans
These plans require you to pay the dental bill upfront and then submit a claim to the insurance company to receive a reimbursement check later.
Point Of Service (POS) Plans
These plans allow patients with managed care dental plans to receive treatment from out-of-network providers. However, the reimbursement is significantly lower compared to what would be covered if the patient saw an in-network provider.
Discount Or Referral Plans
These aren’t technically insurance. Instead, they offer a discount on dental services, similar to using a coupon. But you’re still responsible for the full cost of the discounted bill.
Exclusive Provider Organizations (EPO) Plans
These plans restrict patients to using only participating dentists for reimbursement. This limitation significantly reduces the choice of providers and access to care.
Table Or Schedule Of Allowances Plans
These plans set a fixed amount that the insurance will pay for each procedure, leaving patients to cover any difference between the insurance payment and the actual cost of the procedure.
Each plan varies in coverage, so it’s important to choose one that fits your needs.
What Dental Insurance Covers and Does Not Cover
Due to the fact that there are different types of dental insurance, what your insurance covers depends on the type of insurance plan you get. But in the mean time, here are some common things a dental insurance policy covers:
- Preventive-Only Plans: Cover routine care like cleanings and exams but usually don’t cover major procedures.
- Basic Plans: Include coverage for routine procedures like fillings and extractions, with some coverage for more complex treatments.
- Major Plans: Offer broader coverage, including major procedures like crowns and root canals, often with higher out-of-pocket costs.
- Orthodontic Plans: Specifically designed to cover braces and other orthodontic treatments, sometimes included in broader dental plans.
However, dental policies often have limitations, so it’s important to review your preferred plan before purchasing. For instance, many plans include a missing tooth clause, most don’t cover braces or implants for adults, and many have waiting periods. Be sure to check these details before choosing a plan to ensure it suits your needs.
What to Know About Dental Insurance and Braces
Many dental insurance plans cover braces, but there are important details to consider. According to Karrenbrock, it’s great to choose a plan that covers braces, but you must ensure they are medically necessary.
However, keep in mind that there are restrictions on braces coverage. For example, braces are typically covered only once in a lifetime. If you had braces in the past and need them again because you didn’t use your retainer, your insurance won’t cover the cost. This restriction also applies if you get a new job with a new insurance plan, even if it’s with the same insurance company.
Age is another factor to consider. Most dental insurance plans require you to be under 18 to have braces covered, though some plans won’t cover individuals over 16.
If you have a Medicare plan, it’s important to note that it doesn’t include dental coverage. In this case, you might need to consider a separate dental insurance plan.
In addition, while you can use funds from Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) to pay dental bills, they don’t reduce the actual cost of care. Instead, you gain the tax advantages associated with these accounts.
Alternatives To Braces
Alternatives to braces include treatments such as Invisalign, headgear, retainers, and veneers. While some dental insurance plans may cover these options, you might find that your out-of-pocket costs are higher compared to other services.
How To Find A Dental Insurance Plan That Covers Braces
To find a dental insurance plan that covers braces, follow these steps:
- Research Plans: Start by researching different dental insurance plans. Look for plans specifically listing braces coverage in their benefits.
- Check Coverage Details: Review the coverage details of each plan to see if orthodontics, such as braces or Invisalign, are included. Pay attention to coverage limits, age restrictions, and any waiting periods.
- Compare Plans: Compare multiple plans to find one that meets your needs. Look at factors such as premiums, deductibles, and co-payments.
- Consult with Insurers: Contact insurance providers directly to ask about their orthodontic coverage. They can provide detailed information about what is covered and any associated costs.
- Review Provider Networks: Ensure that the insurance plan includes a network of orthodontists you can choose from or check if you can use out-of-network providers.
- Consider Employer Benefits: If you have dental insurance through your employer, check the benefits package or talk to your HR department about orthodontic coverage options.
Lastly, seek professional advice. Consult with your orthodontist. They may have experience with different insurance plans and can recommend options that work well for orthodontic care.