Braces Plan: Insurance Options for Getting Braces

The words “orthodontics” or “braces” can be intimidating for a number of reasons. However, when you understand more of what orthodontics is about the time, effort and expense of taking proper care of your teeth is more than worth it.

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What are the benefits of orthodontic care and braces?

Orthodontic dentistry is more than just making your teeth straight. From correcting crooked teeth and jaws to helping prevent TMJ, headaches and neck, shoulder or back pain, orthodontic treatment can help you have a healthier body and avoid issues in the future.

A beautiful smile can contribute to healthy self-esteem. Yet, self-esteem isn’t the only reason to go through the effort to get orthodontic care. Improperly spaced teeth can cause swollen, red gums that don’t fit against the teeth and can allow bacteria to grow in your mouth.

Improper spacing can also lead to food getting caught between the teeth which can cause plaque due to the difficulty in cleaning effectively.

Straight teeth allow for easier cleaning, a healthier mouth and can help prevent periodontal and/or gum disease. Additionally, if your teeth are badly aligned, chewing is not as effective and can cause gastrointestinal issues as well as wearing down your teeth quickly and unevenly.

Are all braces the same?

Long gone are the days when silver metal “traditional” braces with plain rubber bands are the only option. Now, depending on your orthodontic needs, fixing your tooth alignment can mean any of the following:

• Metal braces – These brackets are now smaller and less noticeable than they had been. Colored rubber bands help the wearer personalize their look.
• Ceramic braces – The same size and shape as the traditional braces, but the clear or tooth-colored brackets blend in with the teeth.
• Lingual braces – These metal brackets are affixed to the inside of the teeth to make the dental work less obvious.
• Invisalign – These clear, custom-made plastic aligners, much like mouth guards, are removable and replaced every two weeks as the teeth shift.

Each of these options depends on what kind of alignment issues you have and can vary greatly in cost.

How much does orthodontic care cost?

Prior to beginning orthodontic care, it is important to meet with a few orthodontists to find the best fit for you. During that meeting they can determine what care they’d recommend and give you an estimate for the treatment.

Depending on the type of braces you need and where you live, the cost of care can range from $3,000 to $10,000 (average cost in the U.S. is $5,000).

Keep in mind that the average length of treatment is 23 months, so finding an orthodontist that you are comfortable with is an important consideration.

How can I pay for braces or other orthodontic care?

With the high cost of orthodontic care, it can be difficult to budget for the payments. Many dental insurance plans offer coverage for at least part of orthodontic care. Dependent on your age and the type of treatment needed, plans pay may some of the cost by either a percentage of the total or a flat amount.

Most orthodontic practices understand how the high cost of care can prevent or put off treatment.

Make sure you discuss payment options before you commit to a particular provider. Many offices offer payment plans – monthly, quarterly or in a set amount at the beginning, middle and end of treatment.

How do I select insurance to help me offset the costs?

When you are selecting dental insurance coverage, there are many questions you should have answered before you purchase a plan.

• What kind of treatment is covered?
• What is the total coverage amount?
• Is the coverage a flat amount or a percentage of total cost?
• Is there an in-network provider list?
• Do in-network providers have a different coverage level than out-of-network providers?
• What is the coverage for teens and children?
• What is the coverage for adults?
• Does the plan cover x-rays?
• How many dental molds are covered?
• How many follow-up visits/retainers does the plan cover?
• Are there lifetime limits for orthodontic treatment?
• Does the plan work with HSAs (Health Savings Accounts) or FSAs (Flexible Savings Accounts)?
• Is there a waiting period between the beginning of coverage and when treatment can begin?

How do I coordinate insurance coverage and cost of treatment?

Understanding dental care can sometimes be complicated. What is important to understand is that once you commit to orthodontic treatment, you are responsible for all costs incurred whether through insurance or direct payment.

Knowing what your insurance plan covers will help you estimate what your out-of-pocket expenses will be.

To understand coverage, let’s create two hypothetical examples:

Example A:
Total cost of treatment is $5,000.
Your plan pays 50% of the treatment up to a maximum of $3,000. (Maximums may be based on average costs in your state.)
Because your treatment is only $5,000 and the plan will pay 50% of that, you are responsible for $2,500.
Your orthodontist allows for a payment plan of $1,000 before beginning treatment, then monthly payments of $100. The account would need to be paid in full before the treatment is complete. So your treatment would be paid off within 15 months.

Example B:
Total cost of treatment is $6,000.
Your plan pays a flat $2,500 for orthodontic treatment. (Maximums may be based on average costs in your state.)
The difference between total cost and coverage is $3,500.
Your orthodontist allows for a payment plan of 1/3 of the outstanding balance (or $1,167) before beginning treatment, then another 1/3 (or $1,167) six months after treatment begins and the final 1/3 ($1,166) due before the treatment is complete. So your payments are spread out more, but are much higher.

Additionally, some credit companies offer coverage to help you manage the out-of-pocket expenses, so that you can pay your balance after insurance coverage over a longer period of time with lower payments.

Although braces can be costly, they are well worth the investment. With a combination of the right insurance coverage, orthodontist and payment plans you will be well on your way to the excellent dental health.

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