Top 7 Questions about Insurance for Braces

Insurance is the most common way to make healthcare more affordable in the U.S. We have insurance for doctors’ visits, hospital stays, prescriptions, dental treatment, and trips to the eye doctor. But did you know insurance often helps pay for orthodontic treatment as well? Insurance for braces is a real thing, and you may already have coverage but not know it.

How Do I Know If I Already Have Insurance for Braces?

Most orthodontic insurance coverage is found in your dental insurance policy rather than your health insurance. Contact your dental insurance provider or your human resources department if your insurance is provided through your job.

How Can I Get Orthodontic Insurance?

While insurance only for braces or Invisalign is not something you can get as a separate policy, you may be able to add it to your existing dental policy if you don’t have it already. Or, if you don’t have dental insurance at all, you may be able to add it and orthodontic treatment will be included.

Will Insurance Pay for the Entire Cost of Braces or Invisalign?

Unfortunately not. Most policies only pay up to a certain amount for orthodontic treatment, which is not enough to cover braces or Invisalign. However, most orthodontists allow you to use your insurance and pay monthly to keep treatment affordable.

What Does In-Network or Out-of-Network Mean?

This pertains to all types of health insurance, not just orthodontic insurance, and patients are able to see out-of-network healthcare providers if they wish. In general, if a doctor (in this case an orthodontist) is in-network, it means the doctor’s office will submit all claims to your insurance provider and receive payment directly from them. With out-of-network providers, the patient usually has to submit the claim and forward the check to the doctor. There may be a difference in the amount of coverage for in versus out-of-network as well.

How Else Can I Use Insurance to Pay for Braces?

If you have insurance, you may also have a flexible spending account (FSA) or health savings account (HSA). Many orthodontists accept funds from both of these types of accounts for down payments, monthly payments, and even for replacement retainers once treatment is complete. However, you will need to confirm that your provider allows your specific account to be used for orthodontic payments.

Will a New Insurance Provider Automatically Pay for Braces?

If you change jobs or your employer changes insurance providers, you could potentially lose your orthodontic coverage. Some insurance companies will not pay for treatment that was started before your coverage began, while others may have a waiting period before you can use any orthodontic coverage. If you know your insurance is going to change in a few weeks or months, it might actually be best to wait to start treatment until the transition is complete.

Does Orthodontic Insurance Cover Adult Braces Too?

With more and more adults getting Invisalign and braces, it’s becoming more common for insurance companies to provide coverage for adults in addition to kids. Check with your provider to see what ages and amounts your policy covers.

Hopefully these answers help clarify some of your questions about braces and insurance. If you have any additional questions, or if you need braces or Invisalign in Winter Garden, Windermere, Ocoee, or the surrounding area, please call our office at (407) 656-0001.