Can You Buy Orthodontic Insurance? What to Know

Orthodontic care, which addresses the alignment of teeth and jaws, is a common need for many individuals. The associated costs can be substantial, prompting many to explore insurance options. Understanding how orthodontic coverage works within the broader landscape of dental insurance can help manage these expenses. This article will clarify the availability of orthodontic coverage, explain common policy features, and highlight important considerations before purchasing a plan.

Availability of Orthodontic Coverage

Orthodontic coverage is not available as a standalone insurance policy. Instead, it is found as a benefit within a comprehensive dental insurance plan or as an optional add-on. Many individuals receive dental insurance, including orthodontic benefits, through employer-sponsored plans. These group plans often provide more robust coverage than individual policies.

For those without employer-provided options, orthodontic coverage can be obtained by purchasing an individual dental insurance plan that includes such benefits. Some plans may offer orthodontic coverage as an integrated part of their standard offerings, while others might require adding it as a rider for an additional premium. It is important to verify that a chosen individual plan specifically mentions orthodontic coverage, as not all dental plans include it.

Understanding Orthodontic Policy Features

Orthodontic insurance policies come with specific features that determine how benefits are paid. Covered services include traditional metal braces, ceramic braces, and clear aligners, though some plans may have limitations or different coverage levels for cosmetic options. Insurance pays a percentage of the cost, often around 50%, after any applicable deductibles are met.

A deductible is the amount you must pay out-of-pocket before your insurance begins to cover costs. While general dental deductibles can be low, some plans may have a separate, higher deductible for orthodontic care. Orthodontic benefits are also subject to maximums, which differ from annual maximums common in general dental plans. Orthodontic coverage has a lifetime maximum, representing the total amount the insurance will pay for treatment over the policyholder’s lifetime. These lifetime maximums range from $1,000 to $3,000, though some premium plans may offer up to $5,000.

Network providers also play a role in how benefits are applied. Plans have a network of orthodontists who have agreed to negotiated rates. Choosing an in-network provider can lead to lower out-of-pocket expenses, as the insurance company may cover a smaller percentage or none of the costs for out-of-network care.

Key Considerations Before Purchasing

Before committing to an orthodontic insurance plan, several factors warrant careful review. Waiting periods are a feature, meaning there is a specific length of time you must be enrolled before orthodontic benefits become active. These waiting periods can range from 6 to 24 months, with some individual plans requiring up to two years before coverage begins. Confirm the waiting period to avoid unexpected out-of-pocket expenses if immediate treatment is needed.

Age limitations are another consideration. Many dental plans offer orthodontic coverage for dependents up to age 18 or 19. While adult orthodontic coverage exists, it is less common and comes with lower lifetime maximums or higher premiums. Policies may also have clauses regarding pre-existing conditions, potentially excluding coverage for orthodontic treatment that has already begun or for conditions diagnosed before the policy’s effective date.

Evaluating the total financial outlay involves comparing premiums, deductibles, and the percentage of costs covered against potential savings. Orthodontic benefits are paid out over the course of treatment, not as a single lump sum. Also, align the policy’s coverage details with the specific treatment plan recommended by an orthodontist. Exclusions in policies include treatments deemed purely cosmetic, replacement of lost appliances, or services already covered by a medical plan.