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A Guide to Orthodontic Insurance

The average cost of braces is between $5,000 and $6,000 and many dental insurance plans don’t provide coverage for orthodontics. Getting the best orthodontic insurance is part research and part timing. Here’s how to choose and when to purchase coverage.

Quick Look: The Best Orthodontic Insurance Companies

  • Best Overall: Delta Dental
  • Cigna
  • Spirit Dental

What’s Orthodontic Insurance?

Health coverage is segmented more than many other types of insurance. Health insurance, for example, doesn’t cover most dental care and many dental insurance plans don’t cover orthodontia, which refers to braces and related corrective devices like retainers.

We tend to think of braces as a service for children or teens — and while the need for corrective braces is more common for young people, teeth can also shift later in life, leading to many adults that may need braces, retainers or other tooth alignment devices like Invisalign or Smile clear aligners.

Orthodontic insurance is usually purchased as part of a more comprehensive dental insurance plan and can help reduce the cost of braces or other corrective devices as well as your overall dental care costs. Braces are among the costliest of dental procedures and without coverage, the cost of orthodontics can add thousands of dollars per year to family dental care expenses.

Relationship Between Orthodontic and Dental Insurance

Orthodontic coverage is part of a dental insurance policy. A standalone policy that just covers braces isn’t commonly available. The reason orthodontic insurance is bundled with other dental care coverage is that this structure helps to distribute costs amongst a larger pool of insured people, most of which won’t need the coverage during the same time period. This is how most types of insurance work.

Most dental insurance plans cover dental care services by paying for a percentage of the cost. A common structure is 100-80-50, in which 100% of preventative services are covered, like routine exams and cleanings. Under this same structure, 80% of basic services, like fillings, are covered and 50% of major procedures are covered.

Braces and orthodontia usually fall into the 3rd category, which means the insurer will pay 50%. However, there may be waiting periods before you’re eligible for coverage or other limitations to coverage. It’s also common for dental insurance plans that cover orthodontics to only provide coverage for children up to age 19.

Dental insurance plans often have an annual maximum, which is the maximum amount the insurer will pay toward your dental care. However, orthodontic care usually has a separate lifetime coverage limit instead of an annual limit. If braces cost $4,000 and the lifetime maximum for orthodontic coverage is $1,500 per person, you can expect to pay at least $2,500 out of pocket. It’s possible that a deductible or other out-of-pocket costs may apply as well.

What to Expect to Pay

The price of a dental plan that includes orthodontic coverage varies depending on the type of plan you choose, where you live and how many people are covered by the plan. We found family plans with orthodontic coverage for children up to age 19 for about $45 per month.

However, many other services, like fillings, crowns, or root canals were only offered with discounted pricing and no coverage was available through the plan. Stepping up to a better plan fixed the coverage gap but at an additional $20 per month in cost. For a full-featured family plan, expect to pay $60 per month or more.

Is Orthodontic Insurance Worth It?

Orthodontic coverage included with dental insurance plans only pays a percentage of the treatment cost, commonly 50%, and is often subject to a relatively low lifetime maximum. In some cases, the added cost of choosing a plan with orthodontic coverage may still be a good value. In other cases, you may be better served by other solutions.

When it’s Worth It

If the increased cost of a plan that includes orthodontic coverage isn’t appreciably higher, opting for the extra coverage can help reduce the cost of braces or other orthodontic procedures. The main limiting factors are that most plans that include coverage for orthodontia cover 25% to 50% of the cost and then cap lifetime coverage at a limit as low as $1,000. If you purchase a plan with a higher lifetime limit, the coverage may have more value.

The lifetime limit for orthodontic procedures works like a bank account in a way — but you can only withdraw for approved procedures (covered claims) and the balance can only go down. It doesn’t replenish every year like an annual maximum.

For example, if the cost of braces is $5,000 and your coverage is at 50%, you would pay $2,500. But then you have to consider the lifetime maximum. If the lifetime maximum is only $1,000, you would pay $4,000 for the braces and the lifetime maximum balance is reduced to $0 nearly immediately. No more claims for orthodontia will be covered by the plan.

Take the same scenario and raise the lifetime maximum to $3,000. In this case, the cost of braces is covered up to 50%, making your cost $2,500, and you have a remaining balance of $500 to use for future covered claims, like retainers.

The catch is that less-expensive plans that offer coverage for orthodontic procedures often have low lifetime limits of $1,500 or less. Expect to pay a bit more for a dental insurance plan with better coverage.

When it’s Not

Choosing a plan with a low lifetime limit for orthodontic work often doesn’t offer much advantage over not having coverage at all. There may be cases where the extra cost of premiums can be better used. A health savings account could be an option as could a dental discount plan — or both.

You can pair a high deductible health insurance plan with a health savings account (HSA), which then allows you to save pre-tax money for approved medical needs, including dental care. When you use your health savings to pay for approved medical needs, you don’t pay tax on the money. This has the effect of creating an instant discount equal to your income tax rate.

Many dental discount plans offer discounts on braces or other orthodontic work, with discounts of 20% or more. You’ll still have to pay the balance but dental discount plans are very affordable. Many plans are priced at under $10 per month.

If you choose to use both an HSA and a dental discount plan, your HSA can’t be used to pay the premiums for your plan, but the cost of the dental work itself can be paid with HSA funds. The combination of both an HSA and a dental discount plan can result in significant savings on orthodontic procedures or other dental care needs.

Also, be aware of exclusions for orthodontic work. If you have already started the early steps of getting braces and then decide to switch insurers to get coverage, you’re likely to find that there’s no coverage for the remaining procedures. Waiting periods can also apply.

When choosing a less expensive dental insurance plan, the coverage limitations — and particularly the lifetime maximum — can reduce the value of the coverage to a point where you might want to consider other solutions.

How to Get Orthodontic Insurance

Many households can qualify for subsidies when buying dental insurance, so an important first step is to visit the healthcare marketplace or your state’s health insurance portal. Subsidies are based on income and number of dependents.

Available plans and coverage details can vary by state or by region, so it’s important to study plan details for your area before choosing. Expect an online application process and similar network choices to those available for health insurance. You may be able to choose from HMO plans, PPO plans or EPO plans and HMO plans are often the least expensive option.

The Best Orthodontic Insurance Companies

A big-picture view can be beneficial when choosing the best orthodontic coverage because it’s likely that your coverage will be part of a more comprehensive dental insurance plan. However, you’ll still need to consider coverage details as well.

What to Look for in a Company

When choosing the best orthodontic insurance coverage for your family, the priorities for a particular household may differ from the next, but there are some key considerations to weigh in your decision.

  • Network size and type: Before choosing, learn which dentists are covered by the plan. You’ll also find different plan structures, like HMOs or PPOs. HMOs tend to be more affordable but limit service to network dental care providers.
  • Coverage percentage: Some plans don’t cover orthodontic services at all, others may only cover 25% or scale the coverage percentage in the first year. Look for plans with 50% coverage.
  • Annual maximum: The best dental insurance plans cover much more than just orthodontics. The annual maximum is the most your insurer will pay per person in a year for other types of dental care services. More is better.
  • Lifetime maximum: The lifetime maximum is how much your insurer will pay in total for orthodontic work. A lifetime maximum that’s too low makes the coverage less helpful.

Best Overall: Delta Dental

Delta Dental finds a healthy balance between coverage options and affordability. In many areas, you’ll find a plan available to meet nearly any budget or coverage need.

We found as many as 10 different plans in some areas, many with no waiting period and with free exams and preventative care visits.

Many plans have no deductibles and plans that include orthodontic coverage pay for 50% of the cost, subject to policy limits. You’ll find several PPO plans with Delta, which give you the option to choose out-of-network services when needed.

Cigna

Low deductibles and no-charge preventative and diagnostic services are just some of the reasons to consider Cigna dental insurance.

A short 6-month waiting period before orthodontic coverage is available is yet another reason to put Cigna on your list.

Plan details and availability can vary by state but if you’re in an area serviced by Cigna, you’ll find a low lifetime deductible for braces and 50% coverage on some plans. Like many dental insurance plans, Cigna has a low lifetime maximum for orthodontics coverage, but the variety of other services covered makes Cigna offer a compelling value.

Spirit Dental

If you have a big-picture view of dental insurance coverage, Spirit Dental deserves a closer look. While not always the most affordable on a monthly basis, Spirit’s broad coverage limits are much higher than with most competitors. Spirit rewards loyal customers with plans including up to a $5,000 annual maximum by the 3rd year.

Orthodontic coverage follows a similar scale-up over time with 25% coverage for the first 2 years and 50% coverage in the 3rd year.

However, orthodontic coverage is capped with a $1,200 lifetime maximum with some plans and is limited to children under 19. Generous coverage for other types of dental services makes Spirit Dental worth considering.

Choose the Best Orthodontic Coverage

If you or someone in your family needs braces — or might someday, chances are good that the treatment will cost you some money. Full coverage dental insurance plans don’t exist and orthodontic coverage, in particular, often comes with notable limitations to coverage.

If you have access to a health savings account or a flexible spending account through your workplace, consider using these accounts as a tax-free way to plan for braces or other dental care needs. Waiting periods are also common for many procedures, so you’ll want to have your coverage in place as early as possible.

Want to learn more about how you can save money on your insurance? Check out Benzinga’s guides to the best cheap car insurance, the best cheap life insurance companies and the best affordable health insurance companies.