Will My Dental Insurance Cover Braces?
Dental Insurance & Orthodontic Benefits
Many parents wince when they realize their child will need braces. The average cost of braces, according to the American Dental Association's 2020 Annual Survey of Dental Fees was approximately $6,000 for adults, though it should be remembered that many factors can affect the total cost. These factors include not only the circumstances of the patient's dental situation, the type of braces used, but also the region in which the patient receives orthodontic care. Consumer Affairs reports that braces may cost as much as $13,000.
In this article, the following topics will be reviewed to help you with your questions about orthodontic benefits within dental coverage:
- Types of braces and price implications
- Do braces cost more for adults?
- Dental insurance and orthodontic benefits
- A list of dental plans with coverage for braces and other orthodontic care
Types of Braces & Price Implications
Braces are a form of orthodontic service. Orthodontics, a sub-discipline within the field of dentistry, provides treatment for patients not only with improperly aligned teeth but also improperly aligned jaw or bite patterns. Braces have evolved with the times and now there are several kinds of braces available as opposed to a few generations ago when people were essentially limited to metal braces or nothing. The four main categories of braces are:
- Traditional braces
- Invisalign braces
- Ceramic braces
- Lingual (a.k.a. "invisible") braces
Average Cost of Braces
Traditional braces are the metal variety with which most people are familiar. Generally this brace type is considered to be the least expensive of the four mentioned above. Ceramic braces, which look like traditional braces but are transparent, are slightly more expensive. Invisalign braces are clear plastic shells that fit directly over the teeth. Costs vary by circumstances but the Invisalign website provides multiple cost scenarios ranging from $3,400 to $7,100. Less common in the United States than Europe, lingual braces are metal braces that attach to the back side of the teeth and, therefore, are invisible. Consumers who decide to use lingual braces should expect to pay more than the traditional meta version. The OralB webpage devoted to brace costs lists the price range for this option between $8,000 and $10,000.
For more detailed information on your options for braces, see our article "Orthodontia Services."
Do Braces Cost More for Adults?
While braces are associated with childhood, adults can also wear braces to improve their smiles. Braces applied to adults may take longer to straighten teeth and may require a longer treatment period. A longer treatment period, in turn, may mean higher costs for the patient.
Other Orthodontia Services
Orthodontic services extend beyond merely the installation and maintenance of braces. They also include surgical options to address severe jaw alignment issues. Palatal expanders, which expand the size of the upper jaw in a child's mouth and reduce crowding among teeth, are another service covered under orthodontia (palatal expanders are also used for adults but less commonly).
Dental Insurance and Orthodontic Benefits
Many dental plans do not have coverage for services provided by an orthodontist. However, by reviewing a dental plan's summary of benefits (or plan brochure), you should be able to quickly identify if orthodontics are covered and under what conditions (including waiting periods). Below are a few examples of benefit conditions observed in various dental plans offered in multiple states. They illustrate the lack of uniformity among orthodontic benefits and the need for careful shopping on the part of consumers.
Orthodontic benefits are available to all ages under this plan
Orthodontia – 12-month waiting period
1st year of insurance enrollment - Not covered service
2nd year of insurance enrollment and after – 50% after deductible
1st year of insurance enrollment – Not covered service
2nd year of insurance enrollment and after – 40% after the deductible is satisfied
$1000 lifetime maximum
Orthodontic benefits are only available for eligible dependent children up to age 19
1st year of insurance enrollment – 10%
2nd year of insurance enrollment – 25%
3rd year of insurance enrollment – 50%
$1200 lifetime maximum per person for this benefit
1st year of insurance enrollment – 0% (Not a covered service)
2nd year of insurance enrollment and after – 50% coverage after $150 Orthodontia deductible satisfied $1500 Lifetime Maximum per eligible dependent child
As demonstrated in a couple of the above examples, a dental plan that offers orthodontic coverage may use a "waiting period" that delays the benefit's availability for a year.
How to Confirm Orthodontic Coverage
Given the irregular coverage of orthodontic services among dental plans, a consumer can''t apply for insurance and hope for the best. Instead, he or she must confirm not just the presence of orthodontic coverage but the specifics of that coverage. This can be accomplished several ways. First, the consumer can investigate the specific conditions of the dental plan using one of the following resources:
- An online "plan details" button
- A summary of benefits
- A plan brochure
If these resources aren't available or have vague information, the consumer can also use the customer service number for the website providing the dental information they are reviewing.
The below list includes dental plans in each state (and Washington D.C.) that have some level of coverage for orthodontia. Some of these plans may not be available within all regions of the state for which it is listed.
If you are interest in a plan, READ THE PLAN DETAILS BECAUSE OF DIFFERING LEVELS OF ORTHODONTIC COVERAGE AS WELL AS WAITING PERIODS BEFORE SERVICES LIKE BRACES ARE COVERED. Additionally, some dental plans limit their orthodontic benefits to dependent children under the age of 19. Consequently, reading the plan details for the specifics of orthodontic coverage is essential for the savvy shopper.
If you see a plan you like, you can get a dental plan quote in a few clicks.
|Alabama||Guardian Direct||Advantage Diamond|
|Alaska||MetLife||TakeAlong Dental High|
|Arizona||Renaissance Dental||MAX Choice Plus|
|Arkansas||Guardian Direct||Advantage Achiever|
|California||California Dental Network||Plan 595|
|Colorado||Anthem||Essential Choice Incentive|
|Connecticut||MetLife||TakeAlong Dental High|
|Delaware||Delta Dental||Dental for Everyone Diamond Premier|
|Florida||Delta Dental||Dental for Everyone Platinum|
|Georgia||Renaissance Dental||Max Choice|
|Hawaii||Guardian Direct||Advantage Diamond|
|Idaho||Careington||500 Series Dental Savings (Discount Program, Not Insurance)|
|Illinois||MetLife||TakeAlong Dental High|
|Indiana||Anthem||Essential Choice Incentive|
|Iowa||Renaissance Dental||MAX Choice Plus|
|Kansas||Careington||500 Series Dental Savings (Discount Program, Not Insurance)|
|Kentucky||Delta Dental of Kentucky||Bright smiles|
|Louisiana||Guardian Direct||Advantage Achiever|
|Maine||Anthem||Essential Choice Platinum|
|Maryland||Dominion National||Select Plan Premium|
|Massachusetts||Renaissance Dental||MAX Choice Plus|
|Michigan||Guardian Direct||Advantage Diamond|
|Minnesota||MetLife||TakeAlong Dental High|
|Mississippi||Delta Dental||Immediate Coverage Plan|
|Missouri||Careington||500 Series Dental Savings (Discount Program, Not Insurance)|
|Montana||Delta Dental||Dental for Everyone Platinum Premier|
|Nebraska||Renaissance Dental||MAX Choice Plus|
|Nevada||Anthem||Essential Choice Incentive|
|New Hampshire||Anthem||Essential Choice Platinum|
|New Jersey||Guardian Direct||Advantage Diamond|
|New Mexico||Careington||500 Series Dental Savings (Discount Program, Not Insurance)|
|New York||Empire BlueCross BlueShield||Essential Choice Platinum|
|North Carolina||MetLife||TakeAlong Dental High|
|North Dakota||Guardian Direct||Advantage Achiever|
|Ohio||Renaissance Dental||MAX Choice Plus|
|Oklahoma||MetLife||TakeAlong Dental High|
|Oregon||Dental Health Services||Super SmartSmile|
|Pennsylvania||Dominion National||Select Plan Premium|
|Rhode Island||Careington||500 Series Dental Savings (Discount Program, Not Insurance)|
|South Carolina||Guardian Direct||Advantage Diamond|
|South Dakota||MetLife||TakeAlong Dental High|
|Tennessee||Delta Dental of Tennessee||Brighter Advantage|
|Texas||Delta Dental||Immediate Coverage Plan|
|Utah||Renaissance Dental||Max Choice|
|Vermont||Guardian Direct||Advantage Achiever|
|Virginia||Dominion National||Select Plan Premium|
|Washington State||MetLife||TakeAlong Dental High|
|Washington D.C.||Dominion National||Select Plan Premium|
|West Virginia||Careington||500 Series Dental Savings (Discount Program, Not Insurance)|
|Wisconsin||Anthem||Essential Choice Incentive|
|Wyoming||MetLife||TakeAlong Dental High|
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