Braces with Insurance: Everything You Need to Know

Getting braces is a big decision, and one that can come with a hefty price tag. Fortunately, if you have dental insurance, the cost of braces can be significantly reduced. In this article, we will explore everything you need to know about getting braces with insurance, including what types of plans cover orthodontic work, how much you can expect to pay, and frequently asked questions about the process.

Types of Insurance Plans That Cover Braces

Not all dental insurance plans cover orthodontic work. In fact, many plans only cover basic preventive care such as cleanings, fillings, and extractions. However, some plans do offer coverage for braces, either partially or in full. The two most common types of insurance plans that cover orthodontic work are:

1. Dental PPO Plans: These plans offer the most flexibility when it comes to choosing a dentist or orthodontist. They typically cover a percentage of the cost of braces, with the patient responsible for the remainder.
2. Dental HMO Plans: These plans are more restrictive in terms of provider choice, but can offer more comprehensive coverage for orthodontic work.

It’s important to note that every insurance plan is different, and the amount of coverage you receive for braces will depend on your specific plan. Be sure to review your plan’s summary of benefits to determine what is covered and what your out-of-pocket costs will be.

The Cost of Braces with Insurance

The cost of braces with insurance can vary widely depending on a variety of factors such as the type of plan you have, the severity of your orthodontic issues, and the provider you choose. Generally speaking, the cost of braces with insurance can range from $1,000 to $5,000 or more.

If you have a dental PPO plan, you can typically expect to pay around 20-50% of the total cost of braces, with your insurance covering the remainder. If you have a dental HMO plan, you may be responsible for a smaller percentage of the cost, but you may also have fewer provider options to choose from.

It’s important to factor in any deductibles or copayments you may have as well. For example, if your plan has a $500 deductible, you will need to pay that amount out of pocket before your insurance coverage kicks in.

Frequently Asked Questions About Braces with Insurance

1. How long does it take to get approved for braces with insurance?

The approval process for braces with insurance can vary depending on your plan and provider. Some plans may require a waiting period before you can receive coverage for orthodontic work, while others may not. It’s a good idea to contact your insurance company or provider directly to find out more about the approval process.

2. Do I need a referral from my dentist to get braces with insurance?

It depends on your insurance plan. Some plans require a referral from a general dentist before you can receive coverage for orthodontic work. Others do not. Be sure to check your plan’s summary of benefits to find out what is required.

3. Are there any age restrictions for getting braces with insurance?

Most insurance plans that cover orthodontic work do not have age restrictions. However, some plans may only cover braces for children and teens under a certain age.

4. Can I choose any orthodontist or dentist for my braces?

It depends on your insurance plan. If you have a dental PPO plan, you can usually choose any provider you wish. If you have a dental HMO plan, you may be limited to a specific network of providers. Be sure to check with your insurance company or provider to find out what your options are.

5. What if I need to have braces removed early?

If you need to have your braces removed early for any reason, you may be responsible for the cost of that removal. However, some insurance plans may cover the cost of early removal if it is deemed medically necessary.

Conclusion

Braces can be a big investment, but with dental insurance, you can significantly reduce the cost. By understanding what types of plans cover orthodontic work, how much you can expect to pay, and frequently asked questions about the process, you can make an informed decision about whether or not braces are right for you. Be sure to review your plan’s summary of benefits and talk to your insurance company or provider to get a clear understanding of what your coverage entails.