Braces and Invisalign coverage usually has a lifetime maximum benefit amount and/or percentage. Many will receive a fixed benefit amount (for example, $3,000). Others will pay a certain percentage of the treatment for an indefinite period of time. This is frequently 50%. The two are frequently combined. In this case, someone with a 50% payment amount and a $3,000 maximum lifetime benefit would have their dental insurance cover 50% of treatment up to a total treatment cost of $6,000 (a $3,000 benefit).
How are orthodontic claims paid?
It’s worth noting that orthodontic benefits are rarely given out in full. Payments may be spaced out during the course of treatment in monthly, quarterly, or yearly installments, depending on your insurance carrier.
How does orthodontic dental insurance work?
-Orthodontic insurance benefits are usually a specific financial amount with a percentage attached. The insurance company will cover the percentage of therapy up to the lifetime maximum dollar amount, whichever is lower. For example, if your benefit is $1500 at 50% and your treatment charge is $400, you will be reimbursed 50% of your treatment fee, or $200. However, if your therapy costs $3000 or more, no matter how high the price, you will only be eligible for $1500.
How much does insurance normally cover for braces?
Braces are not cheap, to tell you the truth. They shouldn’t be: putting braces on and keeping them on is a medical operation, and it’s best to have it done properly by a registered specialist. But wait a minutedoes insurance pay them if it’s a medical procedure? What is the cost of braces with insurance?
When selecting whether or not to acquire braces for yourself or your child, we understand that money is a major factor. Here, we’ll try to figure out how much braces normally cost with insurance and how to reduce that cost.
Braces: The Range of Prices
A comparison of braces pricing from a variety of dental offices and websites reveals that prices vary significantly. Part of this is due to geographical differences: some states are more expensive than others. A lot of it has to do with the type of braces that are being inquired about.
The following is a list of pricing for various types of braces (prices do not include insurance):
The length of time the braces must be worn is also a factor in the pricing. Braces must be maintained and tightened on a regular basis, which necessitates visits to the orthodontist. The ultimate pricing reflects the number of journeys a person may require. Some offices charge a flat fee for a certain number of visits, while others charge per visit.
So, How Much Do Braces Cost With Insurance?
The pricing ranges listed above are for the expense of therapy without insurance. As you can see, more specialized braces, such as lingual braces or Invisalign, can cost up to 50% more than regular metal braces.
The extent to which braces are covered by health insurance depends on the provider and plan. Some insurance plans do not cover orthodontic treatment for persons above the age of 18, although they do cover it for children under the age of 18. It is very uncommon for insurance to reimburse up to 50% of the entire cost of braces for a youngster (up to a maximum of $1,500). If braces are medically essential, several insurance plans will pay them partially or completely. Of course, if you have separate dental insurance, your chances of getting your braces covered increase.
In 2017, individuals with insurance paid an average of $3,407 out of pocket for standard metal braces.
Braces Might Also Be Tax-Deductible
To be clear, we are not tax specialists, and tax regulations change frequently, so you should see a CPA on this. You may hear that braces that are deemed medically necessary are tax deductible; nevertheless, the cost must reach a particular threshold. All of the fees involved with braces, however, may add up quickly, so keep track of appointment visits, x-rays, and other expenses (see below).
Additional Costs
The cost of braces usually includes everything from the orthodontist’s services to the materials used to make the braces. However, keep in mind that certain offices have unique costs for different items. You might, for example, pay more for:
MyOrthodontist is Here to Help With Braces
If you’re still wondering “how much do braces cost with insurance?” we’d like to know how we can assist you. We recognize that braces are an investment, and we want to help you and your family get the most out of them. Come in for a no-obligation consultation to explore what we can do for you.
Are retainers covered by insurance?
Is the cost of retainers covered? In most cases, a lifetime’s worth of post-treatment retainers (for orthodontic purposes) is reimbursed. Retainers are normally covered after each phase of orthodontic treatment if your plan covers two phases. Benefits, deductibles, maximums, waiting periods, limits, and exclusions are all important considerations.
Is orthodontic insurance worth?
Orthodontic coverage provided in dental insurance policies often pays only a portion of the treatment costs, typically 50%, and is generally limited to a low lifetime maximum. In some circumstances, the extra expense of a plan that includes orthodontic care may be worth it. Other options may be more appropriate in some circumstances.
When it’s Worth It
If the cost of a plan with orthodontic coverage isn’t too much more, getting the extra coverage can help you save money on braces or other orthodontic operations. The primary stumbling blocks are that most orthodontia policies only cover 25% to 50% of the expense, with lifetime coverage caps as low as $1,000. The coverage may be more valuable if you select a plan with a higher lifetime maximum.
In some ways, the lifetime limit for orthodontic procedures works like a bank account: you can only withdraw money for approved procedures (covered claims), and the balance can only go down. It isn’t replenished on a yearly basis like an annual maximum.
For example, if braces cost $5,000 and your insurance covers 50% of the cost, you would pay $2,500. But then there’s the lifespan limit to consider. If the lifetime maximum is only $1,000, the braces would cost $4,000, and the lifetime maximum amount would be lowered to $0 almost soon. Orthodontia claims will no longer be covered by the plan.
Increase the lifetime maximum to $3,000 in the same case. In this scenario, the cost of braces is covered up to 50%, bringing your total cost to $2,500, leaving you with a $500 balance to spend for future covered claims, such as retainers.
The problem is that less priced plans with orthodontic treatment frequently have lifetime restrictions of $1,500 or less. A dental insurance plan with better coverage will cost a little extra.
When it’s Not
Choosing a plan with a low lifetime limit for orthodontic work isn’t always better than having no coverage at all. There may be instances where the premiums paid are better spent. A health savings account or a dental discount plan or both could be a possibility.
A high deductible health insurance plan can be combined with a health savings account (HSA), which allows you to save money before taxes for approved medical expenses, such as dental care. You don’t have to pay taxes on money you put into your health savings account to pay for recognized medical needs. As a result, an instant discount equivalent to your income tax rate is created.
Many dental discount programs provide reductions on braces and other orthodontic work, with discounts ranging from 20% to 50%. Although you will still be responsible for the amount, dental discount plans are relatively reasonable. Many of the plans are around $10 per month.
If you have both an HSA and a dental discount plan, your HSA cannot be used to pay the premiums for your plan, but you can use HSA funds to pay for the dental care. When an HSA and a dental discount plan are combined, you can save a lot of money on orthodontic operations and other dental requirements.
Also, be mindful of any orthodontic work exclusions. If you’ve already begun the process of acquiring braces and then switch insurers to gain coverage, you’re likely to find that the remaining treatments aren’t covered. There may also be a waiting period.
When choosing a less expensive dental insurance plan, the coverage limitations especially the lifetime maximum may lower the value of the coverage to the point that you should examine other options.
How is Invisalign billed to insurance?
Invisalign treatment is covered by many dental insurance plans in the same manner that braces are. Your insurance may cover a percentage of the cost of your Invisalign treatment or a specific monetary amount. In many cases, the amount of money that insurance will pay for orthodontic treatment has a lifetime limit.
Can you use 2 insurance plans for braces?
Is it possible to have dual coverage for braces? In most circumstances, yes, but there are a few standards that insurance companies follow when defining primary vs. secondary coverage, and you should make sure your plan allows for basic benefit coordination.
Does Aflac cover orthodontics?
Is Aflac willing to cover braces? Supplemental dental insurance is available through Aflac. Do those policies, however, provide orthodontic coverage? Yes, in a word. Orthodontics may be covered by Aflac, depending on the plan you choose. However, you must acquire an orthodontic benefit rider for your plan, which is effectively a supplement to your supplemental insurance, in order to have orthodontics covered. Aflac dental coverage will extend to orthodontics after you purchase the rider.
Aflac Dental offers three different plans: Basic, Standard, and Premier. The Basic plan costs $285, the Standard plan costs $400, and the Premier plan costs $450. These policies normally do not cover orthodontia, however Aflac gives a lifetime benefit of up to $1,400 per insured individual with the Orthodontic Benefit Rider.
Does insurance cover Invisalign if you already had braces?
Orthodontic treatment is usually only covered once in a lifetime by dental insurance policies. As a result, if you have previously worn braces, your benefits may not cover Invisalign. Most dentists, on the other hand, provide flexible payment options to help customers fit their treatment into their budget.
Have your braces caused your grin to become misaligned? Invisalign may be the most convenient option to straighten your teeth and return them to their proper positions.
A team of dentists and specialists, including an on-staff orthodontist, work at Family Dental Practice of Newington. As one of our sophisticated procedures, we are pleased to offer Invisalign. Contact our friendly team at 860-821-6007 if you’d like to learn more about Invisalign for orthodontic retreatment.