Most dental insurance do not cover one of the most expensive types of dental treatment — the process of getting braces. If you’re lucky enough to get coverage for this, however, there are also some limitations to it that making use of orthodontic insurance can be a tedious process.
Knowing the basics to orthodontics insurance can then help you maximize your coverage and won’t assume your insurance provider has ripped you off.
Dental Insurance vs Orthodontic Insurance
A dental coverage involves treatments like teeth cleaning, filling, root canal procedures and extraction. These are very basic, but some coverage may also include dental surgery. Orthodontic insurance pertains to the use of dental tools like braces to fix the teeth. And more often than not, this isn’t part of a dental coverage because insurance companies put this under cosmetics procedure, where the risks and expenses may be complicated and expensive.
What’s crucial about this, which many insurance providers will not immediately acknowledge, is that braces treatment is not just purely about cosmetic enhancements. It’s also corrective in nature. Teenagers, for example, may need it so that their jaw and facial muscle development can be fixed. Apart from problems in relation to teeth alignment and spacing, this treatment is very important to a person’s complete physical development.
Corrections using braces may need to be done immediately, but because the cost for this appliance can be expensive, seeking insurance to help cover the expenses is often looked into.
Limitations of Orthodontics Insurance
The limitations with having orthodontic insurance, however, make other people second guess whether or not this would be practical and helpful in the long run.
- AGE OF COVERAGE. For instance, some insurance providers only cover braces cost with patients who are children. As soon as the son or daughter of a parent with insurance coverage reaches the age of 18, the privilege is no longer extended.
- CLAUSES AND WAITING PERIOD. Some orthodontic insurance coverage may also carry a clause that puts a waiting period for when the insurance money will be able to cover the cost of the braces procedure. Or it may include stipulations that prevent any orthodontic treatments to be worked on for a certain period, such as within six months to a year after the most recent dental treatment. This means that if you do decide to go ahead with the braces treatment, you would have to pay the dentist out of your own pocket or budget, on top of paying your insurance for the monthly premiums. After which, you then wait for the reimbursement from your insurance provider.
- MAXIMUM COVERAGE. Orthodontic insurance has a lifetime maximum coverage, meaning to say, you may only be set for a certain amount for the treatment, and this is applicable for the rest of your living years. So, if your insurance provider is only willing to pay $3000 of the braces cost and you end up incurring $5000 for the procedure, you would have already used up the entire coverage you can get from it.
- GROUP PLANS. If you happen to be covered for dental insurance through a group plan, there may also be limitations in terms of how much the plan can only absorb. If you were only given up to $1500 in coverage amount, this would be unfortunate because a braces procedure naturally costs a lot more than that. The reason why others go with a group insurance plan for orthodontia, however , is because the premium rates are cheaper compared to an individual plan.
- OTHER PROCEDURES. With some patients getting braces, it may be necessary to do extractions, fillings and other procedures first to prepare the teeth. This drives up the cost of procedure more, and having the insurance would be of great help. Additionally, the regular visits to the orthodontist should also be covered in the insurance. If it’s not going to be acknowledge by the provider, then this would also drive the cost of the comprehensive braces treatment up.
Considerations In Choosing Orthodontic Insurance
Given all these information, it definitely helps to study all your options and offers first before sticking with an insurance provider. Picking the right one can definitely provide you with the convenience and affordability you need when getting your treatments done.
- If you have an existing dental plan, you can talk to your provider about adding orthodontic cost to your coverage and then discuss the adjustments for the premium rates.
- If you already have a dentist, seek recommendations for a good insurance provider. Or better yet, ask him what types of insurance does he accept in his practice and look into their rates. This way, paying your dental provider through your insurance provider would be a lot more convenient.
- Compare rates between providers, but give consideration to what your family may actually need for coverage. Sometimes, it would be more practical to pay higher premium, if the coverage is more comprehensive.
Orthodontic insurance, as with any type of insurance, can appease your mind and make treatments at least more affordable despite the limitations.