Wondering whether your dental plan will help pay for braces? Often it will, but orthodontic coverage works differently from the rest of your dental benefits. Knowing how it works before treatment starts makes planning a lot easier. Here’s what Arizona families should know.
How Orthodontic Benefits Differ From Dental Benefits
Most dental plans cover cleanings, exams and fillings as part of the standard benefit. Orthodontic treatment is usually a separate benefit, and not every plan includes it. Some employers offer it as an add-on, so it’s worth checking during open enrollment if braces might be in your family’s future.
When a plan does include orthodontic coverage, it usually works a little differently.
- It pays a share of treatment. Plans typically cover a percentage of orthodontic treatment rather than the full amount.
- It may have a waiting period. Some plans require you to be enrolled for a while before orthodontic benefits kick in.
- It may pay over time. Many insurers spread their payments across the length of treatment instead of paying all at once.
- It often needs approval first. Many plans ask for a predetermination, which is a written estimate of what they’ll cover before treatment starts.
Coverage usually applies to braces and often to clear aligners too, though every plan has its own rules.
Lifetime Maximums and Age Limits
Two terms come up in almost every orthodontic benefit, and they’re worth understanding.
Lifetime maximum. Your regular dental benefits usually reset every year. Orthodontic benefits usually don’t. Instead, there’s a lifetime maximum, which is the most the plan will ever pay toward orthodontic treatment for each person. Once it’s used, it’s gone, even if that person needs treatment again later.
Age limits. Many plans only cover orthodontic treatment for children and teens up to a certain age. Some plans include adults, but adult coverage is less common. If you’re an adult considering treatment, check your plan’s details. Our post on Invisalign for adults covers what adult treatment looks like.
HSA, FSA, CareCredit and Monthly Plans
Even with insurance, most families have a portion to pay. These options help.
- HSA funds. Orthodontic treatment generally counts as a qualified medical expense, so you can use HSA money toward it.
- FSA funds. These work the same way, though FSA money usually has to be used within the plan year. Timing treatment around your FSA can help.
- CareCredit. A healthcare financing option many families use for orthodontic treatment.
- Monthly payment plans. Jungle Roots offers monthly plans for orthodontic treatment so families can spread it out over time.
Many families combine insurance with one or more of these. Using HSA or FSA funds alongside insurance is one of the most common approaches.
How to Check Your Coverage
A few minutes on the phone with your insurance company can answer most questions. Call the member services number on the back of your card and ask:
- Is orthodontic treatment a covered benefit on my plan?
- What percentage does the plan pay?
- What is the lifetime orthodontic maximum?
- Is there an age limit or a waiting period?
- Does a deductible apply?
- Are clear aligners covered the same way as braces?
Write down the representative’s name and a reference number for the call. If questions come up later, that record helps.
What Your Evaluation Tells You About Coverage
You don’t have to figure it all out alone. At your complimentary orthodontic evaluation, Dr. Olsen looks at your child’s teeth and bite and recommends a treatment plan. Our team then checks your benefits, explains how your coverage applies and walks you through your payment options before anything starts. If your plan needs a predetermination, we’ll help with that too.
We accept most major insurance plans, including PPO plans with orthodontic coverage. Learn more about orthodontics in Ahwatukee for kids, teens and adults.
Frequently Asked Questions About Braces and Insurance
How do I know if my insurance will cover braces?
The most reliable way is a predetermination. The orthodontic office sends your proposed treatment to your insurer, and the insurer responds in writing with what it will cover. Calling member services is a good first step too.
Does insurance cover Invisalign?
Often, yes. Many plans with orthodontic benefits cover clear aligners the same way they cover braces. Some plans limit or exclude aligners, so check your plan’s details.
Does dental insurance cover braces for adults?
Some plans do, but many limit orthodontic coverage to children and teens. Check your plan for an age limit.
Can I use my HSA or FSA for braces?
Yes. Orthodontic treatment generally qualifies, so HSA and FSA funds can be used toward the portion insurance doesn’t cover.
What is a lifetime orthodontic maximum?
It’s the most your plan will pay toward orthodontic treatment for one person, ever. Unlike regular dental benefits, it doesn’t reset each year.
Want help understanding your coverage? Request an appointment or call our Ahwatukee office at (480) 759-1119 to schedule a complimentary orthodontic evaluation. Our team will check your benefits and walk you through your options.