How to Navigate Orthodontic Insurance & Get Braces Covered
Posted on 06/26/2023
Patient on treatment chair talking to provider

“It’s time!” your dentist might say– Time for you or your child (perhaps around 8 years old) to begin orthodontic treatment.

Hopefully, that family dentist has a trusted orthodontic referral for you, like our partnering dentists do with us here at O’Brien Orthodontics in Englewood and Beavercreek.

Or, even better, your dentists and orthodontontic referral would have already been in collaboration with each other durting routine checkups so the dentist knows what to look for (and when it’s time to refer you over to ortho!).

This is the best case scenario because it means you’d be able to anticipate treatment the year prior, and take the necessary insurance steps to get or confirm coverage at renewal. But even if that’s not the case, don’t fret. Here’s what you would have learned:

  1. Orthodontic insurance coverage is separate and different from general dental benefits.
  2. Orthodontic benefits are not automatically part of a dental insurance plan, so you will need to read your current policy to determine IF your policy includes those benefits, or add orthodontic coverage when the time comes to renew your insurance plan for the next year.
  3. In addition, you will want to explore the different orthodontic coverage/benefits that can be part of your plan.
    1. For example, some plans cover orthodontic treatment until age 19, some until age 26, and others cover adult orthodontic treatment at any age.
  4. Alongside age limitations, you will also want to be aware of the percentage rate and limit at which benefits are paid. Typically, benefits are paid at either 50% or 80% of the total treatment fee, with a maximum benefit limit which can be $1,500, $2,000, $3,000, or higher.
    1. As an example, consider an orthodontic treatment fee of $7,000. A common dental insurance plan with orthodontic coverage may pay benefits at 50% of the total fee ($3,500), but the maximum limit amount is $1,500. Therefore, you would receive the limit amount of $1,500 from insurance, and the remaining balance of the $7,000 treatment fee ($5,500) would be your responsibility. Keep in mind that these maximum limit benefits are usually lifetime limits, meaning that they are paid once per person.
  5. Lastly, what most people do not realize is that in the majority of cases, the insured is not denied benefits if they elect to have orthodontic treatment with a provider who is “out of network” or a provider that does not subscribe to any insurance plans.
    1. The benefits paid out would be the same (some exceptions exist), so it is always good to check with your insurance if there is an orthodontist you prefer who is not necessarily in your network of providers.

So read those dental policies and plan accordingly if you or your dentist think orthodontic treatment is in your near future! With the right doctors and a little research, you can be well-prepared to get the smile you want and deserve as soon as the time is right.

Don’t forget you can always visit us for an orthodontic consultation in Englewood or Beavercreek to get your questions answered! Plus, you’ll speak directly with Dr. O’Brien - that means less time with techs, more face-to-face time with the doctor. Call us to set up your appointment!

Englewood Orthodontist Office

16 W. Wenger Rd.
Englewood, OH 45322
Phone: 937-832-2087

Beavercreek Orthodontist Office

1911 North Fairfield Rd., Suite 320
Beavercreek, OH 45432
Phone: 937-438-1770