Orthodontia and Dental Coverage - Healthpocket

Dental Insurance and Orthodontia

Orthodontia is the branch of dentistry specializing in the treatment and correction of irregularities of the teeth and jaw. Most consumers require orthodontic work to correct an abnormal bite or crooked teeth. Dentists will refer patients to orthodontists when braces or other devices are needed to straighten teeth or for other corrective purposes. The costs for these procedures can vary widely, with the price of pediatric braces ranging from $3,000 to $7,000 while the average price for adult braces is $4,800. Most dental plans only cover orthodontic services for children, although there has been an increase in orthondontia utilization by adults over the past decade.

The Affordable Healthcare Act (ACA) does not include mandated dental or orthodontia coverage for adults. Insurers must offer options for pediatric dental coverage but consumers are not required to purchase any type of dental insurance to meet the mandated health insurance requirement. Dental insurance generally covers 25% to 50% of orthodontic services, including braces and retainers, leaving the consumer to assume the remainder of the cost out of pocket. The majority of dental insurance plans have a lifetime cap on orthodontia, which is separate from the dental lifetime maximum.

Payment Options for Braces

The majority of consumers will need to pay over half the cost of braces out-of-pocket. Some payment options and cost-saving measures are:

  • Ask your dentist to recommend multiple orthodontists. The cost of braces varies between providers
  • Orthodontists may offer various payment options or financing. If considering financing, be certain to determine full cost of orthodontia with interest payments by multiplying the monthly payment by the term of the financing
  • Funds in flexible spending accounts or health savings accounts may be used for braces or other orthodontic work
  • Some nonprofit organizations offer financial assistance to families that cannot afford braces
  • Some dental schools may offer reduced rates on orthodontic services when performed by students working under a teacher

HealthPocket's dental plan comparison tool can help you compare costs of dental or orthodontic coverage in your area.




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