Many people need orthodontic care such as Braces, Invisalign or other type of aligners in their lifetime. While choosing a solution to your orthodontic needs, the issue of the cost becomes an important factor. The good news is that many dental insurance plans offer coverage options to help manage the expenses for orthodontic coverage. However, orthodontic insurance differs from regular dental insurance, and understanding the key factors can help you maximize your benefits. In this article we provide a comprehensive guide on how dental insurances cover Braces and Invisalign and discuss all the details you need to know before starting your orthodontic care.
Comprehensive Guide to Insurance Coverage for Braces and Invisalign
How Orthodontic Insurance Works
Most dental insurance plans that include orthodontic benefits cover a percentage of the treatment cost rather than the full amount. Typically, the coverage is around 50% of the treatment cost or the lifetime maximum amount, whichever is less. The lifetime maximum amount is specific to each plan and may vary among different plans. Typically, insurance plans may offer somewhere between $750 and $3,000 as their lifetime maximum for orthodontic treatments. However, these limits can vary widely, so you need to check with your insurance provider to get the exact amount. This means that even if your plan covers 50% of the treatment, there is a cap on the total amount the insurance company will pay.
For example, if your insurance plan has a $2,000 lifetime orthodontic maximum and your treatment costs $6,000, your insurer will cover up to $2,000 (your plan’s lifetime maximum), and you will be responsible for the remaining $4,000.
What are the Key Factors that Affect Insurance Coverage for Braces and Invisalign?
Every Dental Insurance plan is Unique!
- Insurance Plan: Some plans include orthodontic benefits, while others do not. Make sure your plan specifies orthodontic coverage.
- Age Limitations: Some insurance plans may have age limitations and only cover orthodontic treatments for dependents up to a certain age.
- Waiting Periods: Certain plans require you to wait a specific amount of time before using orthodontic benefits. This waiting period typically does not apply to group dental insurances and are mostly applicable to dental insurances that were purchased individually.
- In-Network vs. Out-of-Network: Choosing an in-network orthodontist may help you maximize your benefits and lower out-of-pocket costs. However, many insurance plans’ coverages might be the same whether you use an in-network or out-of-network provider.
- Insurance Plan Variability: Even two plans from the same insurance company can have different coverage details depending on how an employer has negotiated benefits. For example, two individuals with the same insurance provider might have different orthodontic coverage limits or age restrictions based on their group’s(employer’s) specific agreements with the insurance company.
Always check with your insurance company about the details of their coverage and ask your orthodontist to explain all the coverages for you to ensure you use all the benefits that are available to you.
Does Insurance Cover Invisalign or "Clear" Braces as well?
The insurance companies typically cover orthodontic treatment based on the dental issue being treated and how severe it is—not the type of appliance you choose. Most insurance plans will only reimburse up to the cost of standard metal braces. So, if you opt for more expensive options like ceramic braces or Invisalign, you’ll likely need to pay the difference out of pocket. The upgraded style or material is considered a personal choice, not a medical necessity.
What If You Have Two Dental Insurance Plans? (Dual Coverage)
Understanding Coordination of Benefits (COB)
If you’re covered by two dental insurance plans—such as your own and your spouse’s—then Coordination of Benefits (COB) rules will determine how the two plans work together. Coordination of Benefits refers to the specific set of rules that each insurance company may follow to share the cost of coverage with the other insurance company. When you have two insurance plans, one is designated as the primary and the other as the secondary. There are certain rules that determine which insurance acts as the primary and which acts as the secondary. Usually, the insurance company that has provided coverage for you the longest will be considered the primary insurance.
When paying for services, the primary insurance pays first. The secondary insurance may cover some or all of the remaining balance, depending on its own coverage limits. However, you cannot receive more than the actual cost of treatment when combining payments from both insurance companies.
Your orthodontic office can help verify and coordinate both plans to make the process simple for you.
Can You Use FSA or HSA for Braces or Invisalign?
Yes! Both Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA) allow you to use pre-tax dollars toward out-of-pocket orthodontic expenses. You can use these funds to pay for braces, Invisalign, retainers, and even follow-up visits.
If you’re planning orthodontic care, be sure to allocate FSA funds during open enrollment.
What If You Have Medi-Cal Dental Insurance (California's Medicaid)?
Medi-Cal provides orthodontic coverage for certain demographics, but the rules are very different from private insurance plans. Usually cosmetic only concerns, mild crowding, or minor overbites are not eligible for coverage under Medi-Cal. Furthermore,
The application and approval process can take several weeks and requires documentation.
Please refer to our comprehensive guide for Medi-Cal coverage for Orthodontic procedures for full details.
Steps to Verify Your Orthodontic Coverage
- Check Your Policy: Look for orthodontic coverage details in your dental plan.
- Contact Your Insurance Provider: Confirm benefits, age restrictions, and coverage limitations.
- Ask Your Orthodontist: Many offices can check your benefits and provide a cost estimate based on your coverage.
- Understand Payment Plans: If insurance does not cover the full cost, talk to your orthodontist about their flexible payment plans to make treatment more affordable.
Key Takeaways: Does Insurance Cover Braces and Invisalign?
Understanding how insurance coverage for orthodontic treatment works can help you plan your finances and avoid surprises. Most dental insurance plans that include orthodontic benefits cover approximately 50% of the treatment cost, but only up to a set lifetime maximum. Age limits, in-network providers, and waiting periods all play a role in how much coverage you receive. If you have two dental insurance plans, the coordination of benefits can reduce your out-of-pocket costs, but both plans will still have their own limitations. It’s important to remember that each insurance plan is unique—even plans from the same provider can differ depending on how they were negotiated by your or your spouse’s employer. That’s why the best approach is to have your orthodontist’s office review your insurance details so you can get the most value from your benefits and plan your orthodontic care with confidence
Ready to Start your Smile Transformation Journey?
We Accept Most Insurance Plans and Help You Maximize Your Coverage
If you are considering Braces, Invisalign, or other aligners and want to understand your insurance coverage, schedule a consultation with us. We can help you verify your benefits and explore financing options to make your treatment more affordable. It’s always best to have us check the details of your plan to ensure you get the best value from your insurance.
At Super Orthodontics, we believe that finances should never be a barrier to a healthy smile. That’s why we:
- Accept the majority of PPO dental insurance plans
- Offer complimentary insurance verification before your first appointment
- Help coordinate dual insurance plans to maximize your benefits
- Offer affordable monthly financing options, with low or no down payments
- Accept FSA, HSA, and third-party financing providers
Whether you have one plan or two, or you’re unsure what your plan covers, our experienced team will break it down for you so you know exactly what to expect. No surprises!
Smiles That Speak for Themselves
Hear From Our Happy Patients!
Absolutely outstanding experience! We came here on our child’s dentist’s recommendation, and wow! what an incredible choice! Dr. Assefnia is amazing. His calm, confident approach and genuine attention to each patient’s needs, wants, and concerns truly set him apart. He even offers help on his day off, that level of dedication is rare!
And Bob, the office manager, is phenomenal. He’s professional, warm, incredibly knowledgeable, and always goes above and beyond to make sure we understand every step of the treatment.
The best part? My child’s treatment is already showing remarkable results in such a short time! I couldn’t be happier. I will absolutely be recommending Super Orthodontist to all my friends and family. This place is the real deal!
My son has been with Dr. Assefnia since last November. After searching meticulously for an Orthodontist, which can be quite a daunting task, I was so happy to have found Dr. Assefnia and his great team of staff. They are all so warm and welcoming. The facility has the latest cutting edge technology, super fast and efficient. Dr. Assefnia is great with kids always makes my son feel comfortable. Dr. Assefnia makes going to the ortho feel super easy for my teenage son. He explains what he’s going to do step by step, when you have your first consultation with him, so you know what to expect. They are very professional and even hand you all the info about any problems or solutions for dealing with braces. You can rest assured, you will be in good capable hands with Dr. Assefnia. He earned the title of Super Orthodontics.
As a general dentist and a mom when my 8 years old son needed braces, I trusted Dr Amir with his care. My son went thru phase one with Dr Amir. Every visit was fun and my son looked forward in seeing him. Dr Amir is very kind and has a great sense of humor . We had a fantastic experience and Results were excellent! He is forever my family orthodontist!
As a parent, finding the right orthodontist for my children was a top priority, and I feel incredibly fortunate to have Dr. Amir Assefnia as our family’s trusted orthodontic partner. Over the years, my admiration for his work has only deepened, and I strongly recommend his services to all parents and anyone seeking exceptional orthodontic care.
His warmth and approachability immediately put my children at ease, turning what could be an intimidating experience into one filled with comfort and understanding. He discusses treatment plans thoroughly, ensuring that both parents and children are informed every step of the way. The trust he has built with our family over the years is truly invaluable. In recommending Dr. Amir Assefnia’s services, I believe that every child deserves the gift of a confident smile. His expertise and compassionate approach make him the ideal choice for families seeking a nurturing and skilled orthodontist. Thank you, Dr. Amir Assefnia!
So glad I stumbled upon Super Orthodontics Dr. Amir is truly one of the best orthodontists!! He’s very kind, caring and pays great attention to detail.10/10 would recommend.
Having known Dr. Amir Assefnia for many years, I can definitely say that he is the epitome of excellence in orthodontic care! I am not only a testament to his exceptional work, but I am also an advocate, recommending his services to everyone in need of a skilled and trustworthy orthodontist.
Dr. Amir Assefnia’s commitment to his craft is evident from the moment you step into his practice. His extensive experience and dedication to patient care make him a standout professional in the field. He transforms smiles with precision and artistry! Beyond his technical expertise, Dr. Amir Assefnia fosters a welcoming atmosphere in his practice. His entire staff reflects his commitment to patient-centric care, making each visit a positive and personalized experience.
I have recommended Dr. Amir Assefnia’s services to friends, family, and colleagues, and the feedback has consistently mirrored my own positive experiences. If you are looking for the best orthodontist to get your dream smile, Dr. Amir Assefnia is the orthodontist you can trust to deliver exceptional results.
Dr Amir Assefnia is the best orthodontist! I would’ve started my braces way earlier if I came across him sooner! Super happy with my results 😁. Highly recommend!
Best orthodontist! Great “bedside manner” Dr. Amir explains everything very well and gives us time to ask questions. Dr Amir treated both my kids and myself on our braces journey, and he made it pleasant and comfortable as can be. Thank you, Dr. Amir, for giving us a great smile! I would highly recommend Dr. Amir.
