Don’t get confused about your coverage!

There are a lot of misconceptions about insurance companies and what exactly your benefits cover, especially in orthodontics. You may think that by having dental insurance that you automatically have orthodontic benefits, but that is not always the case. Here are some questions you may want to ask before you sign up for treatment. 

-Do you have orthodontic coverage, not just dental?

-What is the lifetime maximum?

-What percentage of the cost is covered?

-Is there a waiting period?

-What if you have two or more policies? Will it cover all costs?

If you do have a dental policy, check with your company to see if you have orthodontic coverage. If you don't, ask if you can add orthodontic coverage during your open enrollment period to make sure that you have coverage.

What about lifetime maximums. If you call your insurance company to obtain your benefits for orthodontic services, ask what your lifetime maximum is. It typically ranges from $750-$3000, but when they say they cover up to 50%, it is not 50% of the total cost of braces; it is 50% of the total cost up to the lifetime maximum amount.

When you add orthodontic coverage, ask if there is a waiting period. Sometimes when a policy is brand new, a 12-24 month waiting period is issued, so no services are covered until the waiting period is satisfied. It is also common for an age limit to be applied to the benefits, so make sure that you have not reached the age limit.

Benefits include comprehensive orthodontics; meaning your office visits, follow up visits, appliances, retainers, and retention period after braces are removed. Insurance never covers extra retainers or retainer treatment only. So don’t lose your retainers, because you will have to pay out of pocket!

If extractions are requested by your orthodontist, the cost of your extractions will be applied to your lifetime orthodontic maximum. Unless you need a tooth extracted due to a cavity or the tooth is rotting, it will be filed as an orthodontic expense. Typically extractions are requested by orthodontists to make room for teeth if a patient has crowding or if another tooth is coming in and the extracted tooth was preventing normal growth.  

One of the biggest misconceptions, is that having multiple orthodontic policies will cover all costs. If you have two separate policies, the first thing you need to know is which policy is your primary and which policy is your secondary. The primary policy will always cover the lifetime maximum, up to a percentage of the total cost. If your total cost is $6000 for full orthodontic treatment, 50% of that is $3000. So if you have a lifetime maximum of $1500 covered at 50%, $1500 will go towards the total cost of braces. If your secondary policy is $2000 and covers up to 50%, that does not necessarily mean you now have $3500 covered and only owe the remainder. Only $3000 will be covered because $3000 is the 50% of total cost. $1500 will come from the primary policy and $1500 from the secondary, even if the lifetime maximum is $2000. 

We hope that you find this insurance information useful when seeking orthodontic treatment. If you have any other insurance questions, don’t hesitate to email, call, or leave us feedback!