Cost of Braces with Insurance

Paying for the cost of braces can be made more affordable with dental insurance. There are different types of policies which cover braces costs and other dental expenses. These dental and orthodontic insurance plans vary in key aspects and have various options which can affect your bottom line. This article discusses your choices with dental insurance for covering the cost of braces.



Cost of Braces with Indemnity Dental Insurance

This type of plan offers the most flexibility in terms of provider choice. If you purchase an indemnity plan, this enables you to have the freedom to choose your own dentist, rather than selecting a provider from a given list within a network. This type of insurance works on a fee-for-service basis. This means that the insurance company pays the doctor for all or part of the services that you receive from the dentist or orthodontist.

Typically you are required to pay a monthly premium and you may also be required to pay a set deductible amount for certain types of service. Some plans don’t charge a deductible for preventative treatment. As to whether a deductible is charged for a service cost, you will need to check the services schedule of your plan with your specific insurance company. These plans also limit the amount of services that you can receive within a yearly period. You may also need to wait a probationary period before receiving certain treatment.

Even though you have the ability to choose your own dentist or orthodontist under these plans, these policies do charge high deductibles before you can receive most types of services, including braces. The amount the insurance company contributes towards your care varies between 50% and 80% of the orthodontist’s fees. In addition to your monthly premiums, you will be required to pay the surplus of your dentist fees.

Usually, there is also an annual dollar limit which you are able to spend on dental or orthodontic treatments under these plans. The policy you choose may pay either a portion of the professional fees or a set dollar amount. Usually the insurance provider will be able to pay the lesser amount depending on the insurance contract.

Indemnity insurance plans usually cost around $15 to $25 per month. They are more expensive than other policies however you may still be able to save on the cost of braces with these plans.

Cost of Braces with Dental HMO Insurance

This is a common type of dental insurance which offers comprehensive dental care to beneficiaries who participate in these policies. A dental HMO (Health Maintenance Organization) plan can also be known as a capitation plan and are usually the cheapest form of dental insurance. Under these policies, the dentist, orthodontist or other dental services provider is paid by the insurance company a specified amount per person (also known as a per capita basis). So rather than paying for each treatment, the provider is paid for the total number of patients enrolled in the plan regardless of how many times a patient visits the office.

Participation in these policies costs around $5 to $15 per month. There may also be an upfront registration fee. There is usually an annual dollar cap which you are able to spend, so you need to plan the cost of braces carefully in terms of when you commence treatment under these plans. If you are visiting an orthodontist to have braces, you will most likely be required to pay co-payments under HMO policies. However, preventative or routine care is usually free and does not require a copayment.

The main restriction with HMO plans is that you must select your orthodontist from the approved network of provider. If you receive treatment from an orthodontist or dentist outside the network then the insurance company will not be liable to pay any portion of your treatment fees.

As for paying for your braces, your orthodontist will be required to file a claim with your insurance company if they are part of the insurer’s network. You are not obliged to file the claim yourself however you may be charged a co-payment from your dental provider.

Cost of Braces with Preferred Provider Organizations (PPO) Insurance

PPO dental plans are another form of braces insurance which work with a network of approved orthodontists. Once again, there is an annual dollar cap as to the services to which you are entitled and you must pay monthly premiums. If you consult an orthodontist for braces within the network, then you will pay a lesser amount than if you source your provider from outside the network. Higher deductibles and co-payments apply if you step outside the network.

The average monthly premium for PPO dental plans is $20 – $25. Some may also charge an annual deductible, which is a fixed dollar amount that you must pay each calendar year before particular services will be covered. The annual amount that must be paid before receiving braces treatment will be set out in the benefits and payment chart of your insurance policy.

Whilst PPO plans are cheaper than indemnity policies, you will only full benefit of these plans if you go to a provider within the approved list. If your orthodontist is part of the network then you will only be required to pay the annual deductible and a smaller co-payment for the cost of your braces.

If your provider is not within the designated list (going “out-of-network”), then you will be charged a higher amount and you will need to pay the orthodontist directly and file a claim with the insurance company in order to get reimbursed. In this situation the insurer will only be required to pay a small portion of the fees and you are responsible for the rest. If you are considering a PPO insurance plan to cover the cost of braces, make sure your selected doctor is one of the providers within your insurance company’s network.

Cost of Braces with Scheduled Insurance

A less common form of dental insurance, these plans reimburse you for a certain amount based on the fee schedule of the policy. Any surplus charged by your dentist or orthodontist is payable by you and not the insurance company. You will only be able to receive a maximum amount per calendar year and you will have deductibles to pay as well. There may also be waiting periods for getting braces depending on the terms of your plan.

If you wish to get braces paid for under a scheduled policy, investigate the covered procedures and the amounts you will receive under the specific fee schedule chart. This is the only way to determine whether such a plan is worthwhile for braces costs. For example, if your standard dentist charges are $70 for a consultation, the fee schedule may state that you will only be reimbursed $46, then you must pay the balance of $24. With scheduled fee insurance plan, you really need to do your figures to work out whether this is a viable option for braces.

Cost of Braces with Discount Cards

Although not insurance, this is another form of reducing the cost of braces by subscribing to a plan and seeking services from a provider within a network. Typically discount cards are offered for a monthly premium and an upfront one time registration fee. The monthly premium ranges from $15 to $20 and gives you access to huge discounts from providers who are members of the plan. If you wish to consider getting savings for fees and charges associated with orthodontic braces, then read our cost of braces without insurance page for more information on these discount cards.

Dental insurance offers a more cost effective means of paying for the cost of braces and other dental care. Under most plans, you will be able to receive free or very low cost preventive and routine dental care in addition to lowering the cost of your teeth straightening procedures. Many companies offer dental insurance for individuals, groups and family situations if you wish to further minimize monthly payments.