Does Insurance Cover the Cost of Braces?

In the journey to achieving a beautiful and healthy smile, many individuals find themselves considering orthodontic treatment, often in the form of braces or Invisalign. However, the financial aspect of orthodontics can be a significant concern for individuals and families alike. The good news is that dental insurance may provide some relief in covering the costs associated with orthodontic treatment. In this blog post, we'll delve into the complexities of dental insurance coverage for orthodontics to help you better understand whether braces are covered and what factors to consider. We hope this article demystifies the confusing world of orthodontic insurance coverage; however, if you still have any questions please call Amy, our dedicated insurance coordinator, at 720-743-0700 and she will happily share her expertise and experience with you.

Understanding the Basics of Dental Insurance for braces or Invisalign

Dental insurance is designed to help manage the costs of various dental procedures, but coverage specifics can vary widely. When it comes to orthodontic treatment, it's crucial to recognize that not all dental insurance plans provide coverage for braces. Typically, orthodontic coverage is a separate component of dental insurance, and its inclusion varies among plans.

Types of Dental Insurance Coverage for Orthodontics

• Dental Insurance with Orthodontic Coverage:

• Medical Insurance Considerations:

• Specialized Orthodontic Insurance:

Key Factors to Consider:

• Preauthorization:

• Out-of-Pocket Costs:

• Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs):

Navigating the Process:

• Contact Your Insurance Provider:

• Consult with Orthodontic Professionals:

How much of orthodontic treatment does insurance normally cover?

Most PPO dental insurances will cover between $1,000-$1,500 of orthodontic treatment, but that amount can vary. Unlike other dental benefits, orthodontic coverage has a lifetime maximum amount. This means that if you used some of that orthodontic benefit for a previous round of treatment (maybe an expander when the patient was younger), and some money was paid out by the insurance company to the orthodontist, then that money is gone and will not replenish in the new year. The only way to restart your lifetime maximum is to switch insurances but we strongly recommend talking with our insurance coordinators before doing so.

In-Network vs. Out-of-Network: Decoding the Difference

While dental insurance can be a valuable asset in managing orthodontic expenses, the distinction between in-network and out-of-network coverage adds another layer of complexity. Let's explore this important aspect to help you make more informed decisions about your orthodontic journey.

1. In-Network Coverage:

• Preferred Providers: Dental insurance companies often establish networks of preferred providers, including dentists and orthodontists. When you choose an in-network orthodontic professional, you benefit from negotiated rates and discounted fees set by the insurance company and the provider. This typically results in lower out-of-pocket costs for you.

• Predictable Expenses: In-network providers work within the insurance company's network guidelines, making the billing and claims process more streamlined. You are likely to have a clearer understanding of your financial responsibilities, such as copayments and deductibles.

• Maximizing Benefits: Opting for an in-network orthodontist can maximize your insurance benefits, ensuring that you receive the most coverage for your orthodontic treatment.

2. Out-of-Network Coverage:

• Freedom of Choice: If you choose an orthodontist outside your insurance company's network, you have the freedom to select the provider of your choice. This is particularly beneficial if you have a specific orthodontist in mind or if you live in an area with limited in-network options.

• Cost Considerations: While you can still receive some level of coverage for out-of-network services, the costs may not be as predictable as with in-network providers. You might be responsible for a higher percentage of the fees, and the reimbursement process may involve more paperwork.

• Balance Billing Possibility: Out-of-network providers may charge fees that exceed the amount covered by your insurance plan. In such cases, you may be responsible for paying the difference, a practice known as balance billing.

What insurances does Bloom Orthodontics accept? Are you in-network or out-of-network?

At Bloom Orthodontics, we are IN-NETWORK with nearly all PPO dental insurances, which means we offer the highest quality treatment at an affordable rate that has been negotiated with your insurance company. We like to say we, "Exceed expectations without exceeding your budget." For a list of the insurances we work with, please click here. This list includes the most common insurances in the South Denver Metro area but is by no means a complete list. If you would like to know whether or not we accept or are in-network with your specific insurance, please give us a call at 720-743-0700.

What if I don't have dental insurance?

No orthodontic insurance? No problem! At Bloom Orthodontics, we offer NO INTEREST payment options for our patients that will work with their monthly budget. 

Do you have any questions about paying for orthodontic treatment? Call our office today at (720) 732-0700 and our staff will be happy to answer any questions you may have. Then, schedule your complimentary consultation to see what treatment options are available to give you the smile you’ve always wanted!

While dental insurance can alleviate some of the financial burdens associated with orthodontic treatment, the coverage landscape is nuanced. Understanding your specific insurance plan, its orthodontic coverage, and associated costs is crucial for informed decision-making. By taking the time to navigate the intricacies of dental insurance, you can embark on your orthodontic journey with confidence, knowing that your smile transformation is supported by a well-informed financial strategy.