Finance & Insurance

The cost of treatment varies depending on each patient. Some patients will need more complex treatments to correct issues with their jaw before their teeth can be aligned, while others may simply need a few teeth straightened. The duration of treatment can also be a factor. Regardless of the treatments you will need, our fee includes our entire orthodontic program, consisting of diagnostic records, treatment plans, orthodontic appliances, retainers, office visits, and follow-up appointments.

Yes, in most cases, you can use your Flexible Spending Account (FSA) or Health Savings Account (HSA) to pay for eligible orthodontic treatment for yourself, your spouse, and any dependents. These accounts are often offered by your employer and allow you to put aside “pre-tax dollars” to use for medical and other related expenses. Many people can save 25% up to 33% by using these untaxed dollars, depending on their current tax situation. Contact your employer to see if setting up an HSA or FSA might be an option for you. Also, people with very high annual health insurance deductibles can be eligible to set up a HSA directly with their bank; see your bank professional for details.

Orthodontic coverage usually involves a Lifetime Maximum (LTM) Benefit that typically pays out at 50% of the total case fee. There are a few plans that pay more or less than 50%, but this means that they will pay for braces one-time, per patient, and once you have used all the LTM, they won’t pay any more. For example, if your LTM benefit is $2,500, then braces would have to cost $5,000 or more to use your full benefit. If the treatment fee is below your LTM, then the insurance company will only pay 50% of the treatment.

Most orthodontic offices do NOT participate with dental insurance companies, but that does not mean your treatment won’t be covered. Orthodontic insurance works differently than any other insurance coverage, and typically any insurance plan that has an out-of-network orthodontic benefit can be utilized. In many cases, it pays back 10% per month slower, so it may take two to three months longer for out-of-network insurance policies to receive the same full lifetime benefit.

Sometimes, a patient with two guardians has dental insurance available from both people. When this happens, most insurance companies follow the universal rule of billing the guardian whose birthday comes first in the calendar year. After the lifetime maximum is reached, the other guardian’s insurance is billed. Furthermore, it may even benefit you if your insurance changes during treatment. This is because if your new insurance coverage has orthodontic coverage, you can bill it until the new lifetime coverage is met.

But make sure your secondary plan allows for “standard coordination of benefits.” Again, the “birthday rule” determines whose plan is primary and looks at what month that person was born. For example: If guardian #1’s birthday is 2/14/83 and guardian #2’s birthday is 11/20/1978, guardian #1’s plan, in most cases, would be considered the primary insurance plan because that birthday falls first in the calendar year. Typically, the actual age of the subscriber does not determine who is primary. Be sure to ask if your plan allows for “standard coordination of benefits” or has a “non-duplicating clause.” A non-duplicating clause means benefits will NOT be duplicated, meaning it will not also pay towards orthodontic treatment.

Here is a simple example: If both dental plans have a Lifetime Maximum (LTM) of $1,500 and your secondary plan has “no coordination of benefits,” your total orthodontic benefit is primary only or $1,500 LTM. However, when coordination of benefits is allowed, your benefit would be both primary and secondary or $3,000 LTM.

We try to make the insurance process as easy for you as possible. We will automatically bill your insurance provider every month or possibly just once if that is what they require. Insurance reimbursement checks are sent directly to the insurance cardholder. Please understand that we will assist you with the insurance filing but cannot guarantee that treatment will be covered by your insurance carrier, and ultimately you are responsible for all charges incurred.

Orthodontic benefits usually pay out over the course of treatment, not in one lump sum. Insurance companies generally pay an initial payment when the braces are placed and then monthly, quarterly, or annual installments for the remaining months of treatment. If it is estimated that you receive braces for 2 years, then you would want to make sure you keep your dental plan during those 2 years, or at least until your lifetime maximum benefit has been paid. If you drop your dental/orthodontic insurance before your benefit has finished paying, this will result in more out-of-pocket expenses for you. Furthermore, if your dental insurance changes during the course of treatment, make sure the new insurance company takes orthodontic “work-in-progress.”

It’s not common but some rare dental plans do require a waiting period before they will pay for orthodontic treatment. The plan might cover dental cleanings and general dentistry immediately, but sometimes you will have to wait before orthodontic coverage is active. Be sure to ask your dental plan if there is a waiting period for orthodontic treatment.

Some dental insurance plans include an age limit (e.g., 18, 19, or 26) for orthodontic benefits. Other plans have no age restrictions, which is helpful for older adults seeking treatment. Make sure that you verify the age limitations with your dental plan regarding orthodontics.

Since orthodontic treatment typically takes years, it is not uncommon for dental plans to change over time. Maybe your employer increased their dental plan benefits, or you even changed employers and found yourself with orthodontic benefits that you did not have when you or your child started treatment. The important question to ask your new insurance plan provider is if they cover orthodontic “work-in-progress.” If they do, then generally, your benefit is pro-rated based on the time you have remaining for treatment.

CareCredit is a healthcare credit card for out-of-pocket expenses NOT covered by medical insurance, and this includes dental. It offers special financing options that can allow you to spread the costs 24, 36, 48, or 60 months. Once you've applied and been approved, you can use it at any location that accepts CareCredit. For more information about this card, visit www.carecredit.com.