Is supplemental orthodontic insurance a good way to pay for braces for children and/or adults?

The issuing companies design plans that take in more premiums than they pay in claims. This is their purpose for being in the business.

Most people know years in advance of their need for expensive orthodontia. Insurance offers financial protection for unforeseen future events.

Therefore, most people will need to choose from several alternative approaches to make straightening crooked teeth more affordable.

  • Why large families have the most to gain from a policy
  • How tax deductions make quote numbers work

Supplemental Orthodontic Insurance Plans

Supplemental orthodontic insurance can make treatment more affordable for some families needing adult and adolescent braces. The extra plans work best for groups meeting these conditions.

  1. Multiple people (adults and children) with crooked teeth
  2. Treatment begins within a short time window for all
  3. People with medically necessary treatments
  4. Families with other oral care needs

Financing programs are the primary alternative for individuals that do not meet these criteria.

Adults

Supplemental orthodontic insurance for adults can help those who delayed treatment. However, do not expect an economic miracle. Dental braces for adults are far more expensive. Meanwhile, the policy benefits are flat. This leads to higher out-of-pocket expenses.

  • Toot realignment costs more for adults. Mature jawbones are much harder and no longer grow. Grownups tend to have more complicating factors such as cavities, missing teeth, TMJ, and perio-restorative issues caused by an over-bite. In addition, many adults seek less visible appliances such as Invisalign for aesthetic reasons.
  • The insurance claim payments do not adjust for these higher expenses. The plans pay a fixed amount per covered person yearly and for a lifetime. In addition, the policy can cover only two adults (husband/wife, family options).

Health insurance covers braces for adults when medically necessary – not aesthetics. Examples of covered conditions include some of these maladies affecting older people.

  • Sleep apnea
  • Non-biting accidents
  • Temporomandibular Joint Disorders (TMJ)

Children

Supplemental orthodontic insurance for children works best for parents with lots of kids in a tight age range. Most policies have a fixed monthly premium for the two-level choices with dependent coverage.

  • Parent/child covers one adult and all children
  • Family covers two adults and all children

In other words, a household with one child requiring braces pays the same monthly premium as another with five kids. The larger household could extract five times the benefits. However, they may also pay premiums much longer unless they have quintuplets reaching their adolescent years all at once.

Check the age limit on your policy. Some plans stop coverage for children at the age of 18. Others include dependents over 18 while attending college and some extend the limit to age 26. These details matter.

Families

Supplemental dental insurance covering braces works best for families with other oral care needs. You cannot purchase a stand-alone policy covering just orthodontia. However, you can attach a rider to a base plan that pays for a broad spectrum of dental care.

  • Oral surgery
    • Extractions
    • Jaw surgery
  • Prosthodontics
  • Endodontics
  • Basic care
    • Periodontics
    • Cavities & fillings

The families needing extensive dental work find the combination of a base plan with orthodontia rider most affordable. Coverage for these other services has shorter waiting periods. The math behind the premium quote works more in your favor when the policy pays for other interim work.

Understanding Orthodontic Insurance Quotes

A proper understanding of orthodontic insurance quotes means parents should consider more than the monthly premium costs. The issuing companies design plans that take in more premiums than they pay out in claims for dental braces.

Therefore, the average family needs an edge to make the quote numbers work in their favor.

  • Pretax payroll deductions lower the net premium cost
    • FICA tax savings of 7.65%
    • Income tax savings of 10% and higher
  • Only employers can offer pretax payroll deductions
  • Flexible spending accounts enable low monthly payments
  • Premiums for individual plans are tax deductible
    • Amounts above 10% of Adjusted Gross Income yield savings
    • Left-over dental expenses qualify towards the threshold

Keep this one truth in mind when comparing quotes: The companies limit claims with waiting periods and benefit maximums. Supplemental and secondary plans have similar constraints.

Waiting Periods

Dental insurance with no waiting periods for orthodontia is extremely rare. The issuing companies have no interest in paying large certain immediate claims in exchange for small uncertain premiums spread over time. However, every rule has an exception.

  • Medical insurance covers medically necessary braces immediately
    • Reposition teeth after a non-biting accident or injury
    • Treat malocclusion caused by a cleft palate
  • Families with prior creditable coverage enjoy benefits with no waiting
    • No gaps in coverage greater than 63 days
    • Bypass pre-existing condition clauses

The need to straighten crooked teeth should not surprise most people. Get your quote early in the game. Do not expect to buy a new policy covering dental braces without a waiting period. You will not find one. If you do, expect graduated benefits with low yearly and lifetime maximums.

Free programs can help a handful of lucky families bypass the waiting period hurdle. However, the options for finding outside monetary help are very thin. There is no silver bullet.

Maximum Benefits

Dental insurance maximum benefits are an additional set of important definitions for parents to learn before getting a quote and purchasing a policy. Many contain two types of limits that affect how much the policy pays to straighten teeth.

  1. Lifetime orthodontia maximum is a separate limit for braces that caps claims payments for each covered person
    1. A $ 1,500-lifetime maximum benefit means that the patient is responsible for 100% of the costs above this amount
    2. Parents must fund the remaining $3,500 out-of-pocket for the average total cost of $5,000 per person
  2. The annual maximum benefit defines the amount the plan pays each year for each covered person
    1. One yearly limit for all oral care
    2. Some have separate yearly limits for braces

Secondary Plans

Secondary and supplemental orthodontic insurance plans are very different from each other. The two terms sound like synonyms, but in reality, the two designs have important distinctions. Parents needing to fund braces for multiple family members should become familiar with the nuances before getting a quote.

  • Secondary plans coordinate benefits with the primary policy
    • Coordinating benefits means that the secondary policy pays after the first
      • The second cover unreimbursed amounts
      • Both must cover braces (very rare)
    • Having dual policies can expand the lifetime maximum benefit
  • Supplemental policies do not coordinate benefits with the primary
    • Make clam payments based on a fixed schedule for each procedure
    • Choose any provider regardless of network
    • Can extend lifetime maximum when combined with other coverage