What Orthodontic Treatment Does Dental Insurance Cover?

If you or your child are considering orthodontic treatment, understanding what your dental insurance covers is crucial. At Orthodontics of Santa Barbara, we frequently encounter patients who are unsure about their benefits, especially when it comes to orthodontic care. The good news is that many dental insurance plans do offer coverage for treatments like braces and clear aligners. However, there’s a catch—many insurance plans operate on a “use it or lose it” basis, meaning you need to maximize your benefits before the year’s end, or you risk losing them altogether.

Orthodontic treatments can be a significant investment, but insurance can help make it more affordable. Knowing how to navigate your insurance plan and understanding what treatments are covered will help you get the most out of your benefits and avoid leaving money on the table.

What Types of Orthodontic Treatments Are Covered?

Dental insurance can significantly reduce the cost of orthodontic treatments, but the extent of coverage often varies depending on your specific plan. In most cases, dental insurance covers treatments that are considered medically necessary rather than cosmetic. Let’s explore the common orthodontic treatments that may be partially covered by insurance:

Braces

Traditional metal braces remain one of the most commonly covered orthodontic treatments. These braces use metal brackets and wires to correct misaligned teeth and bite issues, such as overbites, underbites, and crowding. Since braces are often deemed medically necessary for improving oral health and preventing long-term dental problems, many insurance plans cover a percentage of the total cost. Some plans may even cover clear or ceramic braces, which are less noticeable than traditional metal ones.

Coverage Tip: Insurance typically covers only part of the cost, with the patient responsible for copays or deductibles. It’s essential to check if your insurance plan has a lifetime maximum for orthodontic care, which limits the total amount the plan will pay.

Clear Aligners (Invisalign®)

Clear aligners, such as Invisalign®, have grown in popularity as a discreet alternative to traditional braces. These aligners are custom-made, removable trays that gradually shift teeth into alignment. While not all insurance plans provide the same level of coverage for clear aligners as they do for metal braces, more and more policies are recognizing them as an effective orthodontic treatment for misalignment and bite correction.

Coverage Tip: Some insurance plans may only cover a portion of the cost for clear aligners, or they may limit coverage based on age, typically focusing on minors. Always confirm whether your plan includes aligners as an eligible treatment.

Retainers

Once orthodontic treatment is complete, retainers are crucial for maintaining the results. Whether you're using fixed or removable retainers, their purpose is to keep your teeth in their new positions. Dental insurance often covers the cost of retainers, particularly when they are part of a comprehensive treatment plan that includes braces or clear aligners. In some cases, the cost of replacement retainers may also be partially covered if they are lost or damaged.

Coverage Tip: It's a good idea to verify whether your insurance plan covers only the initial retainer or if replacement retainers are included in the policy.

Palatal Expanders

Palatal expanders are devices used to widen the upper jaw in children, particularly when a narrow jaw causes crowding or bite issues. This treatment is especially common in younger patients, as their jaws are still developing and are more adaptable to changes. Since this treatment often addresses significant orthodontic issues, it is typically considered medically necessary and is often covered by insurance.

Coverage Tip: Because palatal expanders are generally part of a long-term treatment plan, they may be bundled with other services like braces, making it essential to understand the full scope of your coverage.

Surgical Orthodontics

In more complex cases, jaw misalignment may require surgical intervention, such as orthognathic surgery. This type of surgery is used to correct skeletal issues that braces or aligners alone cannot fix. Surgical orthodontics may be necessary for patients who have severe bite problems, facial asymmetry, or issues with jaw function. Many insurance plans cover a portion of surgical orthodontic treatments, as they are typically considered medically necessary to improve oral health and functionality.

Coverage Tip: Surgical orthodontic procedures may require pre-authorization from your insurance provider, so be sure to consult with both your orthodontist and insurance company to confirm coverage before proceeding.

Why You Should Act Now

If your insurance operates on a calendar-year basis, it’s important to remember that your benefits likely reset at the end of the year. This means that any unused benefits won’t roll over into the next year. Whether you’ve already started orthodontic treatment or are just beginning to explore your options, now is the time to act. By scheduling consultations and beginning treatment before the end of the year, you can maximize your coverage and avoid wasting your benefits.

Insurance Benefits Reset Annually

Most dental insurance plans come with an annual maximum—the total amount the insurance company will pay for your dental care within a year. Once this maximum is reached, any additional costs will be out of pocket. If you’ve met your deductible but haven’t yet reached your maximum, this is the perfect opportunity to take advantage of your remaining benefits.

Starting treatment now can help you split the cost of orthodontic care between two years. For example, you can begin treatment in December and continue into January, effectively utilizing two years’ worth of benefits.

The Cost of Waiting

Delaying orthodontic treatment doesn’t just mean missing out on insurance benefits—it can also lead to more complex (and costly) dental issues down the road. Misaligned teeth can cause problems such as gum disease, tooth decay, and jaw pain if left untreated. By taking action now, you’ll not only save money by using your benefits, but you’ll also prevent potential oral health problems in the future.

How to Maximize Your Benefits

To ensure you’re making the most of your dental insurance, follow these steps:

Review Your Plan : Take the time to read through your insurance policy to understand what’s covered, any exclusions, and the details of your annual maximum. This will give you a clear idea of what treatments to prioritize before the year ends.
Schedule a Consultation : Contact us to schedule an orthodontic consultation and discuss treatment options. We can help you determine what’s covered by your insurance and create a treatment plan that fits within your remaining benefits for the year.
Use Flexible Spending Accounts (FSA) or Health Savings Accounts (HSA) : If you have an FSA or HSA through your employer, you can use these tax-free funds to pay for any out-of-pocket costs for orthodontic treatment.
Get Pre-Approval : Some insurance plans require pre-approval for orthodontic treatments. This process confirms what will be covered and can help avoid unexpected expenses.

Make the Most of Your Insurance Before It’s Too Late

At Orthodontics of Santa Barbara, we’re dedicated to helping you achieve a healthy, beautiful smile in the most cost-effective way possible. If you’ve been considering orthodontic treatment, now is the time to act before your insurance benefits expire at the end of the year.

Our team is here to guide you through the process, helping you maximize your insurance coverage and choose the best treatment plan for your needs. Don’t let your benefits go to waste. Contact Orthodontics of Santa Barbara today to schedule your consultation and get started on the path to a confident, healthy smile!