If you are an adult and considering having your teeth straightened, adult braces can help you realign your teeth for a better smile and to improve the health of your teeth, mouth, and jaw. But, without dental insurance adult braces can be expensive.
While many dental insurance plans cover orthodontia for children 19 years or younger, dental insurance that covers braces for adults is available but it’s not as common since it’s often considered cosmetic.
Dental insurance that covers braces for adults
Does dental insurance cover braces for adults? Some policies do, but finding a dental insurance plan that includes coverage for adult braces can be difficult. Some policies place an age limit on orthodontic coverage—usually around age 19—even though according to a 2017 study, one in every three orthodontic patients are adults¹.
If your dental insurance policy does have coverage for adult braces, find out if there is a yearly maximum benefit or a lifetime maximum for braces. Some policies typically pay a percentage of the dentist’s fees while others pay a flat fee. Lifetime maximum benefit amounts for braces are typically the most common limitation.
Dental insurance that covers braces for adults can help you save money on what can otherwise be a very expensive procedure. According to a 2015 article, it is estimated that the average cost of braces for adults is between $3,000 and $7,000².
If your current policy does not cover adult braces, do not despair. There are other options out there to help you pay for braces.
Individual dental insurance
If your employer-sponsored dental insurance plan does not cover braces for adults, you can enroll in an individual dental insurance plan. Many companies offer stand-alone dental policies. Just verify that the plan has coverage for braces without an age limit.
Guardian Direct® Managed DentalGuard DHMO plans in New York, Florida, Illinois, and Texas do cover braces for adults 19 and over with no waiting period, for a fixed copay of $2,800. Additional copayments may apply for pretreatment and retention. You can find these plans by exploring our Exchange website here. To enroll, please visit healthcare.gov and enroll in a medical plan to get a dental plan.
Guardian Direct Achiever dental insurance plan also covers orthodontia up to 50% after a 12-month waiting period with a lifetime maximum for orthodontia of $1000, though only for members under age 19.
If you are looking for a source of affordable braces for adults, especially if you do not have insurance, look at your local dental school. Many states have dental schools that are open to the public. Those that offer training for orthodontists have certain requirements for students to complete under the supervision of faculty dentists before graduation. If you have this option in your area, the fees can be less than in a private clinic.
Because orthodontic treatment is normally a two to three-year commitment, most orthodontist offices offer payment plans. This may be anywhere from in-house financing to credit card plans designed especially for dentistry. Spreading the fees out over a few years with a low-interest financing plan might help you decide to go ahead with needed treatment.
Personal loans, credit cards
Although these options can be more costly, they can supply a way to pay for adult braces. Most dentists accept credit cards for payment. If you have a good relationship with your local bank, a short-term loan from that institution might be the answer to your financing needs.
Flexible Spending Accounts
If you have a health plan through your employer, you can typically use a Flexible Spending Account (FSA) to pay for some out-of-pocket costs of braces your dental insurance doesn’t cover. You typically can also use an FSA to pay insurance copayments and deductibles for other medical, dental, and orthodontic procedures.
Dental savings or discounts plans
Technically, dental savings plans are not insurance policies. In dental discount plans, a company selling the plan contracts with a network of dentists who agree to discount their dental fees³. Joining the plan allows you to access dental services, including braces, from member dentists at a discount. Make sure to read the fine print and ask specifically if you can use the plan for adult braces.
Is there dental insurance for braces with no waiting period?
Nearly all dental insurance that covers braces involves a waiting period. This means that even if you’ve found a great plan that covers braces to enroll in, you’ll likely have to wait at least 12 months before you can receive orthodontic benefits. Waiting periods typically depend on the state you live in the dental insurance policy you have, among other factors. So, if you’ve been thinking of getting braces either for yourself or for your children, get dental insurance that covers braces as soon as possible so you can save on the cost of orthodontic treatment a year or more from now.
However, even if your dental insurance that covers braces has a waiting period for orthodontic treatment, you still may be able to enjoy certain dental benefits from when coverage begins. All Guardian Direct dental plans have no waiting periods whatsoever for preventative treatment, such as oral exams, cleanings, and X-rays. Plus, these procedures can be covered from 50%-100%, depending on the plan*. This can help you take great care of your teeth in the year leading up to getting braces.
Changing dental insurance during braces
Orthodontic treatment is typically a gradual process. It can take as long as 1-3 years for braces to reposition the teeth in an ideal bite, and in the meantime, it involves regular checkups and adjustments. Switching dental insurance policies while having braces can be tricky, but it is possible.
If you receive dental insurance from your employer and that employer changes insurance while you are receiving orthodontic treatment, your new insurance company typically picks up the payments where the other company has left off, taking into account how many months the previous company has paid and how many months of treatment are left.
If you have individual dental insurance, waiting periods and other restrictions may apply when switching carriers. Plus, your deductible, maximums, and premiums all reset when you change insurance carriers. If you can help it, changing dental insurance during braces probably isn’t the best idea.
Supplemental dental insurance for braces
Because dental insurance isn’t required by law, dental plans are technically supplemental in nature. But just because they aren’t required doesn’t mean they can’t have a serious positive impact. Purchasing supplemental dental insurance to help pay for braces and to complement your major medical plan can benefit your personal health as well as your finances. Just make sure you’re well aware of the premium costs, maximum coverage amounts, and waiting periods.
Note that if you already have a dental insurance plan but it doesn’t cover braces, it may be more cost-effective to switch to a different plan altogether than to buy an additional plan to help pay for braces.
Types of braces
Wearing braces does not always involve a mouth full of metal or wearing headgear. Adults who decide to have their teeth straightened must still go to work, make presentations and speeches, work closely with others, and keep up a professional appearance. Dental technology has advanced and now provides several common choices for adult braces.
Sometimes called invisible braces, these are made from clear or tooth-colored ceramic and are less noticeable than metal ones. They work in the same way as traditional metal but are more expensive. Ceramic braces sometimes pick up stains from tea, grape juice, and other foods and beverages. The greatest advantage of ceramic braces is that they are virtually invisible.
Lingual braces are the same as traditional metal braces except they are placed on the tongue/palate side of the teeth instead of the front. Lingual braces also use metal brackets and wires that require frequent adjustments by the dentist. Typically, more expensive than traditional braces, they are harder to clean but are invisible when smiling and talking.
Using a series of removable, plastic trays that are changed every two to three weeks, aligners, such as Invisalign®, have become a popular method of straightening teeth for adults. There are no brackets or wires that attach to the teeth. Trays that cause the teeth to move come in and out easily for eating, brushing teeth, and cleaning the trays. Aligners typically take longer than other types of braces to move the teeth and cannot be used for serious jaw and teeth misalignments.
Traditional metal braces
Metal wires connected to the teeth by metal brackets are a time-honored method of moving the teeth into alignment. This is the least expensive and most reliable way to straighten teeth. The biggest drawback to traditional braces is typically their appearance and the use of wires that can occasionally come loose and injure cheeks and lips.
Regardless of the type of braces you and your dentist decide is best for you, each method requires time and patience. To move your teeth to their ideal position, the braces or aligners must gently apply force to the teeth over an extended period of time. Trying to move teeth and roots through the bone and turn ones that are tilted takes time. Attempting to move the teeth too fast can cause damage to the roots.
Do I need dental insurance to get braces?
It’s possible to get braces without dental insurance, but it will cost more. Guardian Direct Achiever plan may cover braces up to 50% with a maximum benefit amount—without dental insurance, you’ll be responsible to pay the full balance yourself.
You can try visiting an orthodontic school to help drive the cost down or see whether your orthodontist offers payment plans to make the costs more manageable without dental insurance. But you don’t have dental insurance that covers braces yet and you’re planning on getting orthodontic treatment in the future, purchasing dental insurance may be the best way to help you save money.
How to find the best dental insurance that covers braces for yourself
Dental insurance plans vary greatly from one to the next. It isn’t enough just to find a dental insurance plan that covers braces for adults—you’ll also want to look into the insurance provider’s dental network, the type of plans they offer, whether or not your current dentist or orthodontist will accept your insurance, how much your monthly premiums cost, out-of-pocket costs such as deductibles and co-pays, and more.
We’ve compiled a bank of resources to help you find dental insurance that covers braces and helps you save money on taking care of your oral health.
What does dental insurance cover? Learn if and how dental insurance covers cleanings, fillings, surgery, braces, and more.
Looking for the best individual dental insurance? Learn what you should be looking for.
Dental insurance can help you save money in the long run, but how much does it cost? Learn how much you should expect to pay in premiums and out-of-pocket costs.
Does dental insurance really pay off in the end? Find out whether dental insurance is worth it for you.
Freelancers and self-employed individuals need great dental care, too! Check out the self-employed guide to dental and vision insurance.
Employers aren’t the only ones who can provide you with dental insurance. Learn how to purchase individual dental insurance directly from an insurance provider at a low price.
*Starter plans not available in all states, Costs vary by state and available plan type selected.
Insights for the people.
Join our new digital insurance community that includes tips, resources and useful information from Guardian Direct.
https://www.aaoinfo.org/blog/am-i-too-old-for-orthodontic-treatment/, accessed June 2020
Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.(exp.09/22)