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Does dental insurance cover braces for adults?

Insurance coverage for adult braces is available but it’s not as common. Learn to find a plan for your needs.

If you are an adult and considering having your teeth straightened, adult braces can help you realign your teeth for a better smile but also help 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.

Adult braces costs

Fees for braces are dependent on a wide variety of factors. These include the type of braces used, the severity of the misalignment, and whether your bad bite is caused just by the teeth or if the jaw position is also a part of the problem. It is estimated that the average cost of braces for adults is between $3,000 and $7,000.1

Simply realigning a few of the front teeth will cost less than a case requiring overall movement of all the teeth. The severity of the problem to be corrected is the primary factor that determines cost, according to the American Association of Orthodontists.

Dental insurance policies with benefits for adult orthodontia may cover from 25 to 50%of the costs. Patients are responsible to pay the remaining charges.

Dental insurance that covers braces for adults

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.

If your policy does have coverage for adult braces, find out if there is a yearly maximum benefit or a lifetime maximum for braces. Some policies pay a percentage of the dentist’s fees while others pay a flat fee. Lifetime maximum benefit amounts for braces are the most common limitation.

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’s Managed DentalGuard DHMO plans in New York, Florida, Illinois, and Texas cover $2,800 towards braces for adults 19 and over with no waiting period.

Orthodontic schools

If you are looking for a source of cheap braces for adults, especially if you do not have insurance, look to 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 prior to graduation. If you have this option in your area, the fees can be substantially less than in a private clinic.

Payment plans

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 make the decision to go ahead with needed treatment.

Personal loans and 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. 

Dental savings plans

These are like a buyer’s club for dentistry; they are not insurance policies. You pay an annual membership fee, usually between $100 and $150. Joining the plan allows you to access dental services, including braces, from member dentists at a l discount. Make sure to read the fine print and ask specifically if you can use the plan for adult braces.

What to ask when shopping for insurance for adult braces

If your dental insurance plan does not include coverage for adult braces, you will need to find a plan to suit your needs. Here are a few questions to ask when shopping for insurance to cover your adult braces.

  • What percentage of the dentist’s fees for adult braces are covered? 
  • Is there an annual maximum limit on the benefit for braces? If so, what is the limit?
  • Is there a lifetime maximum limit on the benefit for braces? If so, what is the limit? 
  • Does the plan have a fixed copay? If so, how much is it? 
  • Does the yearly maximum benefit also include other dental services or is there a separate maximum benefit just for orthodontic treatment?
  • Do I have to wait a certain length of time before I can get my braces? If so, how long is the waiting period?
  • Are there any restrictions on the types of braces I can get? 
  • If my braces have already been started before the plan begins, will the rest of my treatment be covered?
  • Can I use any dentist or orthodontist for my braces? 
  • Is there a specific list of in-network orthodontists that I must use?
  • How large is the network of participating dentists? Are there some in my area?
  • How much are the deductibles? Are they assessed annually or only once for the entire fees for the braces?

Why do adults need braces?

Straight, healthy, white teeth can give you confidence at work, school, in social settings, and even at home. But not everyone is born with perfectly straight teeth. Sometimes, we need to take advantage of dental technology to realign our teeth, not just for beauty’s sake but also for the overall health of our teeth, mouth, and jaw.

Some adults get braces because they want to show the world a better smile in business and social situations. Others develop problems chewing or have pain in their jaw joint or temporomandibular joint (TMJ). Braces can correct these and other dental problems that develop as you age.

Why should I get braces?

Orthodontics, or braces, is the field of dentistry dedicated to correcting bad bites. A healthy bite is one where straight teeth properly mesh with the teeth in the opposite jaw. Having a proper bite makes eating, chewing, and speaking easier.

Properly aligned teeth are easier to clean. Teeth that are crowded, misaligned, protruding, spaced too far apart, or do not meet the opposite teeth correctly provide places for bacterial plaque and food particles to hide.

In addition to being difficult to keep clean, misaligned teeth can cause your teeth to wear unevenly. These problems can lead to tooth loss, headaches, difficulty sleeping, and chronic pain. Waiting too long to correct a bad bite allows these conditions to worsen and requires jaw surgery in some cases.

One in every three orthodontic patients are adults.2 Adults who get braces to correct their bad bite can not only end up with an improved smile but also avoid jaw and joint pain and the possible need for surgery later in life.

Using braces to realign your teeth into their ideal positions makes them easier to keep clean and lowers the likelihood of getting gum and bone diseases. Infections of the gums and bone that supports the teeth can lead to tooth loss. Teeth that mesh in proper alignment are easier to keep clean, are more resistant to infections, and are more likely to wear evenly, with no damage to the teeth and joints. 

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 choices for adult braces.

Tooth-colored 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

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. More expensive than traditional braces, they are harder to clean but are invisible when smiling and talking. 

Aligners

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 an out easily for eating, brushing teeth, and cleaning the trays. Aligners 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. Traditional braces give good results, even in the most difficult cases. The biggest drawback to traditional braces is 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.

How long do braces take to work?

Adult treatment typically takes longer than treatment for children and teenagers. Adult jaw bones are more mature and denser, making it harder to move the teeth and roots.

Adults may have fillings, crowns, bridges, missing teeth, and gum disease. Some medications and habits, like smoking and tooth grinding, make adult braces take longer to complete.

While a typical teenager can get reliable results wearing braces for around one to two years, adults sometimes take as much as three years for the teeth to be repositioned in an ideal bite.

Improve your smile and your oral health

While straight teeth can give you confidence and improve your smile, getting your teeth straightened can also mean better oral health. Leaving teeth crooked and misaligned may lead to multiple problems, including cavities, gum disease, difficulty eating, abnormal wear, and jaw pain. 

Braces for adults are becoming increasingly common. Whether you are 17 or 70, wearing braces to properly align your teeth is an investment not only in your dental health but also in your overall health and dental insurance can help you pay for it.

 


Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.

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. This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office.

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Sources:

1. https://www.reuters.com/article/us-money-dental-adultbraces/u-s-adults-are-not-grinning-over-the-cost-of-braces-idUSKCN0Q31TY20150729, 2015
2. https://www.aaoinfo.org/blog/am-i-too-old-for-orthodontic-treatment/, accessed June 2020

 

Individual Dental Insurance products are underwritten by The Guardian Life Insurance Company of America, New York, New York or by one of its wholly owned subsidiaries.  Products are not available in all states. Policy limitations and exclusions apply. The actual limitations and exclusions that apply to your Dental Plan are governed by the policy forms approved for use in your state. Please refer to your policy for a complete list of limitations and exclusions. In the event of a conflict between this document and the language stated in your Guardian insurance policy, the language of the policy shall control. This policy provides DENTAL insurance only. Dental provider networks vary by state, by market and by plan type. Rates are guaranteed for one year for your policy of benefits initially selected. Policies renew annually. Products Underwritten by Guardian Life Insurance Company of America: DENTAL PPO PLANS: Policy Form IP-DEN-16 ET. AL. DENTAL HMO PLANS: FLORIDA Policy Form IP-1-MDG-DHMO-FL-OFF-17 NEW YORK Policy Form IP-MDG-NY-FP-OFF-17. Products Underwritten by Managed Dental Guard, Inc. DENTAL HMO PLANS: NEW JERSEY Policy: IP-MDG-DHMO-NJ-17 TEXAS Policy: IP-1-MDG-DHMO-TX-17. Products Underwritten by First Commonwealth Inc. through its Illinois subsidiaries* DENTAL HMO PLANS: ILLINOIS. Policy: IP-FCW-DHMO-IL-17*First Commonwealth Insurance Company — (IL), First Commonwealth Limited Health Services Corporation — (IL), First Commonwealth of Illinois, Inc.

Guardian Direct plans are underwritten and issued by The Guardian Life Insurance Company of America or its subsidiaries, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. In the event of a conflict between this document and the language stated in your Guardian insurance policy, the language of the policy shall control. GUARDIAN® is a registered service mark of The Guardian Life Insurance Company of America® ©Copyright 2019 The Guardian Life Insurance Company of America.

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