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New Year, New Insurance: Common questions about orthodontic benefits explained.

With so many different insurance companies, policies to choose from, and stipulations for use of benefits, it’s no wonder insurance can get a little confusing when it comes to dental bills and coverage!

As for Orthodontic insurance, here are the most important things you need to know!

1. Who is commonly covered for orthodontic treatment?

Generally, children up to age 18 or 19 are covered for a certain amount. In some cases, depending on the plan, adults can be covered as well. Many insurance plans have age limits for orthodontic coverage, but we’re always happy to do a courtesy benefits check on your plan to see if you qualify for coverage! If you’re looking for a plan that will cover treatment, it’s important to contact your insurance company and ask what their limitations are. Ask if there is an "age limit."

2. When is open enrollment for insurance?

Orthodontic Insurance at VCO Orthodontics in Arlington, VA

Open enrollment for insurance typically falls at the end of the calendar year (November-December). However, some employers have different enrollment structures in place, so always reach out to an HR person for details. If you change your job or have a certain life event, you can select new insurance at different times throughout the year.

3. What does a “waiting period” mean?

If you’re signing up for new insurance, or simply upgrading your plan, there could be a waiting period on the new policy. A waiting period is a specific period of time that you’ll need to be enrolled on a plan first, before becoming eligible for any orthodontic coverage. Most of the time, waiting periods are 12 months. This means you need to be on your plan for 12 months before you can start getting the orthodontic $. Be sure to look out for these waiting periods when signing up for a new plan!

4. How much is usually covered by insurance for orthodontic treatment?

To put it plainly, you can expect your insurance to cover a percentage of the overall treatment cost. Very rarely (almost never) do insurance companies cover the full cost of treatment. Most insurances, where coverage is available, offer to pay a certain percentage of the overall cost UP TO a certain dollar amount, called a lifetime maximum. Once this “lifetime maximum” is used up for an individual patient, it does not renew year after year, the way your other dental benefits do (example: for dental cleanings, x-rays, fillings, etc.)

5. Do I get all my orthodontic benefits up front? Does the insurance company cut a big check for me right away?

Your insurance company determines how they will pay the orthodontic benefit over time; usually it’s paid out in monthly or quarterly installments over the duration of your treatment. Keep in mind the amount of coverage is very rarely paid up front, so if there are any changes to your policy or if it’s terminated at any time, it may affect how much is covered! Let us know right away if you switch insurance policies during orthodontic treatment so we can help you figure out what is covered.

6. Does it matter if I have Invisalign or braces for insurance coverage?

No, this does not make a difference.

7. What insurances do you accept at VCO Orthodontics in Arlington?

We accept Aetna, Carefirst, Metlife, Guardian, Blue Cross Blue Shield, Delta Dental, FEP Blue Dental, Tricare, Cigna, Principal, GEHA, and quite a few more!

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