Understanding Your Orthodontics Plan: 9 Things You Need to Know

Posted on March 24, 2021

In Canada and the United States, over 4 million people see an orthodontist or specialist for orthodontic treatment. Orthodontia, which involves treating teeth and jaw irregularities, is not just for cosmetic purposes or having a perfect smile. 

Orthodontic treatment can actually prevent tooth decay that may lead to gum disease and eventual tooth loss. Many orthodontic issues such as crowded or crooked teeth can worsen over time and make it difficult to clean and maintain your teeth properly.

More people can access orthodontic treatment as many insurance companies have extended their dental packages to cover these services. You can too. If you or your family need these services, understanding your orthodontics plan is important, so you know what treatment will be covered.

This article will outline the things you need to look for so you can better understand your plan. You should also understand exactly what an orthodontist can do for you.

What Does an Orthodontist Do?

An orthodontist is a dentist that specializes in orthodontics. They focus on how teeth are set and aligned in your jaw. This includes how they meet and function, as well as the positioning and sizing of the lower and upper jaw. 

Their services include diagnosing and correcting misaligned bite patterns and malpositioned teeth and jaws. This may include:

  • Spaces between the teeth
  • Overcrowding of teeth
  • Overbites and underbites
  • Crossbites
  • Treatment of temporomandibular disorders (TMD) - an issue that prevents the muscles, bones, and joints of the jaw from working seamlessly together
  • Other jaw-related problems

Depending on the problem, an orthodontist will assess your need for corrective braces and devices. This will include fitting you for braces and adjusting accordingly throughout your course of treatment.

Orthodontist vs. Dentist

There are some major differences between an orthodontist and a dentist. It's important for you to know what they are so that you can access the right specialist for the services you require.

Here are a few things to note. They both work on your teeth and gums and deal with overall oral hygiene or health. They both complete four years of general dental education or dental school, after which they earn the title of 'dentist.'

However, although all orthodontists are dentists, the reverse is not true. Orthodontists study for two additional years in a specialty program and complete the orthodontics exam administered by The National Dental Examining Board of Canada.

There are certain orthodontic services that can only be provided by an orthodontist. These services are usually covered under an orthodontics insurance plan.

What Is an Orthodontics Insurance Plan?

An orthodontics insurance plan is a dental plan that specifically covers braces and other orthodontic procedures. It is usually covered under a general dental plan

A good plan will cover treatments that not only include braces but exams, imaging and retainers as well. It's important to know if there are waiting periods before you receive your plan benefits as well as the minimum deductible. 

Most plans cover up to 50% of the total cost but discount plans can help to cover additional costs. There are a few things you should look for to ensure your plan works for you.

The Key to Understanding Your Orthodontics Plan: 9 Things to Know

If you already have an insurance plan, you should check to see if it includes dental insurance. However, many plans that offer dental coverage may not include orthodontics.

1. Type of Dental Insurance Coverage

To fully understand your orthodontics insurance plan, you should first understand your insurance plan and what the dental component of it, if any, covers. There are usually three ways to get dental coverage:

Third-Party/Employer Insurance

Many employers offer dental coverage as part of their healthcare package. As an employee, you can benefit from the lower group rates offered to companies by their insurance providers. The benefit is even greater if these rates are partially subsidized by your employer.

The cost becomes incidental as it becomes a salary deduction so it stops feeling like an extra cost or burden. There is usually a specific level of coverage which, unfortunately, doesn't always cover orthodontic treatment. The ones that do, often specify that only children 18 and under are eligible.

Ask your human resource department or your plan administrator if your coverage includes orthodontic treatment.

Private Dental Insurance

If your employer's healthcare package does not cover orthodontic treatment, you have the option of purchasing your own dental insurance. It will cost more, but you can ensure you get the best coverage that suits you and your family.

Individual plans involve paying a monthly premium. You may also pay a small co-payment at each visit but the plan will cover a significant part of the treatment cost. There are many dental plan options available in Canada, so choose the one that's right for you

Discount Programs 

Plans that provide up to a 25% discount on dental care at participating dental clinics are also available. They provide a feasible alternative if you don't have insurance or want to supplement your current insurance to lessen your out-of-pocket expense.

The great thing is that you can qualify immediately and there are no restrictions if you have pre-existing conditions. You can sometimes apply these discount plans to cosmetic dental procedures. But you should find out if this includes orthodontic treatment as well. 

2. Plan Levels

Whatever plan you choose, the cost will depend on the level of the plan. The higher the level, the higher the cost but the more coverage you will enjoy. Higher-level dental plans are more likely to cover orthodontic treatments.

3. Waiting Periods

Some plans will only pay for specific procedures after a certain period of time. It's usually considered a waiting period and some plans have shorter waiting periods than others. This may include orthodontic treatment.

Find out if your plan includes a waiting period before you can access orthodontic services.

4. Amount of Coverage

According to the Canadian Association of Orthodontists, insurance usually covers up to 50% of orthodontic treatments. An orthodontic treatment plan can range, on average from $5,000 to $6,000. This will all depend on the course of treatment your orthodontist recommends.

You can pay as low as $3,000 or as much as $10,000 for treatment. After a comprehensive assessment, your orthodontist can usually give you an upfront average cost before beginning treatment. Once you know this, you can find out how much of the cost your insurance plan covers. This will give you an idea of your out-of-pocket cost. You may be able to lower this expense by getting a discount plan

5. Exceptions

There are many types of orthodontic treatments. They can include:

  • Braces 
  • Oral Surgery
  • Head Gear
  • Retainers
  • Removable Appliances

There are also different types of braces available:

  • Metal
  • Invisalign
  • Ceramic
  • Lingual

The costs of these vary. Your diagnosis will determine your treatment. You may need one or a combination of them. Your insurance may not cover it all. Ensure there are no exceptions outlined in your coverage. 

6. Your Co-Payment

Your insurance will cover a certain amount of the payment at every visit, your co-payment is what you pay. Your insurance covers the rest. For basic procedures, there is usually an 80/20 split. Major procedures are often 50/50. 

Your orthodontist would be able to advise you based on the insurance coverage you have. In addition to the coverage and co-payment, you should also find out your deductible amount or limits to your coverage.

7. The Orthodontist You Choose

Most plans have preferred providers. This is basically a network of specific orthodontists for you to choose from. You will want the best care, so choose the coverage that gives you access to the best orthodontists.

Your orthodontist would be able to advise you based on the insurance coverage you have. In addition to the coverage and co-payment, you should also find out your deductible amount or limits to your coverage.

8. Network Discounts

Once you've established that your preferred orthodontist is in your provider network, find out if there are any network benefits you can access. Insurance companies usually negotiate for discounts from the providers in their network. This may include your orthodontist as well.

9. Insurance Claims

After going through items one to eight above, filing your claim should be easy. But don't take it for granted. Ensure you follow your insurance provider's guidelines when filing your claim.

It could make a big difference in having your services paid on time, without your continued treatment being adversely affected. Always request a receipt after each visit if one is not provided. You will need to attach them to your form when submitting your claim.

Making Your Orthodontics Plan Work For You

Understanding your orthodontics plan is the key to making it work for you and your family. Having the best treatment will help to prevent issues that can eventually become painful and lead to more severe and costly complications. 

If you don't have a plan that works for you, there are many good ones available. They provide options not just for your children, but the entire family. 

We can make finding a comprehensive dental plan, that includes orthodontic treatment, less overwhelming. We compare the best plans in Canada, based on coverage, plan levels and deductibles. Get your quotes today and start your journey to an even more healthy and beautiful smile!

SOURCES:

  1.  “Dental Care Plan” Canada Health Saving Program, 25 Feb 2021, canadahealthsavingprogram.ca/benefits/dental-care-plan/.
  2. “The State of Oral Health in Canada - Dental health services in Canada” Canadian Dental Association, 25 Feb 2021, cda-adc.ca/stateoforalhealth/servicescanada.
  3. “How Much Do Braces Cost?” Village Orthodontics, 23 Oct 2019, villageortho.ca/site/blog-orthodontist/2019/10/23/how-much-do-braces-cost.
  4. “Understanding Co-payment” Canadian Dental Association, 25 Feb 2021, cda-adc.ca/en/oral_health/talk/copayment.asp.
  5. “Orthodontics at Any Age” Canadian Dental Association, 25 Feb 2021, cda-adc.ca/en/oral_health/procedures/orthodontics/.
Next Post:
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram