Dental Plans for Orthodontia Coverage

If you are in a sudden rush to get a dental insurance plan to cover orthodontic treatment immediately, you may find the insurance options available to be rather limited. Some dental plans do not cover orthodontia whatsoever while other dental plans have 6-12 month waiting periods before your orthodontic benefit is available.

The only dental plans for individuals and families (group plans may be different) that cover orthodontia immediately are Delta Dental’s DeltaCare USA HMO, Anthem’s Dental Net 3000D HMO & Incentive PPOs (child-only ortho), & Ameritas’ PrimeStar Access PPO.

Blue Shield plans that cover orthodontia

Dental HMO & Standard Dental HMO – $2,650 copay for adult ortho, $2,350 copay for child ortho (12-month waiting period)

Dental PPO – $2,650 copay for adult ortho, $2,350 copay for child ortho (12-month waiting period)

Enhanced Dental PPO 50/$2000 Lifetime Ortho 1500 – $ 1,500-lifetime maximum benefit (12-month waiting period)

Delta Dental plans that cover orthodontia

DeltaCare USA HMO – $2,600-$2,800 member copay (no waiting period)
Premium PPO – 50% coinsurance (6-month waiting period)

Ameritas plans that cover orthodontia

PrimeStar Access – 15% coinsurance year 1, 50% coinsurance year with a $1,000 lifetime maximum benefit

Anthem Blue Cross plans that cover orthodontia

Dental Net 3000D HMO – $1,895 copay for adult ortho, $1,695 copay for child ortho

Essential Choice PPO Incentive – 50% coinsurance with a $1,000-lifetime maximum benefit for child-only $1,000-lifetime maximum benefit (no waiting period but is a child-only benefit)

Essential Choice Platinum PPO – 50% coinsurance with a $1,000-lifetime maximum benefit (no waiting period but is a child-only benefit)

Cigna plans that cover orthodontia

Cigna Dental PPO 1500 – 50% coinsurance after a 12-month waiting period ($1,000-lifetime maximum ortho benefit)

Not only is it important to choose the right dental plan with the right level of coverage, you must also see if your orthodontist is in-network with your dental plan. Dental HMO plans will only cover in-network dentists and you must be referred to any dental specialist by your assigned primary dentist. Dental PPO plans will cover out-of-network dentists but at a reduced payout (please review your plan benefits for the reimbursement rate out-of-network, it is generally much lower than for in-network providers). If your dentist is not in-network, you should consider enrolling in a dental PPO with a high out-of-network reimbursement at a high usual and customary rate. Plans with a maximum allowable charge or MAC have very low out-of-network reimbursement