Paying for orthodontic care often involves more than one resource. Many families combine dental insurance, tax-advantaged accounts, and a monthly payment plan to make treatment fit their budget. Understanding how each piece works can help you plan before treatment begins.
This guide explains how orthodontic insurance benefits typically work, how HSAs and FSAs may be used, what Alabama’s public coverage programs include, and the payment options available at Backus Smiles. For a look at what affects the total fee, see our guide to the cost of braces.
How Orthodontic Insurance Benefits Usually Work
Orthodontic coverage is often separate from the rest of a dental plan’s benefits and follows its own rules. Every plan is different, so it is important to review your own policy, but a few features are common.
Coverage Is Not Always Included
Some dental plans include orthodontic benefits, and some do not. The AAO notes that many dental plans offer some orthodontic coverage for children under 18, while coverage for adults is less common.
Lifetime Maximums
Many plans set a lifetime maximum for orthodontic care. That is the most the plan will pay toward orthodontic treatment for one person, and once it is used, it generally does not reset the way an annual dental maximum does. The benefit often covers only part of the total fee.
Age Limits
Plans that include orthodontic coverage often limit it by age. As one example, an Illinois state employee dental plan applies a per-person lifetime orthodontic maximum and requires treatment to begin before age 19. Your plan’s rules may differ.
Payment Over Time
Insurance companies often pay orthodontic benefits in installments over the course of treatment rather than all at once. If coverage ends partway through treatment, remaining payments may stop.
Questions to Ask Your Insurer
- Does my plan include orthodontic benefits, and for whom?
- What is the lifetime maximum, and how much has been used?
- Is there an age limit or a waiting period?
- Are adults covered?
- How are payments made during treatment?
- Is a pre-treatment estimate required?
How Our Office Helps With Insurance
At Backus Smiles, we accept and file insurance assignment to help you make the most of your benefits. Our team works to determine benefits before your first visit when possible, and our insurance coordinator reviews your total benefits and payment schedule during your complimentary first visit, so you have that information before leaving.
Using an HSA or FSA
Health savings accounts and flexible spending arrangements let you set aside pre-tax dollars for qualified medical expenses. Many families use them for orthodontic care.
- What counts. IRS Publication 502 lists braces among dental treatments whose costs can be included as medical expenses. Teeth whitening is not included.
- How accounts connect. Expenses that qualify as medical care under the tax code are also eligible to be paid or reimbursed from an HSA or FSA, according to IRS guidance. You cannot also deduct an amount on your tax return if it was paid from one of these accounts.
- Planning ahead. FSA contributions are usually chosen during open enrollment, so knowing your expected orthodontic costs can help you decide how much to set aside. Our office can help you plan orthodontic expenses around a flexible spending plan.
Account rules vary by plan and can change, so check with your plan administrator or a tax professional about your situation.
Alabama Medicaid and ALL Kids
Alabama Medicaid
Alabama Medicaid’s dental program covers certain services for children under 21 who have full Medicaid eligibility. Orthodontic treatment is covered only when it is medically necessary. Those services must be requested through a qualified multidisciplinary clinic, such as one administered by Alabama Children’s Rehabilitation Service, and approved by Medicaid in advance.
ALL Kids
ALL Kids is Alabama’s Children’s Health Insurance Program, administered by the Alabama Department of Public Health. It provides low-cost coverage, including dental care, for eligible children under 19. According to the ALL Kids dental benefits summary, orthodontia is covered under the medical plan for certain diagnosed conditions.
In both programs, routine braces for cosmetic or mild alignment concerns are generally not covered. Children with cleft lip and palate or other craniofacial conditions may qualify, and our guide to cleft lip and palate care explains how orthodontics fits into that treatment.
Payment Options at Backus Smiles
Our office offers several ways to make treatment more manageable.
- Personalized payment plans. We arrange a payment plan designed to fit within your family’s budget, and it can be set up in our office or from home.
- Paying in full. Courtesies are offered to patients who pay their orthodontic fee in full at the beginning of treatment.
- Credit cards. We accept MasterCard and Visa.
- Insurance filing. We file insurance assignment on your behalf.
- Flexible spending plans. We can help you plan orthodontic expenses using pre-tax dollars.
Our financial and insurance information page has more detail, and our financial coordinator can answer questions about your specific situation.
Putting It All Together
A family might use insurance to cover part of the fee, pay part of the remaining balance with FSA or HSA funds, and spread the rest over a monthly payment plan. Whether you are considering braces or Invisalign in Birmingham, your consultation is a good time to map out a plan that combines the resources available to you.
Get Your Questions Answered
Our team is glad to review your benefits and walk through payment options before you make any decisions. Families looking for an orthodontist in Vestavia Hills and nearby communities can visit our Homewood-area office, and the first visit is complimentary. Call (659) 734-1740 or contact our office to schedule.