In my work as an insurance broker, I spend a lot of time going over the details of “what is covered” with the dental insurance plan I and my client have chosen.  One of the most frequently asked questions I receive when speaking with people is this,

“Why are braces or Invisalign NOT covered under my dental insurance plan!?”

This is unfortunately true.  Most dental insurance plans I work with, whether purchased individually or offered as an employee benefit, cover (pay a benefit of toward the cost of) braces and Invisalign, but only for those age 19 or younger.  The insurance companies are helping to pay for children’s coverage.  But, it seems as if insurance companies are not recognizing, and offering benefits for the growing trend of adults (19+) utilizing the services of their dentists to straighten their teeth.

Why?  The answer boils down to the definition itself of “risk” for an insurance company.  If an insurance company offers coverage and charges premium to a random and diverse group of people, and roughly half of the individuals need to file a claim, everything works correctly.  There is enough money from collected premiums to pay all claims, pay administrative costs, with a small amount left over for the insurance company.

This very simple definition of a good risk applies to covering braces and Invisalign for children (-19) on dental insurance plans.  The insurance company offers this benefit to all children covered by the plan.  But, only a percentage of the children need braces or other corrective procedures performed.

Insurance companies are thus wary of offering true dental benefit coverage for adults (19+) because of adverse selection.  If a product such as this were offered, with the premium justifiably a bit higher than other comparable dental insurance plans, the only people who would choose the dental insurance with orthodontic coverage for adults would be the adults who know, or who are considering, braces, Invisalign or other orthodontic procedures.  With close to a 100% claims rate, the plan would falter financially  (more claims paid out than premiums coming in), and eventually close.

I am not sure if we will ever have a true orthodontic benfit for adults in dental insuance plans.  The few plans I have found on the internet that proclaim to offer benefits for braces and Invisalign for adults are not true indemnity dental insurance plans, but discount plans.

How can you choose braces or Invisalign as an adult, while softening the financial burden of the cost?  Here are two ideas:

1.  Does your employer offer a Flexible Spending Account (F.S.A.)?  With an F.S.A. you can set aside monies from your pay on a pre-tax basis to pay for qualified medical expenses, as outlined by the I.R.S.  Braces and other orthodontic procedures count as a qualified medical expense.  Paying for braces or Invisalign procedures through your F.S.A. would allow you to see an approximate 20-25% reduction in costs, realized through less Federal and State taxes paid. 

2.  With a Health Savings Account (H.S.A.) you might have through your health insurance plan, you can also pay for braces, Invisalign or other orthodontic procedures “pre-tax,” as they count as a “qualified medical expense.”  Again, you would see an approximate 20-25% reduction in costs, realized through less Federal and State taxes paid.

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