Dental insurance that covers braces for adults without a waiting period is an oxymoron—a self-contradicting group of words.
Insurance covers unforeseen future hazards, while most adults with crooked teeth see the need for orthodontia and want Invisalign treatment to begin immediately.
Therefore, issuing companies rarely issue plans with this feature combination, and if they do, restrictive covenants limit their value.
You may want to pursue other strategies to make treatment more affordable, such as payment plans that spread costs and savings programs that reduce prices.
Meanwhile, health insurance and Medicaid will sometimes cover adult orthodontia when medically necessary, even if you have a pre-existing condition!
No Waiting Period Dental Insurance
Issuing companies limit the ability to buy dental insurance covering metal braces (or Invisalign) for adults without a waiting period, making treatment more affordable. Insurers seek profits and have no reason to trade $1,000s of immediate claim payments for $100s of future premium dollars.
Insurance Alternatives
Dental insurance for adults with braces without a waiting period is not available in every state, and these plans do not help much with orthodontia costs when available.
Free braces for low-income adults are also scarce, as demand outstrips supply. Therefore, you may want to investigate alternative strategies for paying for treatment.
Payment Plans
Payment plans are a reasonable alternative to dental insurance without waiting periods. Adults wanting braces may not be able to pay the orthodontist upfront.
Payment plans for braces without insurance spread costs over time, making treatment more affordable. Plus, you do not have to fund monthly premiums for a policy with limited orthodontic benefits.
Savings Plans
Savings plans are another alternative to dental insurance without waiting periods. Adults wanting braces might save 30% by getting treatment from a local orthodontist who offers members discounts.
Find orthodontists in your area participating in one or more of five dental savings plans. Remember, these programs are not insurance; you get immediate benefits (discounted care) at a lower monthly premium.
HSA Funding
A Health Savings Account (HSA) is another reasonable alternative to dental insurance without waiting periods. Adults needing braces can pay the orthodontist with tax-favored dollars.
You can use an HSA for cosmetic dental work when medically necessary. Have your orthodontist document the malocclusion level using a commonly accepted point system and submit this evidence to the administrator before beginning treatment.
Guardian Company
The Guardian company offers the only dental insurance covering braces for adults over nineteen without waiting periods that we could find. However, these plans help few patients modestly, if at all.
Research the Guardian’s plans at their marketplace and verify two concepts.
- They offer plans in only four states: Illinois, New York, Florida, and Texas. You are out of luck if you live in one of the other forty-six.
- Buying the coverage does little to lower your costs of straightening teeth.
- You must purchase one of their medical plans to get the dental insurance, meaning most people will have to wait until January for the coverage to begin – unless you experienced a qualifying life event.
- Only their Dental Health Maintenance Organizations (DHMO) include immediate orthodontic benefits, meaning your primary care dentist must refer you to an orthodontist participating in the network.
- You must self-fund a fixed $2,800 copayment in addition to the monthly premiums for the health and dental insurance, making the potential savings challenging to calculate because you pay for many other services you might not need.
No Waiting Period Health Insurance
Health insurance will sometimes cover braces for adults with no waiting period when the orthodontic treatment is medically necessary. Since most people already have this coverage, you do not have to spend extra money on premiums to derive a significant immediate benefit.
Private Coverage
Private health insurance sometimes covers braces for adults without a waiting period because the company cannot deny claims for covered services due to a pre-existing condition. The Affordable Care Act prohibits this practice.
You might get your medical insurance to cover braces by demonstrating that the proposed orthodontia is medically necessary: a procedure that prevents, diagnoses, or treats an injury, disease, or symptoms.
Examples of medically necessary treatment might include repositioning teeth to correct one of these health problems.
- Accidental non-biting injury (broken jaw)
- Temporomandibular Joint Disorders (TMJ or TMD)
- Sleep apnea (crooked teeth restrict or block airflow)
Medicaid Coverage
Low-income adults enrolled in Medicaid may already have insurance for braces without a waiting period. However, this publically-funded program does not include orthodontic benefits for individuals over nineteen, so how can this be true?
Medicaid covers braces for adults nationwide under its health insurance umbrella. Collaborate with your orthodontist to document the medically necessary reason and submit the letter to your Managed Care Organization (MCO) for pre-approval.
Orthodontists near you who accept Medicaid are easy to find. Go to the provider directory published by the MCO or Dental Benefits Manager that manages your plan and enter your zip code. Call the office to verify participation before booking your appointment, as these lists are not always current.
