What You Need to Know Before You Choose a Plan
Let’s face it—insurance can be confusing. And when it comes to orthodontic insurance, things can get even trickier. At Austin Orthodontics, we want the best for our patients, and that includes helping you make smart financial decisions.
While we don’t control how insurance companies operate, we can offer some helpful insights to make sure you’re informed and prepared when selecting or switching your orthodontic coverage.
How Orthodontic Insurance Works (It’s Different!)
Unlike typical medical or dental insurance, orthodontic insurance doesn’t pay the full benefit up front. Instead, payments are made on a schedule determined by the insurance provider, and spread out over the duration of treatment. If the policy is cancelled for any reason, these payments stop also – even if the full benefit has not been reached.
For example, if your child begins a two-year treatment plan, your insurance company may pay out the benefit monthly, quarterly, or even annually—not all at once. Each policy varies, and unfortunately, we don’t have control over how often or when those payments are made.
Dual Coverage for Orthodontic Insurance
If a patient is covered under two dental insurance plans (for example, both parents have orthodontic coverage through their employers), this is called dual coverage. In these cases, the two insurance companies may coordinate benefits to determine which plan pays first and how much each will contribute toward treatment.
Here’s how it typically works:
- Primaryinsurance is often determined by the birthday rule—whichever policyholder’s birthday falls first in the calendar year (month and day, not year) is considered the primary plan.
- Secondaryinsurance may then cover a portion of what remains after the primary plan pays its share, depending on each policy’s coordination of benefits.
It’s important to understand that not all plans coordinate benefits in the same way, and some may NOT provide additional payment once the primary insurance has paid.
Before starting treatment—or if you’re adding or changing coverage—be sure to check with your HR Department, insurance broker or the insurance companies directly. They can clarify how coordination of benefits works for your specific plans and help you avoid unexpected limitations or overlaps in coverage.
What Happens If Your Insurance Changes Mid-Treatment?
Life happens—maybe you switch jobs, your plan changes, or your orthodontic coverage gets dropped. When that happens, any remaining unpaid benefit from your original policy may not be fulfilled, and the unpaid balance could:
- Become your responsibility, or
- Be transferred to a new policy if the new insurance allows for it.
This is why it’s so important to be proactive and ask the right questions when considering a new policy during treatment.
Key Questions to Ask Your Plan Administrator When Switching Orthodontic Insurance Mid-Treatment
If you find yourself needing to change insurance plans while already in treatment, be sure to ask:
1. Do any of the plans being offered cover “work in progress” treatment?
This is critical. “Work in progress” means the patient has already started treatment—whether braces were placed an hour ago or a year ago.
Some policies do not cover treatment that has already started, meaning you could pay premiums for coverage with a new policy you can’t even use.
2. How does the premium compare to the remaining balance?
Before enrolling in a new plan, evaluate whether the cost of the new premium makes financial sense in relation to what your old insurance had left to pay.
Your goal is to choose coverage that truly benefits you and your family, without surprising out-of-pocket costs.
The Bottom Line
Orthodontic insurance doesn’t work like typical coverage—and understanding how and when benefits are paid can save you a lot of stress (and money). While we can’t access or interpret every policy detail, we encourage you to reach out to your insurance provider directly with questions on your specific policy terms.
At Austin Orthodontics, we’re always here to support you throughout your smile journey. While we can’t speak on behalf of your insurance provider, we’re happy to assist by sharing the information available to us—such as treatment timelines and payment plans—so you can navigate your insurance coverage more confidently with your provider.
With a smile,
—Your Austin Orthodontics Family