Dental Insurance Plans and Your Orthodontic Care

Dental benefits claim form with glasses and ballpoint pen

Your experience with getting braces will at some point probably involve navigating the intricacies of dental insurance plans and how they impact your orthodontic care. You may come across clauses like “contains certain exclusions, exceptions, reductions, limitations, waiting periods, and terms for keeping them in force.” Understanding the basics of dental plans, as well as the fine print, is vital to ensuring that you know exactly what you can expect.

Outside of state insurance (MediCare and Medicaid), the two most common types of dental insurance plans are Dental Maintenance Organizations (DMOs) and Preferred Provider Organizations (PPOs). It is important to note that not all orthodontists will accept dental insurance.

However, if your preferred doctor does accept insurance, and these are the two options available to you (or if you already have one), here are few things to consider.

Dental Maintenance Organization (DMO)

This is essentially the dental care version of a medical HMO. If your provider is in network, his rates are subject to a reduction based on the fee schedule of the specific insurance.

Knowing the full cost of services is important when considering whether to choose a DMO. In many instances, your quoted fee schedule will not incorporate all of the associated procedural needs or devices. This is why we recommend that you speak to your treatment coordinator to get the full picture.


  • Typically no annual deductibles and maximums
  • Most cover adult orthodontic treatments


  • Your preferred doctor might not be part of your network
  • You may have to pay in full if you go out of network

Preferred Provider Organization (PPO)

A dental PPO plan similarly offers the best rates for service  from the network of providers that it participates with. However, a PPO allows more freedom to choose your doctor, both within and outside of the network.

It’s good for those who have commitment issues. Ideally, however, switching your orthodontist should only be as a result of changing your zip code (which we discussed in this article).


  • Open access to in-network doctors
  • Freedom to choose doctors that might not be in your network
  • No referrals are needed


  • Going out of network will increase your out-of-pocket expense
  • there are usually annual and lifetime maximums

Here are some questions to ask your insurance provider:

  • Is orthodontic work covered?
  • If so, how much?
  • Is there an annual maximum? What is it?
  • What is the waiting period?
  • Are there any age limitations?

Of course, numerous variables will go into the choice. But the first step is knowing just how much orthodontic care you will need and what each provider will cover. Consider the different scenarios and weigh them against the criteria that is most important for your perfect smile and healthy bite.

The particulars, and names, of plans differ between providers. As a general rule, the smaller the network to choose from, the better the insurance.

At Orthodontic Associates, we accept all DMOs/HMOs and PPOs and continue to maximize our potential patient pool by providing excellent care using cutting-edge appliances and revolutionary services.

Contact us to set up your initial consultation and see how we can help to get you a perfect smile and healthy bite. We look forward to making you smile!



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