Posted by Does dental insurance cover retainers? The shocking truth awaits you! Studies by the American Dental Association even show that, without retainers, the teeth can shift up to 1mm per month, which will potentially undo all that hard-earned straightening.
Did you know without dental insurance it can cost you a whooping $300- $5000 to get a single set of retainers? If you are aware of such a huge financial burden then we understand why you are asking this question “Does dental insurance cover retainers?”
We have just all the information you need as it concerns retainers, from types to policy benefits to factors that affect coverage, alternatives, and many more. Let’s get started.
Table of Contents
Does Dental Insurance Cover Retainers?
Yes, some dental insurance plans do cover retainers depending on the type of retainer, your specific insurance plan, policy type, and medical necessity.
Now, we will go into detail to explain these factors, and we will start by understanding how your dental insurance can be affected by the types of retainers you need.
You may love to check this out: Does Dental Insurance Cover Wisdom Teeth Removal?
How Dental Insurance Covers Retainers Based on The Type of Retainer?
The following are the two main types of retainers and how dental insurance offers cover for them:
- Orthodontic Retainers
- Preventative Retainers
1. Orthodontic Retainers:
Good news! Most dental insurance plans cover orthodontic retainers. It is part of the benefits you get for orthodontic treatments in your insurance plan. These are retainers you get to help keep your teeth in their new position and prevent shifting after having braces or other orthodontic treatments.
Here, the cost of the initial set of retainers used to keep your teeth in position and maintain teeth alignment after you’ve had braces or clear aligners is usually covered as part of your overall orthodontic treatment package.
This is so because retainers are essential for the long-term success of orthodontic treatment.
You also need to know that there are cases even under orthodontic treatments where your dental insurance plan may not cover retainers or may offer you limited coverage. Some of these cases include:
- Retainer Replacement:
It is important to note that you may have limited coverage for additional sets of retainer replacements after the first set of retainer you got needs replacement. This may be due to wear and tear, loss, or damage caused by long-term use.
Some plans may offer you coverage for a certain number of replacements per year, while others may demand co-payment from you or they may not even cover them at all.
- Age Restrictions:
As an adult, the level of coverage you get for orthodontic retainers varies depending on your plan. Some plans only cover braces or other orthodontic treatments for children including retainers but leave the adults to foot their bills for retainers.
- Cosmetic Orthodontic Exclusion:
From experience, we have found that insurance companies do not cover treatments done merely for cosmetic purposes. So, if your reason for getting your braces treatment was deemed purely cosmetic by your insurance provider, then the retainers associated with it will be completely excluded leaving you with the cost.
2. Preventive Retainers:
Unfortunately, most dental insurance plans may not offer to cover you for preventative retainers because insurance companies consider it an optional luxury for cosmetic purposes and not as a medically necessary treatment.
It is the type of retainer you get to prevent your teeth from naturally shifting as you age not because had braces or any other orthodontic treatment. However, you may be offered discounts for these retainers or you may just get limited coverage from some plans.
But Don’t lose hope totally.
Below are situations where you can actually get coverage for preventative retainers.
- If your case is that of bruxism which is also known as teeth grinding then you might get coverage for retainers because in this case, you need retainers to protect your teeth from damage making it fall under medically necessary procedures.
- You may also get a limited amount of coverage or discounts for “preventive care” or “restorative services” especially. If applicable in your insurance plan.
See this: Does Dental Insurance Cover Deep Cleaning?
Some Other Factors Affecting Dental Insurance Coverage For Retainers
Here are the factors that determine whether or not you get coverage for retainers:
- The specifics of your plan
- Insurance Plans Types
- The Percentage Coverage
- Annual Maximums and Limitations
- Deductibles
- Pre-Authorization, and
- Pre-existing Conditions
#1. The Specifics of Your Plan:
To understand the specificity of your plan, the easiest route is to your insurance provider’s website. Check sections that mention “member resources” or “plan details”
There you’ll find the details of the kind of policy your plan runs in your policy documents which is also called “Benefit booklet”. In this benefit booklet, you will get all the information you need on what your plan covers and how much it covers it, especially for retainers.
Read your booklet carefully to understand the below key terms as they largely affect the extent of the coverage you get for retainers.
#2. Insurance Plan Types:
- Individual plans offer you flexibility but might have lower coverage limits for retainers.
- Family Plans; Know that sharing your coverage with your loved ones can unlock broader benefits, which can potentially include better orthodontic and retainer coverage for your family.
- Employer-sponsored plans usually come with generous coverage, that has the potential for comprehensive orthodontic and retainer benefits included.
Note that, not every dental plan covers orthodontics. So if unfortunately, your plan is one of those that doesn’t cover orthodontic treatments then, it is not likely that your plan will cover retainers too.
#3. The Percentage Coverage:
Your plan may actually be one of those that cover orthodontics fortunately for you. But the percentage covered may vary from other covered services. Study your plans and documents to understand the details.
#4. Annual Maximums and Limitations:
There is a maximum amount your plan covers per year for certain services which includes orthodontics. You have to be sure the cost of your retainers doesn’t exceed this limit.
You might also encounter certain limitations that come with coverage for retainers that are specific to your plan. Some of them may require you to purchase from in-network providers. You have to comply.
#5. Deductibles:
There is a certain amount you have to pay before your insurance company takes over to cover the cost. For instance, if your retainers actually cost $300 and your deductible is $100, you’d pay the first $100, and then your dental insurance will cover the remaining $200, depending on your specific plan.
#6. Pre-Authorization:
Your insurance company might want to be sure that some procedures are medically necessary and retainers might be under such procedures.
When you get written proof from a dentist that qualifies the need for your retainer as medically necessary then you get a go-ahead coverage from your insurance providers.
#7. Pre-existing Conditions:
If you had pre-existing dental issues, like severe crowding or jaw misalignment before going for a retainer procedure, your eligibility for retainer coverage after braces might be higher.
Read Also: Does Dental Insurance Cover Bonding?
Proven Ways To Maximize Your Dental Insurance Coverage For Retainers
Below are some proven ways to help you maximize your dental insurance coverage for retainers:
- Communicate with your insurance provider
- Choose in-network providers for better rates
- Discuss retainer options and documentation needs with your dentist
Let’s take a closer look at each of them!
1. Communicate with your Insurance Provider:
Ensure you get clarifications concerning whatever you find unclear in your insurance plan. Do not delay contacting your insurance provider to find out more about your coverage for retainers.
Ask specific questions concerning percentage coverage, potential limitations, and out-of-pocket costs that may come with coverage for retainers as specific to your plan.
2. Choose In-network Providers for Better Rates:
By experience, we have established that going for in-network orthodontists or out-network providers is the best decision you could take. They negotiate rates with your insurance provider thereby potentially reducing the actual cost for your retainer which is not so In the case of out-of-network providers.
After all who doesn’t want to get the same service at the lowest possible cost?
3. Discuss Retainer Options and Documentation Needs with your Dentist.
Your dentist is the best guardian who will guide you into the best Strategies to take to Maximise your plan. They can see to it that your treatment requirements align with your dental insurance plan as it concerns retainers.
Where your document requires Pre-authorization, they could give you sound proof that will enable your insurance provider to certify that your need for a retainer is “medically necessary “. Hence granting you direct coverage for retainers.
You can see that cooperating with both your dentist and insurance provider will be highly financially advantageous to you in getting the best coverage for retainers.
Alternatives Options If Your Dental Insurance Plan Does Not Cover Retainers
We have established that most insurance plans cover retainers. We have also seen scenarios where your plan may not cover retainers.
Now that you’ve seen both sides of the question. The first step you should take is to acknowledge which side you are on.
If your case is one of those that your insurance plan does not offer coverage for retainers. You don’t have to worry we have put together expert strategies that will help you get those retainers regardless.
Below are alternative options you should check out:
#1. Go for Financing Plans:
Many dentists and orthodontists may offer you in-house financing plans which will help distribute the cost over some months to help you better manage the cost.
Flexible Spending accounts (FSAs) and Health Savings Accounts (HSAs) help you to pay in pre-tax dollars for health care expenses which include retainers.
#2. Compare Costs:
If you do extensive research on different retainer types (fixed, removable, clear aligners) and compare their prices with different providers you might discover budget-friendly alternatives that will best suit your needs.
Cost Factors to Keep in Mind
While you consider alternatives keep in mind that there are potential cost factors.
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Anticipate the Cost Variability due to Materials and Durability.
Different retainers have various lifespans which are dependent on the materials they are made of which also affects the price. Depending on how long you intend to use one and how much you can afford, make your decision on which to go for.
The cost for retainers ranges from $150 to $500 for fixed retainers and $200 to $1,000 for clear aligners. Do well to research different options and compare prices before you commit.
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Consider Replacement Costs:
You have to put the cost for potential replacement in place after you have determined the lifespan of your retainer. Some materials might cost you more for replacement.
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Your Location and Provider Matters:
Depending on your location and specific provider prices may vary significantly. So make sure you shop around to compare competitive rates.
Frequently Asked Questions
[sc_fs_multi_faq headline-0=”h3″ question-0=”Does my dental insurance cover retainers?” answer-0=”Of course, Yes! Some dental insurance plans offer coverage for retainers under orthodontic benefits. Review your benefits book to find out what it says concerning retainers. Also, contact your insurance provider for clarifications.” image-0=”” headline-1=”h3″ question-1=”Are there financing options available for retainers?” answer-1=”Yes, there are financing options available for retainers. Many dentists and orthodontists offer you in-house financing plans to help distribute the cost over some months to make payments easier for you.” image-1=”” headline-2=”h3″ question-2=”Where can I find more information about retainers?” answer-2=”To find more information about retainers, your dentists or orthodontists are the most recommended resources for you to consult. You can also visit reputable dental organizations and websites. They’ll offer you helpful information on retainer types and costs.” image-2=”” headline-3=”h3″ question-3=”What else can I do to keep my retainer costs down?” answer-3=”To keep your retainer cost down, go shopping and compare prices from various providers. Put less expensive retainers that can also meet your needs into consideration. Find out if your dentist offers discounts or package deals for people without insurance.” image-3=”” headline-4=”h3″ question-4=”Do I need retainers forever?” answer-4=”No, you won’t need retainers forever. Though most people wear retainers for several years to prevent their teeth from shifting, the exact duration of time you wear yours depends on your own individual case. Seek the advice of your dentist to know your own personal needs.” image-4=”” count=”5″ html=”true” css_class=””]
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Conclusion
Now that you understand dental insurance does cover retainers under specific factors based on your specific plan. It is important you carefully study your benefit booklet to understand what your plan says concerning retainers.
Make you keep an open communication with your dentist and insurance provider. This will help you make better-informed decisions as it concerns Insurance coverage for retainers.
We hope you got value!
See you some other time.