Starting orthodontic treatment is a significant investment—both in time and money. You have likely done the research, chosen an orthodontist, signed a contract, and begun the journey toward a straighter smile. But what happens when life throws a curveball? Perhaps you are starting a new job, your employer is switching providers, or you are shopping for a better rate on the health insurance marketplace.
The question suddenly becomes urgent: What happens to my braces if I change my dental insurance?
This is one of the most common yet misunderstood situations in dental healthcare. Orthodontic treatment is unique because it is not a one-time procedure like a filling or a crown; it is a long-term process that spans months or even years. Switching insurance mid-treatment can be tricky, but it is certainly manageable if you know the rules of the game.
In this comprehensive guide, we will break down everything you need to know about changing dental insurance while wearing braces. We will cover how orthodontic benefits work, what happens to your current contract, how to vet a new plan, and the steps you need to take to ensure your smile—and your wallet—stay healthy.
Changing Dental Insurance During Braces
Understanding the Unique Nature of Orthodontic Benefits
Before diving into the “how” of switching, it is crucial to understand the “why” behind the complexity. Dental insurance generally treats orthodontics very differently than it treats basic restorative care.
Most standard dental insurance plans operate on a calendar-year cycle with annual maximums (usually between $1,000 and $2,000). You meet your deductible, get your cleanings, and the insurance pays a percentage of any fillings or crowns up to that maximum. It resets every year.
Orthodontic benefits, however, are almost always a lifetime maximum benefit.
The Lifetime Maximum Explained
Instead of an annual cap, orthodontic benefits have a flat dollar amount allocated for the entire time you are covered by that specific policy. This amount typically ranges from $1,000 to $3,000, depending on your plan.
Here is the critical part: Once your orthodontist files a claim and the insurance company pays out that lifetime maximum, that specific policy’s obligation for your orthodontic treatment is finished. Forever. If you change jobs or insurance carriers, that money does not follow you. You start over with a new lifetime maximum under the new policy.
Important Note: This is different from your regular dental cleaning coverage. While your regular check-ups reset every January 1st, your braces benefit is a “use it or lose it” pool of money specific to that insurance contract.
Percentage vs. Fee Schedule
Some plans pay orthodontic benefits based on a percentage of the total treatment cost (often 50%), while others use a fixed fee schedule (e.g., the plan pays a flat $1,500 toward braces, regardless of the total bill). Understanding which type you have is essential because it dictates how much of your total bill is covered.
The Big Question: What Happens to My Current Contract?
When you started your braces, you likely signed a contract with your orthodontist. This is usually a treatment agreement, not an insurance agreement. It states that you are responsible for the total fee of the orthodontic work.
Most orthodontists do not expect you to pay the entire $5,000 to $8,000 upfront. Instead, they structure payments in one of two ways:
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Paid in Full Upfront: You pay the discounted total cost on day one.
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Monthly Payments: You pay a down payment, followed by monthly installments over the 18-24 months of treatment.
When you change insurance, you are not changing your contract with the orthodontist. You are merely changing who is helping you pay for it.
Scenario A: You Have Already Received the Insurance Payout
If your current insurance has already paid their portion (the lifetime maximum) to your orthodontist, and you switch to a new insurance company, the new insurance company will generally not pay anything further.
Why? Because they will view the treatment as having already started. Most new insurance policies will not cover a procedure that began before your effective start date with them. They consider it a “pre-existing condition” in the world of dental benefits.
Scenario B: You Are Still Within the Payout Period
Sometimes, insurance companies pay for orthodontics in installments over the first 12 months of treatment rather than a lump sum. If you switch carriers in the middle of this payout schedule, the remaining installments from the old insurance will stop. You will then need to see if your new insurance will pick up where the old one left off—which, as we will discuss, is rare but possible.
Can You Switch Insurance Mid-Treatment? (The Realistic Answer)
Let’s be direct: Yes, you can physically change your dental insurance while you have braces. However, getting the new insurance to pay for the remaining treatment is difficult, but not impossible.
The outcome depends almost entirely on the specifics of your new plan. Here is a realistic breakdown of the three most likely scenarios:
1. The New Plan Excludes Ongoing Orthodontia (Most Common)
This is the reality check. Many dental insurance plans have clauses stating they will only cover orthodontic treatment if it begins while you are actively enrolled in their plan. Since your treatment began under a different carrier, they classify it as an active, ongoing course of care and will deny the claim.
2. The New Plan Offers “Takeover” Benefits (Less Common)
Some employer-based plans or higher-tier PPO plans offer a “takeover benefit.” This means if you can prove you were covered by previous insurance and have paid for treatment, the new plan might offer a reduced benefit to help cover the remaining balance. This is often a flat fee, such as $500, rather than a full lifetime maximum.
3. The New Plan Has a Fresh Lifetime Maximum (Rarest)
In very specific circumstances, usually when switching between different types of plans or if the new plan does not ask for proof of prior treatment start date, you might be able to claim a brand new lifetime maximum. However, this is ethically and contractually gray. Insurance companies will audit this, and if they find out the treatment started before your coverage began, they can demand their money back, leaving you with the bill.
A Step-by-Step Guide to Switching Plans
If you know you have to switch plans (due to a job change or cost savings), do not panic. Follow this systematic approach to protect your finances and your treatment.
Step 1: Review Your Current Insurance Status
Before you cancel your old policy, call the customer service number on the back of your card. Ask these specific questions:
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Has the lifetime orthodontic maximum for my policy been paid out in full?
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Was it paid as a lump sum or in installments?
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What is the exact date my coverage ends?
Step 2: Talk to Your Orthodontist’s Financial Coordinator
Your orthodontist’s office deals with insurance changes every single day. They are your best resource. Ask them:
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“If I switch to [New Insurance Company] on [Date], what is the likelihood they will cover the rest of my treatment?”
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“Do you have experience billing this new insurance company for active orthodontic cases?”
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“If the new insurance denies coverage, what will my new monthly payment be?”
They can often run a “benefits verification” on the new plan to give you a preliminary answer before you even switch.
Step 3: Vet the New Insurance Plan Before Enrolling
Do not just look at the monthly premium. Look at the fine print of the Summary of Benefits and Coverage (SBC) . Look for specific language regarding:
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Orthodontic Benefits: Is there a waiting period? (e.g., “Coverage for orthodontics begins 12 months after the effective date.”)
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Active Treatment Clauses: Look for wording like “Treatment must commence while covered under this plan.”
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Lifetime Maximum: What is the dollar amount offered?
Step 4: Time the Switch Strategically
If possible, align the switch with your payment schedule. For example, if you pay your orthodontist monthly, try to ensure your old insurance covers as much of the treatment time as possible before the new policy kicks in. Avoid a gap in coverage where you have no insurance and no payments are being made toward the claim.
Step 5: Gather Your Paperwork
If you believe your new plan might offer a takeover benefit, gather the following documents immediately:
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An itemized receipt or ledger from your orthodontist showing payments made to date.
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An Explanation of Benefits (EOB) from your old insurance showing what they paid.
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A letter from your old insurance confirming your coverage dates.
How Orthodontists Handle Insurance Changes
It helps to understand the situation from the orthodontist’s perspective. They have already started a service for you. They have a contract with you, not your insurance company. Whether the insurance pays or not, the orthodontist expects to be paid for their work.
The Patient Responsibility Shift
When you sign up for braces, the insurance money is essentially a gift card toward your bill. If you switch insurance and the new company denies the claim, that “gift card” money vanishes. The remaining balance of your treatment simply reverts to being your responsibility.
Most orthodontists are very understanding. They know life happens. If your new insurance denies coverage, they will usually work with you to set up a new, adjusted monthly payment plan to cover the remaining months of treatment.
Friendly Reminder: Do not avoid telling your orthodontist that you switched insurance. They will eventually find out when they submit a claim and it gets denied. Being proactive shows respect for their business and allows you to negotiate new payment terms before you fall behind.
Comparing Plan Types: PPO vs. Indemnity vs. HMO
When selecting a new plan while undergoing orthodontic treatment, the type of plan matters significantly.
| Feature | PPO (Preferred Provider Organization) | Indemnity (Fee-for-Service) | DHMO (Dental HMO) |
|---|---|---|---|
| Provider Choice | You can see any dentist, but pay less in-network. | You can see any dentist. | You must choose from a specific network list. |
| Orthodontic Coverage | Common. Usually covers 50% up to a lifetime max. | Varies. Often has high lifetime maximums but higher premiums. | Rare. Often has no ortho coverage for adults. |
| Mid-Treatment Switch | Risky. New PPO may deny active treatment. | Best chance. Indemnity plans often have more flexible coverage rules. | Difficult. If your orthodontist isn’t in the HMO network, you pay 100%. |
| Claim Process | Insurance company negotiates rates with the dentist. | You pay the dentist, insurance reimburses you. | The dentist accepts a fixed low rate; no claims filed. |
Key Takeaway: If you are mid-treatment, switching to a strict DHMO (HMO) plan is usually the worst option, as most orthodontists do not participate in these low-reimbursement networks. An Indemnity plan offers the most flexibility but often costs more in monthly premiums.
What If the New Insurance Denies the Claim?
Denials are common when changing insurance during active treatment. If you receive a denial letter, do not just accept it and pay the bill immediately. You have options.
Filing an Appeal
You have the right to appeal the insurance company’s decision. While it is an uphill battle, it is worth trying. In your appeal letter, you should include:
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A letter from your orthodontist explaining the medical necessity of completing the treatment.
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Proof of continuous coverage (showing you didn’t just get insurance to cover braces and then cancel).
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The previous insurance’s EOB showing the start date of treatment.
The “Coordination of Benefits” (COB) Loophole
If you have dual coverage (e.g., you are on your employer’s plan and your spouse’s plan), there are rules about who pays first. Usually, your own plan pays first (primary), and the spouse’s plan pays second (secondary).
If you switch to a new primary plan, but your old coverage hasn’t quite ended yet (overlap at the end of a month), the two insurance companies will talk to each other. The secondary might pick up some costs the primary didn’t, but this is complicated and usually temporary.
Financial Planning: What to Do If You Lose Coverage
Losing your job—and your dental insurance—can be stressful. If you find yourself without insurance mid-treatment, here is how to handle the financial aspect.
1. Ask About an In-House Discount
Some orthodontists offer a discount for patients who lose their insurance coverage through no fault of their own. If you were receiving an “insurance discount” (a negotiated rate because the dentist is in-network), the doctor might extend that same discounted fee to you even if you pay cash now.
2. COBRA Coverage
Under COBRA (Consolidated Omnibus Budget Reconciliation Act), you can usually stay on your employer’s dental plan for a period of time after leaving your job. However, you will have to pay the full premium (your share + the employer’s share + a fee). This is expensive, but if you are deep into a costly orthodontic treatment, it might be worth it for a few months until you secure new coverage.
3. Negotiate a New Payment Plan
Be honest. Tell the financial coordinator, “I have lost my insurance. I still want to finish my treatment, but I need to adjust my budget.” They would much rather work out a sustainable payment plan with you than have you default on your account.
Checklist: Dos and Don’ts for a Smooth Transition
To make this process as painless as possible, keep this checklist handy.
DO:
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DO notify your orthodontist’s office immediately when you know your insurance is changing.
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DO request a “predetermination of benefits” from the new insurance company before you cancel the old one. This tells you in writing what they will pay.
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DO keep a folder with all your orthodontic receipts and old EOBs.
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DO read the new policy’s certificate of coverage, not just the marketing brochure.
DON’T:
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DON’T cancel your old insurance before your new one is 100% active.
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DON’T assume your new insurance will “just pick up where the old one left off.”
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DON’T ignore bills from your orthodontist while waiting for the insurance to sort itself out. Late fees may apply.
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DON’T lie on a new insurance application about when your treatment started.
Frequently Asked Questions (FAQ)
1. Can I switch from my parent’s dental insurance to my own plan while I have braces?
Yes, but this is a common transition for young adults. If you are aging out of a parent’s plan (usually at 26), your new individual plan will likely consider your braces a pre-existing condition and deny coverage. Plan for this by saving money to cover the remaining payments once the parental coverage stops.
2. Will my new insurance cover the removal of my braces?
Generally, insurance companies classify the removal (de-bonding) as part of the total orthodontic treatment cost, not a separate procedure. If they denied the active treatment claim, they will likely deny the removal claim as well. You will likely need to pay for the removal appointment out-of-pocket.
3. What if my new insurance has a waiting period for orthodontics?
Many plans have a 6-to-12-month waiting period before they cover major services like braces. If you are already in braces, this waiting period effectively means they won’t pay anything, as the treatment time will likely be over before the waiting period ends.
4. Does the type of braces matter? (Metal vs. Invisalign)
For insurance purposes, usually not. Most plans have a set dollar amount or percentage for “comprehensive orthodontics,” which covers both traditional braces and clear aligners like Invisalign. However, if your treatment type changes (e.g., you switch from braces to aligners), the new insurance might question it.
5. I am getting a new job. Should I decline dental insurance to save money?
If you are mid-treatment, declining dental insurance is likely a mistake. Even if the new insurance doesn’t cover your remaining braces, having a plan will cover your cleanings and any other dental issues (cavities, etc.) that might arise. You are better off having the coverage for preventive care and hoping for a little orthodontic help than having none at all.
Additional Resources
Navigating the fine print of insurance policies can be overwhelming. For unbiased information regarding your rights as a patient and consumer, you can visit:
[Healthcare.gov: Dental Coverage in the Marketplace]
(https://www.healthcare.gov/coverage/dental-coverage/)
This resource helps you understand the difference between embedded and standalone dental plans, which is crucial if you are purchasing insurance independently rather than through an employer.
Conclusion
Changing your dental insurance while wearing braces is a complex process, but it is far from a disaster. The key takeaway is that orthodontic benefits are a one-time “lifetime” pool of money tied to a specific policy. Once you switch carriers, that pool is usually gone. However, by communicating openly with your orthodontist, meticulously reading the fine print of new plans, and understanding your appeal rights, you can navigate this transition smoothly. While you may end up covering more of the cost out-of-pocket than you initially planned, protecting your investment in your smile is always worth the effort. Stay proactive, ask the right questions, and your smile will be just fine.
