Understanding Orthodontic Insurance: Open Enrollment Tips from Escott Orthodontics
Now’s the time to review your insurance and spending accounts to invest in your smile
Table of Contents
Introduction
What Is Orthodontic Insurance?
How Orthodontic Insurance Works
Why Open Enrollment Matters
What to Ask Your Insurance Provider
Using FSA and HSA for Orthodontics
Choosing the Right Orthodontic Plan
What Treatments Are Covered (And What Are Not)
What If You Don't Have Orthodontic Insurance?
How Escott Orthodontics Supports You
The Escott Experience
Next Steps During Open Enrollment
Conclusion
Frequently Asked Questions
Introduction
Open enrollment season is more than a chance to pick a health plan — it's a crucial moment to rethink your dental and orthodontic coverage, especially if you've been considering
braces or
Invisalign®. At
Escott Orthodontics, serving Lake County, College Park, and Baldwin Park in Florida, we believe that knowing how to navigate insurance can transform your smile journey from confusing to empowered.
With over
665 five-star reviews and honored as "Best of the Best – Orthodontist" five years in a row by
Lake Sumpter Style Magazine,
Dr. Christopher Escott and
Dr. Hunter Davis lead a practice built on transparency, excellence, and patient advocacy. In this article, you'll get clear, actionable guidance on orthodontic insurance, how to use FSA/HSA benefits, and how to make open enrollment work
for your smile.
What Is Orthodontic Insurance?
Many people assume that standard dental insurance automatically covers braces and alignment, but that's not always the case. Orthodontic insurance is a specialized subset of dental benefits that focuses on treatments designed to realign teeth or jaws, such as braces and clear aligners (Invisalign®, etc.). While dental insurance typically covers cleanings, fillings, crowns, and periodontal care, orthodontic coverage is often optional, limited, or subject to different terms and conditions.
Here's what orthodontic insurance often includes:
- Partial coverage (often 25–50%) of treatment cost
- Coverage of braces, sometimes aligners
- Diagnostic imaging, initial exams
- Occasional coverage of retainers
On the flip side, many plans exclude:
- Cosmetic-only alignments (if no functional issue)
- Adult or over-age-18 treatments (some plans cap age)
- Replacement appliances (lost retainers, broken trays)
At Escott Orthodontics, we help patients dissect their plan language to see exactly what's covered and what isn't, so there are no surprises.
How Orthodontic Insurance Works
To fully benefit, you need to understand key insurance concepts:
Lifetime Maximum
Orthodontic plans often impose a total benefit ceiling per patient for their entire lifetime (e.g., $1,500 or $2,500). Once you hit that maximum, no more coverage is provided again under that plan.
Coverage Percentage
Even after meeting your deductible (if applicable), your plan may only cover a certain percentage of the orthodontic expense (e.g., 50%), leaving you responsible for the remaining amount.
Waiting Periods
Many plans require you to wait a defined number of months (such as 6 or 12) after enrollment before you can use orthodontic benefits. If you're switching plans or enrolling anew, that delay could affect when treatment can begin.
Age & Eligibility Restrictions
Some plans only provide orthodontic benefits to dependents under the age of 18 or 19, depending on the plan. Adult coverage is less common, although it is growing in availability.
In-Network vs. Out-of-Network
Visiting an in-network provider typically reduces your out-of-pocket costs and streamlines the claims process. At Escott Orthodontics, we accept many major insurance plans and support patients in determining whether we are in- or out-of-network with their specific plan.
By mastering these aspects, you'll know exactly how much your insurer may contribute and how much you'll need to budget.
Why Open Enrollment Matters
Open enrollment is your only (or best) opportunity each year to select dental and orthodontic coverage, change plans, or enroll in benefits like FSA or HSA. If you miss it, your options may be locked in until the next window, unless you experience a qualifying life event (job change, marriage, etc.).
This is particularly important for orthodontics because:
- You may add or upgrade a plan that includes orthodontic benefits.
- You can plan your FSA or HSA contributions to cover future treatment.
- You can lock in current network access before benefits or providers change.
Escott Orthodontics encourages patients to treat open enrollment like planning a major purchase: go in informed, ask the right questions, and align your benefits with your treatment goals.
What to Ask Your Insurance Provider
Before you finalize your plan, ask directly:
- Is orthodontic coverage included? Many dental plans don't include it by default.
- What is the lifetime maximum benefit?
- What percentage of treatment is covered (i.e. 25%, 50%)?
- Are braces and Invisalign® both covered? Some plans classify aligners as "cosmetic."
- Do benefits kick in immediately or after a waiting period?
- Are there age restrictions?
- Is Escott Orthodontics in-network under my plan?
- Are retainers or follow-up appliances covered?
Please bring a printed or digital summary of your plan benefits when you meet with us; we can help translate the insurance jargon and give you a realistic estimate.
Using FSA and HSA for Orthodontics
Even a solid insurance plan often doesn't cover 100% of orthodontic treatment. This is where
Flexible Spending Accounts (FSA) and
Health Savings Accounts (HSA) shine. They let you use pre-tax dollars to pay for eligible medical expenses, including braces, aligners, and retainers.
FSA Overview
- Employer-sponsored
- "Use it or lose it" — funds typically must be spent by year-end (or within a grace period)
- 2025 contribution limit ~
$3,200
HSA Overview
- Requires qualifying high-deductible health plan (HDHP)
- Funds roll over year to year
- 2025 limits ~ $4,150 for individuals, $8,300 for families
Why It Helps
Suppose your treatment costs $4,000. Even if insurance covers 50% ($2,000), you're still responsible for $2,000. If you set aside that difference in an FSA or HSA with pre-tax income, you effectively reduce your tax burden. Escott Orthodontics can provide a treatment estimate in advance, allowing you to calculate your contributions accurately.
Choosing the Right Orthodontic Plan
When comparing your options during open enrollment, keep these strategic points in mind:
- Lifetime Maximums: A plan with a $2,500 max is more valuable than one with a $1,000 max.
- Coverage Percentage: Higher coverage percentages reduce your burden.
- Waiting Periods: If you want to begin planning treatment soon, avoid long waits.
- Provider Networks: Choosing a plan where Escott Orthodontics is in-network often saves you money.
- Adult Coverage: If you or your spouse plan to seek treatment, ensure adult orthodontics is included.
- Aligner Coverage: Some plans exclude Invisalign® entirely. Be sure to read the fine print.
If you're uncertain, bring your plan documents to us—we're happy to help you compare and select the option that gives you the best value for your smile.
What Treatments Are Covered (And What Are Not)
Typically Covered
- Traditional metal braces
- Ceramic (tooth‑colored) braces
- Some clear aligners (if specified)
- Diagnostic workup (x-rays, scans, initial exam)
Often Excluded
- Adult treatments (in some plans)
- Replacement retainers or lost aligners
- Experimental or non‑standard appliances
At Escott Orthodontics, we assist patients in obtaining
pre-authorization from insurers by submitting treatment plans and documentation to maximize acceptance and coverage.
What If You Don't Have Orthodontic Insurance?
No insurance? No problem. We offer multiple flexible financial solutions to make orthodontics accessible:
- In-House Payment Plans: Interest‑free monthly payments through our office.
- Third‑Party Financing: Partners like CareCredit with promotional terms.
- Pay-As-You-Go: Spreading cost per visit, rather than lump sum.
- Multi-Patient Discounts: Special pricing is available when more than one family member is undergoing treatment.
Before you commit, we provide a
transparent estimate of your total cost (from the initial scan to the final retainer), ensuring there are no hidden surprises.
How Escott Orthodontics Supports You
We pride ourselves on removing barriers—especially when it comes to insurance and payments. Here's what we offer:
- Free Insurance Verification
Please provide us with your plan details, and we'll handle the rest: checking eligibility, coverage levels, and benefits. - Pre-Treatment Estimates & Pre-Authorization
Before you start, we submit your treatment plan to your insurer so you know your share of the cost ahead of time. - Claims Management
We file your claims, follow up on denials, and resubmit if necessary, so you don't have to. - Documentation & Tax Support
Do you need invoices, medical necessity letters, or receipts? We can help with that. - Transparent Communication
We explain all benefits and costs in simple, clear terms so that there are no surprises and no hidden fees.
At Escott Orthodontics, your financial ease matters as much to us as your clinical outcome.
The Escott Experience
What sets us apart isn't just clinical skill—it's how we make you feel. Across our three Florida locations, our patients frequently say: "They simplified the insurance process and helped me understand exactly what I owed."
We combine:
- Warm, family-style care
- State-of-the-art technology (digital scans, 3D imaging)
- Flexible scheduling (early and late hours)
- Transparent, patient-first approach
With over 665 five-star reviews and repeated recognition as “Best of the Best,” our dedication to excellence speaks for itself. That’s why families across Central Florida choose Escott Orthodontics to bring sunshine to every smile, and we’re truly honored to have earned your trust.
Next Steps During Open Enrollment
Ready to turn this planning into action? Here's a streamlined checklist:
- Review your current dental plan and check if orthodontics is included.
- Ask your HR or insurer the key questions: lifetime max, waiting period, aligner coverage, etc.
- Plan your FSA or HSA contributions based on estimated orthodontic costs.
- Schedule your complimentary consultation at Escott Orthodontics.
- Let us verify your benefits and provide a complete treatment estimate.
- Compare your plan options with our team's help and select the one that offers you the maximum orthodontic value.
- Begin your treatment early in the year to ensure you use your benefits fully.
You can book via our website,
escottortho.com, or call:
- Lake County Office: 352‑383‑6166
- College Park (Orlando): 407‑648‑5511
- Baldwin Park (Orlando): 407‑898‑6711
Don't let another enrollment season pass without making your smile a key part of your strategy.
Conclusion
Orthodontic treatment is a long-term investment — both in your health and in your confidence. With open enrollment as your launching pad, you can align your insurance, tax‑advantaged accounts, and financial strategy to make that investment with ease. At Escott Orthodontics, we make it our mission to clarify the process, support you every step of the way, and deliver results that delight.
Whether you're a parent exploring braces for your child or an adult considering Invisalign®, there's no better time than open enrollment to get smart about your coverage. With over 665 glowing reviews and multiple "Best of the Best" honors, we're honored to be your partners in transformation. Let's turn your orthodontic goals into reality together!
Frequently Asked Questions
What's the difference between dental and orthodontic insurance?
Dental insurance generally covers preventive and general care (cleanings, fillings, crowns). Orthodontic insurance specifically targets treatments that adjust alignment, like braces or aligners—and often comes with its own rules (lifetime maximums, waiting periods, age limits).
Can I use my FSA or HSA to cover the cost of Invisalign?
Yes. Both FSA and HSA allow use of pre-tax funds for eligible orthodontic treatments, including Invisalign®, braces, retainers, diagnostic imaging, and more.
What if I miss open enrollment—can I still start treatment?
If you miss the window, you typically cannot change or add benefits until the next period—unless you qualify for a special enrollment due to a life event. However, you can still begin treatment through self-pay or financing options at Escott Orthodontics.
Does Escott Orthodontics help with insurance paperwork and claims?
Absolutely. We verify benefits, submit claims, follow up on denials, provide documentation, and offer clear, jargon-free explanations of your benefits and obligations.
How do I get started with a consultation?
Visit
escottortho.com or call our offices in Lake County (352-383-6166), College Park (407-648-5511), or Baldwin Park (407-898-6711) to schedule your
complimentary consultation. We'll scan, plan treatment, and review insurance, all at no charge.
Ready For Your Smile to Shine?
