If you’re considering braces or Invisalign® for yourself or your child, understanding how insurance fits into the picture is important—but often confusing. That’s why we’re here to help!

One term that pops up a lot is “out-of-network.” So, what does that really mean for your orthodontic insurance and how much will you end up paying?

So what does out-of-network insurance mean?

Let’s start with the basics. Every insurance plan has a list of providers (dentists, orthodontists, etc.) that it partners with. These are called in-network providers. When you see someone in-network, your insurance typically pays a larger portion of the cost because they’ve negotiated lower rates with that provider.

An out-of-network provider, on the other hand, isn’t contracted with your insurance. But that doesn’t mean you can’t see them—it just means your insurance may cover a little less, or you might pay a bit more upfront.

But here’s something most don’t know: in many cases, especially with orthodontic insurance plans, the difference in cost isn’t as big as you’d think.

In Network vs Out of Network Dental: What’s the real difference?

When it comes to dental insurance, many plans work on a reimbursement model. This is especially true for orthodontic insurance. Whether you’re using insurance for braces or Invisalign insurance, your plan may allow you to choose any orthodontist and then reimburse you a percentage of the cost, regardless of network status.

The real difference lies in how much your plan is willing to pay—and how much paperwork you may need to do. With in-network providers, everything is usually handled for you. With out-of-network care, you may need to submit a claim yourself. At Morejón + Andrews Orthodontics, we do the paperwork so you don’t have to.

Understanding Your Orthodontic Insurance

Orthodontic coverage is often part of a dental plan—or added on as an option. These plans typically help pay for braces, Invisalign, or other orthodontic treatments, especially for children. If you’re researching orthodontic insurance for a child, know that many plans have age limits, often capping benefits at age 18.

Another key detail? Orthodontic insurance usually doesn’t work like medical insurance with yearly deductibles and co-pays. Instead, it often has a lifetime maximum benefit.

What is the orthodontic lifetime maximum benefit?

One of the most important things to understand is your orthodontic lifetime maximum benefit. Unlike regular dental insurance that renews every year, orthodontic coverage usually comes with a one-time limit—often $1,500 or $2,000 (but it depends on your plan). Once your insurance pays that amount toward braces or Invisalign (whether in-network or out-of-network), they’re done.

That’s why choosing the right orthodontist based on quality of care and experience—not just network status—is so important. After all, they’ll be the one creating your forever smile!

Can I still use my insurance for Invisalign or braces if the orthodontist is out-of-network?

Yes! Even if your orthodontist is out-of-network, most insurance companies will still pay something toward your treatment. If you’re using orthodontic insurance for your child or yourself, it’s worth calling your insurance company to ask:

• What’s my lifetime orthodontic benefit?
• What percentage do you cover for out-of-network providers?
• Is there any deductible or waiting period?

Then, talk with your orthodontist’s office—they’ve likely worked with many insurance plans and can help you maximize your benefits.

At Morejón + Andrews Orthodontics, your first consultation is completely free—with no pressure or obligation to begin treatment. We’ll provide a personalized smile transformation plan that outlines what your insurance will cover and walk you through our affordable financing options tailored just for your budget.

The bottom line

Choosing an out-of-network orthodontist doesn’t mean you’re out of luck. Many patients use their orthodontic insurance plan successfully with out-of-network providers every day! What matters most is getting care from a provider you trust. And with the right team at your back, you can make sure your insurance works for you—no matter what network your orthodontist is in.

Have more questions about your coverage? Book your complimentary consultation at our Ormond Beach or Palm Coast orthodontic offices today! Our team is happy to help you navigate your insurance and get you (or your child) smiling confidently in no time.