What You Need to Know to Make the Most of Orthodontic Coverage This Enrollment Season

Table of Contents

Introduction

Meet Our Doctors

Why Open Enrollment Matters for Orthodontics

Understanding Orthodontic Insurance Coverage

Employer-Sponsored Plans vs. Marketplace Options

Using FSA and HSA Accounts for Orthodontic Care

What Treatments Are Usually Covered?

Questions to Ask Your Insurance Provider

Budgeting for Braces and Aligners with Insurance

How Shift Aligners and Invisalign® Fit Into Insurance Planning

Timing Your Treatment for Maximum Benefits

Why Choose Ortho South

Conclusion

Frequently Asked Questions

Introduction

Every fall, families across Alabama sit down to review their health and dental insurance plans during the annual open enrollment period. For many, this feels like a maze of options, deadlines, and fine print. But if you or your child may need braces or aligners, this season is more than paperwork, it's an opportunity to save thousands of dollars on orthodontic care.

At Ortho South, we understand how overwhelming insurance decisions can feel. That's why we're here to guide you through the process. With over 705 five-star reviews and recognition as Alabama's most experienced aligner provider, our team has helped countless families in Pelham, Calera, and beyond use their benefits wisely to achieve a healthy, confident smile.

In this guide, we'll break down everything you need to know about open enrollment, from understanding insurance coverage to using flexible spending accounts, so that you can maximize your orthodontic benefits this year.

Meet Our Doctors

At Ortho South, our patients are cared for by two highly skilled and compassionate orthodontists:

• Dr. Brandon Boggan brings decades of orthodontic experience and is known for his innovative approach to treatment planning. His leadership has positioned Ortho South as the most trusted practice for advanced aligner solutions.
• Dr. Zehra Syed combines clinical expertise with a patient-first mindset. Families appreciate her clear communication and dedication to creating a positive orthodontic experience for both children and adults.

Together, Dr. Boggan and Dr. Syed lead with our tagline—Smile On!—because we believe every patient deserves a treatment plan that is effective, affordable, and supported by smart financial choices.

Why Open Enrollment Matters for Orthodontics

Orthodontic treatment is a long-term investment in both your health and your confidence. Braces and aligners don't just improve your smile, they also support proper bite alignment, healthier gums, and easier cleaning for years to come. With treatment costs often ranging between $3,500 and $7,000, the role of insurance in reducing your financial burden cannot be overstated. Open enrollment is your opportunity to set yourself up for success before treatment even begins.

During this period, you can:

• Review coverage and select a plan that includes orthodontic benefits, ensuring your family's needs are met before the year begins.
• Pair insurance with FSA or HSA accounts to stretch every dollar further by using pre-tax funds toward orthodontic expenses.
• Time your treatment start strategically to maximize coverage across multiple plan years.
• Budget ahead for out-of-pocket costs, so payments are spread out comfortably instead of feeling like a sudden surprise.

Families who plan during open enrollment often save thousands of dollars compared to those who delay or overlook benefits. For example, starting treatment in December allows many families to utilize two years of insurance maximums, covering more of the cost without doubling expenses. When you take advantage of this window, you're not just signing up for insurance, you're aligning your financial resources with your smile goals, making orthodontics more affordable and stress-free.

Understanding Orthodontic Insurance Coverage

Not all dental plans are created equal. Orthodontic coverage varies, and it's essential to understand what's included before committing.

Here are the basics:

• Lifetime Maximums: Many plans set a lifetime cap (often $1,500–$3,000) on orthodontic benefits.
• Percentage Coverage: Insurance typically pays a percentage (commonly 50%) of treatment costs until the lifetime max is reached.
• Age Limits: Some plans cover orthodontics exclusively for children, while others extend benefits to adults as well.
• Waiting Periods: Certain plans require you to hold coverage for a period before orthodontic benefits begin.

By reviewing these details now, you can avoid surprises later and make sure your plan aligns with your treatment needs.

Employer-Sponsored Plans vs. Marketplace Options

When it comes to orthodontic coverage, you may have access to:

• Employer-Sponsored Plans: Often the most robust, with better group rates and more comprehensive orthodontic coverage. These are especially valuable for families with multiple children in treatment.
• Marketplace Plans (Affordable Care Act): Pediatric orthodontic coverage is commonly included, but adult coverage may be limited or unavailable. These plans are worth reviewing closely if you purchase insurance independently.

Pro tip: If both parents have dental insurance, ask about dual coverage. In some cases, benefits can be combined to further reduce out-of-pocket costs.

Using FSA and HSA Accounts for Orthodontic Care

Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) are powerful tools for making orthodontic treatment more affordable. These accounts allow you to use pre-tax dollars for qualified medical expenses, including braces and aligners.

• FSAs: Funded annually by your employer, FSAs are "use it or lose it," meaning unused funds may expire at year's end. They're ideal for planned orthodontic expenses.
• HSAs: Available with high-deductible health plans, HSAs roll over year to year and can build long-term savings.

By pairing insurance coverage with FSA or HSA funds, many families save hundreds (sometimes thousands) on treatment.

What Treatments Are Usually Covered?

Coverage varies, but most insurance plans include:

• Traditional braces for children and sometimes adults.
• Clear braces as an alternative option.
• Invisalign® or Shift Aligners—coverage may vary depending on the plan, so please ask specifically.
  
  

Important: Cosmetic whitening, retainers after treatment, and accelerated treatment options are often excluded from coverage. Always check your plan's fine print before starting care.

Questions to Ask Your Insurance Provider

Before open enrollment ends, contact your insurance provider and ask:

1. Does my plan cover orthodontic treatment for children? Adults?
2. What percentage of treatment costs are covered?
3. What is the lifetime maximum for orthodontics?
4. Are there waiting periods before coverage begins?
5. Does coverage include clear aligners, such as Invisalign or Shift Aligners?
6. How are claims processed—lump sum or monthly?
7. Can I use FSA or HSA funds in combination with coverage?

Clear answers to these questions will help you make informed decisions.

Budgeting for Braces and Aligners with Insurance

Even with insurance, there will likely be out-of-pocket costs.

Here's how to prepare:

• Know your numbers: Add up insurance coverage, FSA/HSA funds, and estimated out-of-pocket costs.
  
  
• Plan monthly payments: Most orthodontists, including Ortho South, offer flexible payment plans that allow you to spread the cost over time.
  
  
• Consider timing: Starting treatment early in the year can allow you to use benefits across two plan years.
  
  

Example: A family begins treatment in December, applying their 2025 benefits, then continues into 2026 to use another year's maximum. This strategy can result in significant cost savings of thousands.

How Shift Aligners and Invisalign® Fit Into Insurance Planning

At Ortho South, patients deserve flexibility when it comes to aligner treatment. That's why we offer both Invisalign®—the most recognized clear aligner brand worldwide—and our own custom-made Shift Aligners, designed right here in our office. Both systems use clear trays to gradually and precisely move teeth, but patients often wonder if insurance will treat them differently.

The answer is simple: Insurance views Invisalign® and Shift Aligners the same way. Because Shift Aligners are billed under the same orthodontic treatment codes as Invisalign® and traditional braces, most insurance plans provide equal coverage.

That means:

• Invisalign®: Typically covered under orthodontic benefits for both children and adults.
• Shift Aligners: Also covered under standard orthodontic codes, making them just as eligible for reimbursement as Invisalign®.

For patients, this means you don't have to choose your aligner system based on insurance—you can select the option that best fits your lifestyle, treatment goals, and budget, knowing your benefits will apply to either.

Patient Snapshot: One of our Pelham patients, Sarah, came to us unsure whether to move forward with Invisalign® or Shift Aligners. She loved the idea of a locally designed system but worried her insurance wouldn't cover it. After reviewing her plan, we showed her that both aligner options were covered the same way. With that reassurance, she chose Shift Aligners for the added convenience of in-office design and faster turnaround. Her insurance applied seamlessly, and she was able to save significantly by pairing coverage with her FSA funds.

Our team is here to walk you through these details step by step. During your consultation, we'll verify your benefits, compare options, and help you maximize savings while giving you the confidence to choose the aligner treatment that works best for you.

Timing Your Treatment for Maximum Benefits

Timing is everything when it comes to orthodontics and insurance.

Open enrollment is the time to:

• Start treatment in alignment with your plan year.
• Use benefits across multiple years by staggering start dates.
• Combine insurance with FSA/HSA contributions for double savings.
  
  

Our treatment coordinators at Ortho South specialize in helping families create personalized financial timelines that maximize their benefits without compromising care.

Why Choose Ortho South

Families across Pelham and Calera trust us because:

• We are Alabama's most experienced aligner provider.
• Dr. Brandon Boggan and Dr. Zehra Syed bring decades of combined orthodontic expertise.
• We offer braces, Invisalign®, and Shift Aligners to fit every lifestyle.
• 705+ five-star reviews highlight our reputation for excellent care and results.
• We make treatment affordable, offering insurance guidance, flexible financing options, and personalized care plans.

At Ortho South, we believe orthodontic care should be stress-free—from your smile journey to your financial planning.

Conclusion

Open enrollment doesn't have to be overwhelming. With the right information, you can maximize your orthodontic benefits and save significantly on braces or aligners.

At Ortho South, we are here to help you every step of the way. From reviewing your insurance options to creating a payment plan that fits your budget, our team will ensure you get the most out of your coverage.

📍 Pelham & Calera, Alabama

📞 Call us today at 205-664-4140

🌐 Visit orthosouth.com to schedule your complimentary consultation.

"The staff at Ortho South was amazing at helping us understand our insurance and financing options. They made the process simple and stress-free." — recent patient review

Smile On with confidence this open enrollment season!

Frequently Asked Questions

What is open enrollment?

It's the annual period when you can sign up for, renew, or change your health and dental insurance coverage.

Does dental insurance always cover orthodontics?

No. Some plans cover children only, while others cover both children and adults. Always review your plan.

Can I use FSA or HSA funds for braces or aligners?

Yes. Both accounts allow you to use pre-tax dollars for orthodontic treatment.

How do lifetime maximums work?
Your plan may cover a set amount (e.g., $1,500–$3,000) toward orthodontic care, regardless of total treatment cost.

Are Invisalign® and Shift Aligners covered the same way as braces?

Often yes, but it depends on your specific plan. Ask your provider and we can help verify.