Orthodontics and your health insurance

Costs for a child under 18 years

What do braces actually cost? The Nederlandse Zorgautoriteit (Dutch Health Authority) sets the rates for orthodontics each year. There are a number of factors that determine the price of orthodontics. Such as the type of braces and the number of treatments needed. In addition, braces can be more expensive for certain options. Transparent braces for example can cost more. It’s useful to know that you don't have to pay the costs all at once. On average, the total cost of braces is between € 2,000 and € 3,000, for a treatment duration of two to three years. The cost of braces may vary from one orthodontist to another. This is because a treatment plan is made up of different procedures and each procedure has a fixed rate. The treatment plan is determined by the orthodontist for every individual client.

Does your insurance cover orthodontics for children?

Orthodontics is almost never reimbursed by the basic insurance, not even for children. There are exceptions for serious development or growth disorders of the mouth, teeth or jaw. For example the treatment of a cleft lip is covered. Is your child under 18 and do you want to be covered for braces? As a parent, you can take out supplemental insurance to cover orthodontics for your child.

Note: The child requiring treatment should be insured under the parent with the supplemental orthodontic insurance policy.

Deductible

You only pay a deductible for care under the basic insurance. Orthodontics is only covered by the basic insurance for serious development or growth disorders of the mouth, teeth or jaw.

Do you have supplemental insurance for orthodontics? Then you don’t pay the deductible.

Supplemental insurance for orthodontics under 18 years

Have you taken out supplemental insurance for orthodontics? Then you’ll receive reimbursement for the treatment up to a certain maximum amount. A specific duration often also applies to the reimbursement of costs.

For example: You’re insured for two years with the same health insurer and the reimbursement from your supplementary package is € 2.000. Then the reimbursement is for those two years, not per calendar year. Of course, you can also use the entire amount within one year.

Want to switch to another insurer after the first year? It’s something to consider carefully. Does your child still have braces, and do you still need reimbursement for these treatments? Then compare the cost of the premium with the costs yet to be incurred. Is there still € 500 in costs to come? Then you can compare health insurances and switch to another health insurer. Be aware that there may be a waiting period when switching health insurers. Some health insurers will only reimburse orthodontic costs after you have paid for one year of supplementary orthodontic insurance with them. If you are in the middle of an orthodontic treatment, it won’t be beneficial to change.

Want to know which health insurance policies are good for braces? Then it's a good idea to compare the different policies. Consider the following when making a decision:

• ​What’s the premium?
• What’s the maximum reimbursement?
• Which costs are reimbursed?
• What’s the reimbursement percentage?
• What are the additional conditions?

Orthodontics above 18 years

The maximum rates for orthodontics are determined by the Dutch Health Care Authority. The cost depends on several factors such as the type of braces and the number of treatments you need. Also, the cost of braces may vary from one orthodontist to another. This is because a treatment plan is made up of different procedures and each procedure has a fixed rate. The treatment plan is determined by the orthodontist for every individual client. You’ll receive an indication of the costs based on your treatment plan.

Does your health insurer reimburse orthodontics for adults?

Orthodontics is not covered by the basic insurance in most cases. Orthodontics is only covered by the basic insurance if you have a serious development or growth disorder of the mouth, teeth or jaw. But this is most often diagnosed and already treated in children under 18.

Deductible

You only pay a deductible for care that is covered by the basic insurance. The basic insurance only covers orthodontics for serious development or growth disorders of the mouth, teeth or jaw. Do you have supplemental insurance for orthodontics? Then you don’t pay the deductible.

Supplemental insurance for adult orthodontics

Different reimbursements apply for people aged over 18 than for children. Are you 18 years or older? In that case the reimbursement for braces from health insurance is very limited. If you want braces as an adult, you can choose to take out supplemental insurance. But premiums for this are often high, and the coverage is relatively low. As a result, you’ll often have to pay a high amount yourself. This is why many people choose to pay for their braces themselves.

Supplemental insurance: What to look out for

Want to know which health insurance policies are good for braces? Then it's a good idea to compare the different policies. Consider the following when making a decision:

• ​What’s the premium?
• What’s the maximum reimbursement?
• Which costs are reimbursed?
• What’s the reimbursement percentage?
• What are the additional conditions?

Additional conditions of insurers

Most insurers have additional requirements for orthodontics. There might be a waiting period, medical underwriting or a one-time reimbursement.

Waiting period 

Some insurers have waiting periods for reimbursement. This means that you have to be insured for a few months to a year before you’re entitled to reimbursement. So it's good to take this into account when looking for supplemental insurance. And make sure you get that insurance in time so that the waiting period won’t be a problem.

Medical underwriting 

Medical underwriting is when the insurance company looks at your health care costs in the past, present and future. Based on that analysis, they estimate the risk. Do you expect to incur high costs? Then the insurer may choose not to accept your insurance application.

One-time reimbursement 

With most health insurers, you’ll receive a once-off reimbursement. This means that during the term of the insurance you’ll only receive the reimbursement once. For example, you’re entitled to a reimbursement of € 1.000? Then you can only claim up to that amount once.