Insurance for Orthodontics – Are You Covered?

An adult male and a young boy are smiling

Do you or a family member need orthodontic treatment but are confused if your insurance covers it or not?

Orthodontic services cover many treatments, such as teeth alignment, space maintainers, and braces. These can be expensive for many people, so it’s important to find out whether your dental insurance might cover part or all of the cost.

However, determining if and how much of the treatment may be covered can be confusing.

To help with this, we will look at this issue in more detail.

What type of orthodontic coverage can you expect from health insurance?

When it comes to orthodontic care, coverage will vary depending on the dental plan you choose and the individual provider.

For kids and those under 18, insurance companies are required to provide a dental insurance option that meets the Affordable Care Act (ACA) requirements.

In some states, if a child experiences pain or chewing difficulties, the dental provider may be required to cover all expenses.

When trying to find the answer to “does insurance cover orthodontics?” keep in mind that coverage can vary from plan to plan.

For example, some plans only cover preventive care and partial restorative treatments. At the same time, others may have more extensive coverage.

Some private insurance plans may cover some of the costs of braces, such as the procedure itself. However, they might still require you to pay certain fees, such as co-payments.

When you’re shopping for dental insurance plans, you will want to compare the features and benefits to see if orthodontics is included.

You also want to pay special attention to any limitations regarding braces coverage. For example, it may only apply to braces needed for certain conditions or up to a specific age.

Orthodontic treatment, such as braces, is typically covered under dental insurance plans, but the amount of coverage can vary depending on the specific plan. Some plans may have a separate coverage level or a lifetime maximum for orthodontic treatment, while others may not cover it at all.

When does health insurance cover adult orthodontics?

Health insurance will sometimes cover orthodontics for adults when treatment is deemed medically necessary. To qualify, the procedure must assist in diagnosing, preventing, or treating a disease, injury, or related symptoms.

To get coverage, you need to show that straighter teeth will treat one of the following complaints or relieve associated symptoms:

  • Non-biting accidents that impact the positioning of teeth
  • Symptoms related to Temporomandibular Joint Disorders (TMD)
  • Crooked teeth that restrict airflow and worsen or cause sleep apnea

However, most health insurance policies won’t cover cosmetic orthodontic procedures for patients over 21.

Does Medicaid cover braces?

Medicaid covers medically necessary procedures — in some cases, braces fall under this category for children.

Medicaid is a type of federally-funded and state-funded health insurance plan available to people with low incomes. If you fall under a certain threshold, usually the poverty level in your state, you might qualify for Medicaid assistance in your particular state.

If braces are medically necessary for you or your child, then Medicaid must cover the costs.

Final thoughts

Working through the maze of rules and regulations for dental insurance coverage can sometimes be exhausting.

But don’t fret; help is at hand.

Our team is more than happy to answer any questions about dental insurance and help you deal with any claim.

We provide a wide range of financing options, including in-Office interest-free financing.

Speak to our team or directly with Dr. Griffin to find out more.

Call us today to discover if you or your family member are covered by dental insurance for your orthodontics treatment.

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