Orthodontic treatment can transform a smile, correcting misaligned teeth and bite issues, but the cost can be significant. Many patients wonder whether their insurance plan covers orthodontic care. While the answer varies depending on the type of insurance, coverage often exists, especially for children and teenagers.
In this guide, we will explore how insurance applies to orthodontics, including both medical and dental plans, and what you need to know before starting treatment.
In most cases, dental insurance is the primary form of coverage for orthodontic care. However, not all dental insurance plans cover orthodontics, and those that do typically have specific limitations.
Many dental insurance plans provide orthodontic coverage for children under 18. This coverage often includes traditional braces, retainers, and sometimes clear aligners. However, the extent of coverage will vary based on your specific plan.
Some may cover up to 50% of the total cost, while others may only cover a set dollar amount or nothing at all. It’s essential to review your policy or contact your provider for details.
At UrgentDent, we offer Orthodontic Services for patients of all ages, making it easy to receive the care you need.
Orthodontic treatment is not just for children. Adults may also seek orthodontic care to correct bite issues or align their teeth. However, coverage for adult orthodontics is less common and often comes with stricter limitations. Many plans that offer adult orthodontic benefits may have higher deductibles or lower coverage percentages than pediatric plans.
To learn more about the types of orthodontic services available, check out our previous blog on What Are Orthodontic Services?
Health insurance, unlike dental insurance, typically does not cover orthodontic treatment unless it’s deemed medically necessary. For example, if misalignment causes significant functional problems, such as difficulty chewing or breathing issues, your health insurance may provide some coverage.
Some health insurance policies will cover orthodontics if it’s part of treating a medical condition, such as jaw surgery for severe bite misalignment or issues related to sleep apnea. In these cases, your doctor or orthodontist may need to provide documentation proving the necessity of the treatment.
For patients who require surgery to correct jaw alignment or other structural issues, health insurance may cover the surgical portion of the treatment but not the braces or aligners used afterward. Understanding your plan’s fine print can help you determine what is included.
If you’re unsure whether your case qualifies as medically necessary, it’s best to consult both your orthodontist and your health insurance provider. At UrgentDent, we’re here to help guide you through the insurance process and offer consultations to assess your needs.
Some dental insurance plans have waiting periods before orthodontic coverage kicks in. This can range from six months to two years. If you or your child is considering braces or aligners, it’s important to plan ahead to avoid unexpected costs.
Many insurance plans have a lifetime maximum for orthodontic coverage. This means once you reach that limit, your plan will no longer contribute to any additional orthodontic costs. This maximum is usually around $1,000 to $2,000 per individual.
Before starting orthodontic treatment, some insurance companies require pre-authorization to ensure the treatment is necessary and falls under their coverage guidelines. Failing to get pre-authorization could result in your claim being denied.
At UrgentDent, we work with major insurance providers to ensure that you get the most out of your coverage, so you can focus on achieving your ideal smile.
In general, medical insurance does not cover standard orthodontic treatments like braces or aligners. However, it may cover orthodontic procedures if they are necessary to correct medical issues, such as:
In cases where the patient has severe jaw misalignment (such as an overbite or underbite) that affects their ability to eat or speak, medical insurance may provide coverage if surgery is needed.
If orthodontic treatment is needed after facial trauma or injury, it could be considered medically necessary and may be covered by your health insurance. This includes cases where braces are required to stabilize teeth after an accident.
For more information about other dental services we offer, explore our General Dentistry Services.
Orthodontic treatment can range widely in cost depending on the complexity of the case and the type of treatment chosen. On average, braces cost between $3,000 and $7,000, while clear aligners like Invisalign can range from $4,000 to $8,000. With insurance, you may be able to reduce these costs significantly.
For a detailed look at the cost of orthodontic treatment and how insurance can impact your out-of-pocket expenses, visit our Orthodontic Services page.
For patients without insurance or those whose plans don’t cover orthodontics, UrgentDent offers flexible payment options and financing plans to make orthodontic care more affordable. Additionally, we offer consultations to help you understand what’s best for your needs and budget.
You can also learn more about related dental treatments we offer, such as Root Canal Treatment and Teeth Whitening, to ensure your overall dental health is taken care of.
If you are interested in orthodontic treatment or want to learn more about your insurance options, contact us at UrgentDent or call 219-513-0555 to schedule an appointment today.