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Does Dental Insurance Cover Orthodontic Care? | RMHP Blog

Does Dental Insurance Cover Orthodontic Care? | RMHP Blog



When Does Dental Insurance Pay for Braces?

Orthodontic treatments can significantly improve the look of your smile and correct unpleasant symptoms related to developmental issues.

Unfortunately, these treatments can also be expensive, especially when you have to pay out of pocket. Here's how to determine if your dental insurance will cover orthodontic care, along with tips to help you find a plan with comprehensive benefits.

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

Most major medical insurance plans don't provide coverage for dental care, which requires you to purchase a separate supplemental plan.

When it comes to orthodontic care, coverage will vary depending on the dental plan you choose and the individual provider. For kids under the age of 18, insurance companies are required to provide a dental insurance option that meets the requirements of the Affordable Care Act (ACA).

Dental plans for children will differ from one state to another, and some plans may require higher out-of-pocket costs for sealants, topical fluoride, preventive care, and/or fillings.

Some states require dental providers to cover all or part of the cost for braces, depending on the severity of the child's misaligned teeth. For example, if a child experiences pain or chewing difficulties, the policy may be required to cover all expenses.

In Colorado, residents can acquire dental insurance that provides partial coverage for orthodontics for both children and adults. Covered orthodontic services will typically include traditional braces and certain other specified dental care and treatments.

With that said, dental coverage will depend on whether orthodontia is medically necessary to correct developmental or debilitating issues. Since not every dental plan will cover orthodontic services, it's important to read individual plan materials carefully.

How can I get a plan that covers braces?

There are several ways to get dental insurance:

  • If you work for an employer that offers comprehensive dental insurance coverage, you can choose a plan as part of your employee benefits.
  • If not, you can buy one on your own through a health insurance carrier.

It can be helpful to compare available plans online, and most providers have an online search tool you can use. When comparing plans, it's important to carefully consider the available coverage, potential out-of-pocket costs, and the available provider network.

Does Medicaid cover orthodontic care?

In Colorado, Medicaid will only cover orthodontic treatment for kids and teenagers under 20. Adults on Medicaid who need orthodontic treatment will have to pay out of pocket or use a private insurance policy.

For kids under 20, Medicaid will typically pay for the full cost of braces, as long as the Medicaid dental examiner deems the treatment medically necessary.

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 the diagnosis, prevention, or treatment of a disease, injury, or related symptoms.

To get coverage, you and your dentist need to make the case that straighter teeth will treat one of the following maladies 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, note that most health insurance policies won't cover any cosmetic orthodontic procedures for patients over the age of 21.