Does Health Insurance Cover Orthodontics?
Health insurance plans generally do not cover orthodontics. Orthodontic care does not fall under the realm of health insurance but rather, under the realm of dental insurance.
Not all dental insurance plans cover orthodontics, either. Those that do have orthodontic coverage typically have specific stipulations you must follow to be eligible for coverage.
Why would I want or need orthodontics?
Sometimes the need or desire for orthodontics is obvious. Visibly crooked teeth, gaps between teeth, or major bite misalignments might be something you know you want fixed. The overall goal of orthodontics is to produce what the industry refers to as a good bite, which is a bite where the upper and lower teeth properly align.
If you suffer from a bad bite, it can affect your appearance as well as the way you chew, eat, and speak. Leaving a bad bite to fend for itself, so to speak, can eventually cause pain and disrupt your jaw’s normal functioning.
Even if you don’t experience any problems or issues with the way your jaw functions, your orthodontist may note less-obvious issues that would do well with correction. Then there are always the issues that are more cosmetic in nature, such as a gap in the teeth that won’t cause any ill effects on the bite, but may be detrimental to a person’s self-esteem because it deters from their appearance.
The American Association of Orthodontists says that people can receive orthodontic treatment at any age, although it is sometimes most effective in teenagers who are still growing. If the jaws and teeth are still developing when treatment is applied, it can make it easier to correct issues. The Mayo Clinic says the usual time for braces is after all baby teeth are gone and most of the permanent teeth have appeared.
A number of signs can point to the need for orthodontic treatment for you or your child. Children who suck their thumbs may be affecting the alignment of their bites, as do kids who suck their fingers or consistently have other oral habits such as teeth grinding. Children who lose their baby teeth early or later than average may also want to see an orthodontist.
If you or your child have trouble biting, chewing, or speaking because of your teeth, a trip to the orthodontist may be helpful. Other signs include breathing only through your mouth, teeth that protrude, noises or shifting in your jaw, and teeth that constantly scrape or bite the interior of your mouth.
Teeth that are crowded or growing in the incorrect areas can merit a trip to the orthodontist, as can a misalignment of top and bottom teeth, teeth that meet abnormally, or asymmetry in the face that may be caused by a dental issue.
If you or your child make a habit out of grinding your teeth or cannot close your lips comfortably around your teeth, it may be time to schedule an orthodontic appointment. Your dentist may also suggest you see an orthodontist if he or she notices issues. Your first visit with an orthodontist only needs to be a consultation where you can learn about treatment options and costs.
What kind of orthodontic treatments are available?
The standard treatment of metal braces is still available, but you may also have other options. The exact treatment option that may work for you depends on your specific issues. Orthodontic treatment has advanced to include braces that are the same color as your teeth, braces that fit behind your teeth, and clear alignment units that fit between the teeth.
Retainers may be part of the treatment to help ensure your teeth stay properly aligned once braces are removed. Retainers usually only need to be worn for a set amount of time until it’s certain your teeth are stabilized. Other possibilities may also be available, although costs can vary greatly among treatment types and dental plans may be very specific with what they cover.
What type of stipulations would pertain to orthodontic care?
Dental plans may only deem you eligible for coverage if you meet their specific requirements. Such requirements may include only certain types of treatments, using orthodontists in the insurance’s network, and the start date of treatment. Some plans may not cover work that has already begun nor will they retroactively reimburse you for work that has already been completed.
Other plans may cover treatments that began under your previous insurance company’s coverage. Most plans have a lifetime maximum that will only pay up to a certain amount regardless of how much your total treatment plan may cost.
Dental insurance companies may also ask you to provide them with information before they even tell you what may or may not be covered under your plan. In such cases, you may need to obtain a pre-treatment estimate of what the orthodontist says needs to be done and how much it will cost.
The wisest thing to do before even scheduling a consultation with an orthodontist is to review what your dental insurance covers. You may be able to increase your coverage and level options to include orthodontics, but be forewarned some dental plans may have an extended waiting period before your new orthodontic coverage goes into effect.