Your child needs braces. Whether you’ve been setting money back in preparation for this common “rite of passage,” or you are feeling uncertain as to how you will pay for such treatment, you’re not alone. Knowing how and where the money will come from to pay for your child’s orthodontics can be a worrisome event; however, if you have dental insurance, you may be relying on their help to cover a portion of the total cost. But will it make a difference? Does your plan even offer orthodontic treatment coverage? Read on to learn why it’s best to get your child or teen the care they need early on.
Will Dental Insurance Provide Orthodontic Coverage?
Every dental insurance company is different. This means you may or may not have available coverage for your child’s orthodontics. Most policies, however, do provide some level of coverage but there can be restrictions that you will need to understand before moving forward with treatment.
When seeing an orthodontist, they may recommend braces because their teeth or bite are causing problems when eating or speaking. If this is the case, there is a very good chance that your dental insurance will pay a portion of the cost. However, if the orthodontist is recommending orthodontia for aesthetic reasons, you’ll likely need to pursue an alternative option as payment since this method of treatment is not considered “medically necessary.”
What Services Are Considered “Orthodontic” and Are Eligible for Coverage?
Again, not all dental insurance companies will include the same limitations, restrictions, and allowances, so you’ll need to speak with a representative to better understand what is viewed as “orthodontic coverage.” The following services, however, are most commonly provided by an orthodontist and may be considered eligible under “orthodontia” in your policy:
- Orthodontic consultation and exam
- Tooth extractions
- Follow-up treatment visits
- Orthodontic appliances (i.e., retainers, palate expander, jaw repositioning devices, braces, space maintainers, aligners)
You can choose to purchase a dental plan through your employer or individually, but you’ll want to make sure the policy you choose contains adequate orthodontic coverage. Naturally, you’ll incur out-of-pocket expenses, which are ultimately calculated based on your deductible, annual maximum, co-pays, and any exclusions.
Also, do not forget to check the different rates that come with seeing an in-network versus out-of-network provider. Although you may be able to receive treatment, you’ll likely pay much less by choosing to see someone who is in-network with your insurance company.
About the Author
Dr. Marissa Mikolich has more than a decade of experience helping her patients achieve beautiful smiles. She obtained a doctoral degree in dentistry from The University of Pennsylvania School of Dental Medicine before going on to receive a master’s degree in oral biology from The Ohio State University College of Dentistry. She and her team at Mikolich Orthodontics will walk you through the entire process of orthodontic treatment from start to finish and assist when it comes to navigating the financial side of braces. If you or your child are looking for an orthodontist near me, contact us via our website or by calling (330) 967-4110.