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What Does Orthodontic Insurance Cover?

Posted: June 19, 2024

Does the idea of affordable insurance to keep your family’s smiles healthy make you grin? If so, you may be interested in finding an orthodontic insurance policy.

Orthodontic coverage is insurance that pays for orthodontic health care. Orthodontia includes diagnosis, prevention and treatment of dental and facial irregularities to align teeth and jaws correctly. As an extension of a broader dental plan, orthodontic insurance provides full or partial coverage of orthodontic health care for qualifying clients.

You can access orthodontic insurance as an individual or as part of a larger family or business package. Solutions offered through your company will typically be the most affordable, but they may not provide a wide range of options.

Each policy is unique, so it’s important to check what a policy covers before making a decision. Some specific items that orthodontic insurance can cover include:

  • Examinations
  • X-rays
  • Braces
  • Retainers
  • Aligners
  • Bite correctors
  • Space maintainers
  • Jaw surgery

While healthy, properly aligned teeth and jaws are important to our well-being, these treatments can be costly without insurance. Orthodontic coverage can make procedures like these much more affordable.

Are you considering expanding your dental plan to keep your teeth and jaws in line? This article will answer your FAQs related to orthodontic insurance and what it covers.

Does Dental Insurance Cover Orthodontics?

Not all dental insurance policies include orthodontic coverage. Those that do usually offer partial rather than full coverage and only apply to a limited number of procedures. The scope and extent of coverage, as well as the criteria to qualify for it, vary from one policy to another. It’s important to look at the terms of your dental policy to see if orthodontic care is covered.

If your dental plan does not cover orthodontia, you can consider buying orthodontic coverage as an extension to your policy or switching to a dental policy that includes orthodontics.

Does Insurance Cover Braces for a Child?

It’s typical for dental insurance plans to cover braces for children and teenagers under 18. This is good news since braces for your child can cost $5,000 to $6,000 or more without insurance.

Braces can keep your child’s smile healthy and help prevent orthodontic issues as they grow up. Childhood is the time that orthodontic issues are the easiest and most affordable to correct, so the American Association of Orthodontists recommends that you begin checkups and any necessary interventions from age 7.

Check your dental plan and ensure you understand the orthodontic coverage it offers, should your child need braces. If it doesn’t, an orthodontic insurance policy can meet that need.

Does Insurance Cover Braces for Adults?

Orthodontic insurance can cover braces for adults. Most basic dental insurance plans will not cover braces for individuals older than 18. Although braces are usually worn during childhood, a quarter of orthodontic patients getting braces are over 18. This means most dental plans do not cover many who could benefit from braces.

If you are over 18 and would like coverage for braces, you can look for orthodontic insurance that offsets the initial and maintenance costs for adult patients.

Does Medicaid Cover Braces?

Medicaid, known as Medi-Cal in California, covers braces under certain conditions. Braces must be a medically necessary intervention for the patient for California’s Medicaid coverage to apply. Medi-Cal will not cover braces for cosmetic purposes.

Medi-Cal can assist with a limited set of orthodontic treatments. These generally include cases of malocclusion, cleft palate or craniofacial anomalies that are considered handicapping and require medically necessary treatment. The coverage is limited to individuals aged 21 or younger.

What Is an Orthodontic Lifetime Maximum?

An orthodontic Lifetime Maximum is the highest total amount that your insurance policy will pay for any orthodontic care over your entire life or as long as you have that policy.

Since this is the maximum amount of coverage available for the policy’s full term, it is not renewed at any point. The only way to access additional coverage once you have reached your Lifetime Maximum is to take out a new policy if you are eligible for one.

When comparing dental or orthodontics coverage policies, it’s important to consider the Lifetime Maximums they offer. Different insurance providers offer policies with varying Lifetime Maximums. You’ll want to choose a policy with a Lifetime Maximum that is adequate for your needs.

Is Orthodontic Insurance Worth It?

Orthodontic Insurance could be a worthwhile addition to your insurance portfolio. There’s more to orthodontics than just a pretty smile. It’s true that orthodontic treatments have helped people achieve a smile that gives them more confidence. However, the benefits of orthodontic care go beyond the cosmetic.

Orthodontists work to maintain and restore healthy teeth and jaws. There are many benefits of orthodontic health, including:

  • A pain-free eating experience
  • Reduced choking risks through better chewing
  • Improved digestion
  • Stronger teeth
  • Resilient jawbones
  • Disease-resistant gums
  • Prevention of dental emergencies
  • Superior oral hygiene
  • Better breath
  • A winning smile

Millions of Americans have or need braces, and over half of U.S. adults have alignment problems with their teeth. Considering these facts alongside the high costs of uninsured treatment by a reputable orthodontist, there’s a good chance that orthodontic coverage can help you afford care that improves your and your family’s quality of life.

Whether orthodontic insurance is worth it for you depends on your unique financial situation and priorities. Not all policies are equal, and not all good policies are equally relevant to you. Consider orthodontic coverage policies individually and compare them to make an informed decision.

Find the Right Orthodontic Insurance for You

If you want to take out orthodontic coverage, you can benefit from professional help in making sense of all the competing options. The right orthodontic insurance can keep you and yours smiling through every season of life.

Health for California is here to help you find the best coverage for your needs and budget. Whether you’re uninsured or considering a switch, our quick online form will find an ideal quote for you. This is a 100% free service designed to help you make the best insurance choice for yourself, your family or your business.

Our application process is personalized. We pay attention to who you are and what you need. From there, we compare policies from some of the most trusted providers of insurance in California to find your perfect coverage.

If you have questions about choosing the right orthodontic insurance, call us today for free guidance from our helpful agents.