Does insurance cover braces? This is a common question asked across dental offices and discussed in online forums because people haven’t quite understood the relationship between insurance and orthodontic treatment. We sought to find out the whole truth behind the insurance cover for brace and we talked to a professional from a top medical insurance service provider from Houston and he was more than helpful in providing useful information. Here is what he had to say on insurance and orthodontic treatment;
First of all, it is important to note that insurance is very important in orthodontic treatment. Without insurance, the cost of acquiring braces for example, is double the amount of getting the same braces with insurance. If you care about the dental health of your family therefore, it is therefore important to ensure that you are subscribed to medical insurance because you never know when you will need the braces. So, does dental insurance cover braces and any other cosmetic procedure?
A few policies and insurance providers may cover the cost of braces while some may not. Others will partially cover the cost of the braces and the rest will be paid by the patient. All this will depend on the specific insurance plan that one is subscribed to. For most insurance companies, the premium plans offer the most comprehensive covers and will most likely cover for the cost of the braces. The reason for the braces will also play a vital role in determining whether the insurance will pay for the braces or not. If the insurance company deems the braces treatment as cosmetic and not necessary per se, then they most likely are not going to pay for the braces. If the braces are a requirement or are needed because of an accident or a dental complication that could not be avoided, then most insurance companies deem such as necessary treatment and will facilitate the payment for the braces.
It is very rare for insurance companies to cover cosmetic procedures. Unless the patient has a medical need recommended by the dentist, the insurance company will not oblige and pay for the cost of the braces. This is especially true for adults because most children who get braces get them for medical reasons. This is why there is a higher number of children whose orthodontic treatment is covered by insurance than that of adults. Most adults in truth, get braces for the sake of cosmetics and improving their aesthetics and such is not covered by medical insurance companies.
You must also understand that all dental plans have an annual limit referred to as a cap. This limit or cap dictates the amount of money they will pay put for services over the course of a year. This means that once you reach the upper limit, the insurance company will no longer be responsible for the payment of your services for the rest of the year. Considering that medical braces and other cosmetic procedures can be very expensive, they may end up wiping out any further benefits from your insurance service provider for the rest of the year. Even for people subscribed to the most premium insurance plans, risk exceeding the insurance cap the moment they start including the orthodontic treatment as part of the services covered by insurance. The decision in such a scenario rests with you the patient. Choose to use the benefits all at once or pay for the orthodontic treatment using separate means and continue enjoying the benefits of insurance for the rest of the year.
There are some dental insurance plans that set a waiting period for certain procedures. Some companies include orthodontic procedures as part of this program while some don’t. It is therefore wise to check with your service provider to be absolutely sure that braces are included in the program.
There is the other option of Medicaid and Medicare that offers to cover for orthodontic procedures. Most hospitals accept Medicaid for general dental services but they deem braces and other orthodontic procedures as a specialty service and therefore the benefits may vary from one state to another. If you are eligible for Medicaid then, you should ask for its eligibility in your state and sometimes it may cover the cost of getting braces especially in young children.
As we have seen, it can be a daunting task to try and find out what is covered and what is not covered as far as insurance is concerned. The best thing to do therefore is to always contact your insurance service provider about the benefits you can enjoy as a patient and whether orthodontic procedures are covered as well. It is also important to seek guidance from your dentist especially on matters such Medicaid because some hospitals accept it while others simply don’t. Contact us here at Vita Dental Houston with any questions about dental insurance coverage and braces and we will gladly help you out.