Many patients with crooked teeth do not have a dental plan with orthodontia coverage, but most have health insurance through a private company or Medicaid.
Therefore, learning to get braces covered by medical insurance might be the best way to make orthodontic treatment affordable.
You must demonstrate that you have a medically necessary reason, which is more challenging to prove for adults than for children.
Your orthodontist can use our sample letter to improve your claim approval chances, a far better strategy than shopping for a new health insurance plan that covers braces.
The primary way to get braces covered by health insurance is to demonstrate that the orthodontia is medically necessary: the procedure prevents, diagnoses, or treats an injury, disease, or symptoms.
Table Of ContentsAdults over nineteen face the steepest hurdles when trying to get braces covered by health insurance because the list of medically necessary reasons is much shorter.
Free braces programs for adults are scarce also, as demand far exceeds the supply at dental schools and clinics. Therefore, you might need to explore alternatives if your needs are more cosmetic.
Payment plans are a viable alternative for adults when their health insurance denies claims for orthodontia because they do not have a medically necessary reason.
Monthly payment plans for braces spread the treatment costs out over time, making it easier to afford cosmetic treatment. A third-party finance company usually backs the program, relying on referrals from orthodontists who prefer their money upfront.
Buying a dental plan with orthodontic benefits is another reasonable option for adults when their health insurance denies claims for braces but requires patience to pay off.
Dental insurance for braces for adults without waiting periods is an unreasonable expectation. Issuing companies want no part of such a deal. However, you might be able to buy a plan that kicks in a year from now, providing significant discounts from in-network orthodontists.
Adults might get medical insurance to cover braces when orthodontia treats an injury, disease, or symptom. Some of these situations might qualify if you submit a well-supported letter of medical necessity (see sample letter below).
Getting your medical insurance to cover Invisalign for adults will prove incredibly challenging, even when your orthodontist builds an iron-clad case that the proposed treatment is medically necessary.
As a premium option, Invisalign is far more expensive than traditional metal braces. Your orthodontist must show that the clear aligner trays were indispensable and that lower-cost alternatives could not correct your TMJ or sleep apnea.
A Health Saving Account (HSA) sometimes covers cosmetic dental work that falls into a gray area. Even though the Invisalign clear trays serve an aesthetic purpose, they do straighten teeth and qualify for HSA reimbursement.
Children under nineteen have more opportunities to get health insurance to cover braces because the list of medically necessary orthodontic procedures is longer.
In addition to the accidents and illnesses applicable to adults, children can often get their medical insurance to pay for orthodontic work that corrects congenital deformities that result in physically handicapping malocclusions.
For instance, United Healthcare covers the correction of severe craniofacial deformities resulting from several specific conditions.
People often ask the wrong questions, and what health insurance covers braces is one. Shopping around for a new plan will not make your orthodontia more affordable, but submitting a letter of medical necessity to your existing carrier might!
Medicaid is the only health insurance that covers orthodontic braces without a medically necessary reason. This publically-funded program for low-income families often includes dental benefits that vary by state.
Each state defines handicapping malocclusion differently, but all use an indexing or point system that quantifies the misalignment of your child’s teeth.
Find an orthodontist that accepts Medicaid in your area. Then, work with this provider to document the severity of your child’s malocclusion using the point system required by your state. Submit the documentation to the Dental Benefits Manager administering your plan for pre-approval.
A sample letter of medical necessity is more likely to help your cause than asking what health insurance covers braces for adults. Shopping around for a new plan is a dead end, as issuing companies follow similar claims underwriting rules.
Submit a letter of medical necessity to your existing company to pre-certify your orthodontic treatment plan. Have your orthodontist include as many of these elements in the document as possible.
