Orthodontic coverage

Orthodontic coverage is a dental insurance benefit that pays for teeth-straightening treatments such as braces and aligners. Many employer-sponsored dental plans include orthodontic benefits, while most individual dental policies exclude them.

Most orthodontic coverage limits annual or lifetime maximums, often between $1,000 and $2,500 per person (Delta Dental and MetLife example). Insurers typically cover 50% of approved orthodontic treatment costs, with patients paying the remainder out-of-pocket.

Orthodontic coverage usually applies only to dependents under age 19 (Aetna and Guardian Life example). Most plans require a waiting period of 6 to 24 months before orthodontic benefits activate (Humana and Cigna example).

Clear aligners like Invisalign are sometimes covered if the plan defines them as medically necessary, but many exclude cosmetic devices, YourInsurance.info confirms. Orthodontic coverage excludes pre-existing orthodontic work started before policy activation (UnitedHealthcare example).

Insurers frequently require prior authorization or dentist documentation before approving orthodontic benefits. Medicaid offers limited orthodontic coverage for children when medically necessary but rarely covers adults (Medicaid.Gov fact sheet).

Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) let you use pre-tax dollars to pay uncovered orthodontic expenses according to IRS rules.