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Does Insurance Cover Braces?

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Does Insurance Cover Braces?

One of the MOST complicated conversations we have with new patients in our office is often not about their orthodontic treatment plan, but rather about how their insurance applies to helping pay for the costs of orthodontic treatment.  Indeed, insurance IS VERY complicated, and in this post we will simply hope to shed light on some of its key elements and characteristics.  While we will likely not answer all questions, we hope we help clarify some of the most common questions.

Medicaid             In the state of SC, orthodontics is not covered by Medicaid Insurance. There is a program through Medicaid, Children with Special Health Care Needs (CSHCN), in which orthodontics is covered.  Patients must pre-qualify for this program by having an orthodontist complete a scoresheet and submit it to the CSHCN office.  Dr. Lewis’ office works closely with CSHCN and can complete scoresheets for our patients.

Group Insurance              Most larger companies have group dental insurance plans, and a majority of those plans cover orthodontic treatment. Group orthodontic insurance can also be complicated.  Most plans cover at a certain percentage (50%) up to a lifetime maximum.  That lifetime maximum is usually $1000 to $2500.  At Dr. Lewis’ office we will confirm insurance coverage for our patients.  We also file insurance and accept assignment of benefits (which means we will let the insurance company pay us directly).   So what happens when the patient is a child and is covered under more than one plan (say mom and dad’s)?  This leads to a highly complex situation.  It’s possible to get coverage under BOTH plans, and we will also verify this coverage pre-treatment.

Private insurance            When it comes to private insurance, things actually can be more complicated.  Most of the private plans out there can actually cost more than the benefit you receive, especially if you join the plan just for orthodontic treatment.  Make sure to look at these plans closely (the monthly cost, how long you are required to keep the insurance, and the benefit provided).

Does Insurance Cover Invisalign?             Another question we get all the time is, “does Insurance cover Invisalign?”  Most all plans that cover braces DO indeed cover Invisalign as well.  This has changed in recent years, and now nearly every plan that covers metal braces will also cover Invisalign as well.  Typically, the level of insurance coverage is the same.

Just because you have dental insurance does not mean that there is orthodontic benefits coverage on the plan.  This is a great question to determine if you are thinking about braces for someone in your family BEFORE signing up for a specific plan.  Assuming your dental insurance is done through your employer, the question about orthodontic coverage is a great one to ask your HR rep before deciding on what plan is best for your family.

So hopefully this begins to shed some light on how dental insurance works for orthodontics.  If you live in the Upstate area and have additional questions, give Tina a call and she’ll be happy to answer any questions you might have.

No matter what your coverage, we can work out an interest-free payment plan that helps getting a beautiful smile for you and your family an affordable and attainable goal.  Dr. Lewis is a highly trained orthodontic specialist and all assistants in our practice are certified orthodontic assistants through the American Association of Orthodontics.

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