Does My Insurance Cover Orthodontic Treatment?
There are many different types of dental insurance plans, PPOs, DMOs, Medicaid, Union dental plans, and discount dental plans, each having different rules and restrictions on coverage for braces (or Invisalign) and sorting out these differences can be a daunting task.
The most common type of dental insurance are PPOs also known as Preferred Provider Organization – most people have these. These plans are usually offered through your employer and are accepted by almost all dental offices. PPO plans usually allow a fixed amount for you to apply toward the cost of your orthodontic treatment. If you have a PPO plan, here are a few things you should find out.
If you are unable to figure these things out, our front desk staff at MBO can assist in verifying your orthodontic benefits when you come in. With all PPO plans, phase 1, metal braces, clear braces, or Invisalign treatment options should be covered. The most common insurance carriers that offer PPO dental plans are Metlife, Aetna, Cigna, Delta, GHI, and Guardian. MBO participates in all major PPO networks.
PPO Insurance Plans
- Does my plan have orthodontic benefits?
- What is the lifetime maximum coverage amount?
- Are there any age limitations?
- Who does the orthodontic benefit apply to? Myself only or my dependents as well?
- Are there any waiting periods?
DMO or DHMO Insurance Plans
DMO or DHMO are also known as Dental Health Maintenance Organizations. You must select a primary care dentist within the network who will be responsible for coordinating all of your dental needs. Your primary care dentist would need to write a referral for you to see a specialist only when he deems it necessary and orthodontic benefits are usually none or very limited.
Medicaid, Child Health Plus, Family Health Plus, and other Government health plans
To qualify for braces under these government sponsored plans, the patient must be under 21 years old and meet strict severity standards. MBO does accept these plans and would assist in submitting diagnostic records and paperwork for approval only if you meet the severity guidelines. If approved, only metal braces are allowed – you cannot opt for clear braces or Invisalign.
Union Dental Plans
If you are a member of a local worker’s union such as, 1199, 32BJ, DC37, or any other, orthodontics may be covered by the union. Each union will have their different benefits levels and policies about coverage. A pre-determination request and approval is always required prior to starting any treatment.
If approved, similar to PPO plans discussed above, payouts are always prorated over a 24 month period.
No Dental Insurance? Interested in Orthodontic Treatment?
If you do not have or are unable to qualify for coverage, please note that our treatment fees are highly competitive and we do have many interest free payment options for you to select from. If you are ready to get started, start here by scheduling an appointment. We offer free consultation for patients visiting our office for the first time.
