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Does Insurance Cover Adult Orthodontics?

Some dental insurance plans offer an annual or lifetime maximum benefit for adult orthodontics. Unfortunately, most dental plans do not provide coverage. However, in some cases, orthodontics can be a medical necessity. If referred by your dentist because of a medical issue, you should attempt to verify coverage with your medical healthcare insurance provider. If you plan to get orthodontic treatment, contributing to an HSA or FSA account can help finance your treatment. 

What if a problem comes up and I can’t make my payment?

If you are unable to make your payment(s) for orthodontic treatment, communicate that to your orthodontist immediately. The orthodontist needs to be aware of this change in your circumstances.

Do I have to sign a contract?

Typically, a contact is signed when you decide to move forward with orthodontic treatment.

Do orthodontists take credit cards?

Many orthodontists accept major credit cards. Check with your orthodontist’s office about whether credit cards are accepted as payment, and if so, which ones.

How do I find an orthodontist who takes my insurance?

To find an orthodontist who takes your insurance you can:

  • Call 48ͼ orthodontists to ask if they accept your insurance
  • Contact your insurance company and request a list of their providers

Just because an insurance company lists someone as a provider of orthodontic treatment, it does not guarantee that the doctor is an orthodontist. To be sure any provider truly is an orthodontist, use the 48ͼ’ (48ͼ) Find an Orthodontist service. The 48ͼ only admits orthodontists, who have training in the orthodontic specialty, as members. Selecting an 48ͼ orthodontist for orthodontic care is your assurance that the doctor is an orthodontist.

I do not have employer-provided insurance for orthodontic treatment. Can I buy insurance myself?

Yes, you can purchase orthodontic insurance.

Does insurance cover orthodontic treatment?

Many people have dental insurance that includes orthodontic benefits, usually provided by their employer. Such insurance covers a portion or percentage of the fee for orthodontic treatment, many times there may be a specific dollar amount or lifetime cap.   If your dental insurance is through your employer, your human resources department may be able to provide coverage details. The information can also be obtained directly from the insurance company. With your permission, the orthodontist may be able to confirm your insurance benefits for you, such as:

  • The amount of coverage or the percentage of the fee covered
  • If there any limitations to your coverage are specified
  • Whether you are required to choose from the insurance company’s providers

Not all providers used by insurance companies to provide orthodontic treatment are orthodontists. To be sure any provider you are interested in using is an orthodontist, check the Find an Orthodontist service, where you will find members of the 48ͼ (48ͼ). The 48ͼ only admits orthodontic specialists as members.

Can I use my flexible spending account or health savings account funds for orthodontic treatment?

Yes, funds from flexible spending accounts and health savings accounts can be used to pay for orthodontic treatment. Talk to your orthodontist about how to make the best use of your benefits.

Do I have to make a down payment?

A down payment may or may not be required. Speak with your orthodontist or their team members about payment plans that are offered.

Do orthodontists offer payment plans?

Yes, most orthodontists offer a variety of payment plans to make orthodontic care fit your budget. Payment plans offered can vary from orthodontist to orthodontist.