Dental health is important for maintaining overall well-being. One common concern for many people is how to pay for braces. If you’re considering braces to straighten your teeth, understanding your insurance coverage is a key step. Many dental insurance plans, including Aetna, offer different levels of coverage for orthodontic treatments. In this article, we will explore if Aetna dental insurance covers braces, the types of coverage available, and how to determine if your plan includes orthodontic care.
What is Aetna Dental Insurance?
Aetna is one of the leading health insurance providers in the United States. They offer various types of insurance plans, including dental coverage. Aetna dental insurance helps individuals and families pay for dental care, including preventive services like cleanings and exams, as well as more complex procedures such as fillings, root canals, and orthodontics.
Aetna provides dental insurance through employer benefits or individual plans. Each plan offers different levels of coverage, so it’s important to understand the details of your specific plan.
Does Aetna Dental Insurance Cover Braces?
Yes, Aetna dental insurance can cover braces, but coverage depends on the specific plan you have. Not all Aetna plans offer orthodontic benefits. To know if your Aetna plan covers braces, you need to check the details of your policy.
Types of Aetna Dental Plans
Aetna offers several types of dental plans, and each one may offer different coverage for braces. Here’s an overview of the main types of plans Aetna provides:
Aetna PPO (Preferred Provider Organization) Plans
PPO plans typically offer a wide network of dental providers. These plans usually cover braces for children, and some may also cover braces for adults. However, the coverage may come with age restrictions, and the plan may limit the amount it pays for orthodontic treatments.
Aetna DHMO (Dental Health Maintenance Organization) Plans
DHMO plans usually have lower premiums but fewer choices of providers. These plans may offer orthodontic coverage, but they typically require that you use in-network orthodontists. Additionally, the coverage may be more limited than a PPO plan.
Aetna Indemnity Plans
Indemnity plans give you more flexibility to choose any dentist or orthodontist. However, these plans are less common today. If you have an indemnity plan, check to see if orthodontic coverage is included and what the terms are.
Does Aetna Cover Adult Braces?
Aetna dental insurance often covers braces for children, as orthodontics is considered a medical necessity for correcting developmental dental issues. However, when it comes to adult braces, coverage can be more limited. Some Aetna plans may cover adult braces if they are deemed medically necessary, such as in cases where misaligned teeth are causing other health issues like difficulty chewing or speaking.
For purely cosmetic reasons, Aetna dental insurance typically does not cover adult braces. If you’re considering braces for cosmetic purposes, you may need to pay for the treatment out-of-pocket, or explore financing options.
Does Aetna Cover Braces for Children?
In most cases, Aetna covers braces for children, especially if they are deemed medically necessary. Orthodontic treatment for children is often covered because it is common to correct alignment issues during their developmental years. Aetna’s coverage for children’s braces may include:
Traditional metal braces
Ceramic braces
Invisalign or clear aligners (though this may depend on the specific plan)
To qualify for coverage, you may need to meet certain eligibility criteria, such as age limits or approval from a dentist or orthodontist that the treatment is necessary.
What Does Aetna Orthodontic Coverage Include?
Aetna’s orthodontic coverage varies depending on your plan, but typically, it includes a range of services related to braces. Some of the services that may be covered by Aetna dental insurance include:
1. Initial Consultation
Most Aetna plans will cover an initial consultation with an orthodontist to determine if braces are necessary. This consultation may include an exam and X-rays to assess the alignment of your teeth.
2. Braces Installation
If braces are deemed necessary, Aetna dental insurance may cover the cost of installing braces. This coverage may include the installation of traditional metal braces, ceramic braces, or clear aligners, depending on your plan.
3. Regular Adjustments and Checkups
Braces require regular adjustments and visits to the orthodontist. Aetna may cover the cost of these visits, which typically occur every 4 to 6 weeks.
4. Retainers
Once your braces are removed, you may need to wear a retainer to keep your teeth in place. Some Aetna plans cover the cost of retainers, though this may depend on the specifics of your plan.
5. Invisalign or Clear Aligners
Some Aetna plans also cover Invisalign or clear aligners. These options are less visible than traditional braces, and they are often used for adults. However, not all plans include coverage for clear aligners, so you should check your specific policy to see if this treatment is covered.
What is the Cost of Braces with Aetna Dental Insurance?
The cost of braces can vary widely based on factors like the type of braces you need, the duration of treatment, and your location. Aetna may cover part of the cost, but you will likely need to pay a portion out-of-pocket.
Deductibles and Co-pays
Aetna plans typically have deductibles and co-pays for orthodontic treatment. This means that you may need to pay a certain amount out-of-pocket before your insurance coverage kicks in. The amount you pay can vary depending on your plan.
For example, Aetna might cover 50% of orthodontic expenses after your deductible has been met. This means you would pay the remaining 50%, which can be a significant amount. Some plans also have an annual maximum benefit, which limits how much the plan will pay for orthodontics in a given year.
Out-of-Pocket Costs
Even with insurance, the out-of-pocket costs for braces can be substantial. In some cases, the full cost of braces may range from $3,000 to $7,000, depending on the type of braces you choose and the length of treatment.
To reduce out-of-pocket costs, some people choose to use Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs) to cover orthodontic expenses.
Lifetime Maximum Benefit
Many Aetna dental plans have a lifetime maximum benefit for orthodontic treatment. This means that the plan will only pay a certain amount over the life of the policy for orthodontic care. Once you reach this limit, you will be responsible for paying the remaining costs.
How to Determine If Your Aetna Plan Covers Braces
To find out if your Aetna plan covers braces, you can follow these steps:
Review Your Plan Documents
The best way to understand your coverage is to review your Aetna dental plan documents. These documents should outline what is covered, including orthodontics.
Contact Aetna Customer Service
If you have questions about your coverage, you can contact Aetna customer service for clarification. They can help you understand your benefits and explain any limitations or exclusions related to braces.
Speak to Your Dentist or Orthodontist
Your dentist or orthodontist may be able to help you understand your insurance coverage. They can also assist with submitting any necessary paperwork to Aetna for approval.
Request Pre-Authorization
If you’re unsure whether braces will be covered, you can request pre-authorization from Aetna. This involves submitting a treatment plan to Aetna for approval before you begin the treatment.
Alternatives to Aetna Coverage for Braces
If Aetna doesn’t cover braces, or if your plan provides limited coverage, there are other options available:
1. Payment Plans
Many orthodontists offer payment plans that allow you to spread the cost of braces over time. This can help make the treatment more affordable.
2. Financing Options
There are third-party financing companies that specialize in helping people pay for braces. Some orthodontists partner with these companies to offer low-interest or interest-free financing options.
3. Medicaid and State Programs
If you meet certain income requirements, you may be eligible for Medicaid or state-funded programs that cover orthodontic treatment.
Conclusion
Aetna dental insurance can cover braces, but it depends on your specific plan. Coverage for children’s braces is more common than for adults, and the cost of treatment can vary. It’s important to review your plan documents or contact Aetna customer service to understand your coverage. If your plan doesn’t offer full coverage, there are alternative payment options available to help make braces more affordable.
By understanding your Aetna dental insurance and exploring all available options, you can make an informed decision about your orthodontic care.
Related topics:
