Orthodontic info
Will dental insurance cover a replacement retainer?
No, under most plans: replacements are "an out-of-pocket expense," in the words of the American Association of Orthodontists (AAO), because "most plans include retainers as part of the initial orthodontic package," and your own plan's orthodontic terms decide whether yours is an exception.
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A lost or broken removable retainer comes before any insurance question: the AAO's advice is to "contact your orthodontist immediately about a replacement." Whether the plan pays for that replacement is the plan's answer, not the practice's.
Does a plan's orthodontic package include the first retainers?
Most plans include retainers, by the AAO's account, "as part of the initial orthodontic package." Carvalho & Roth Orthodontics offers clear removable and fixed bonded retainer options, and whether your treatment plan includes the first retainers is a question to raise at the consultation, where the cost of Invisalign or braces is explained.
Why is a replacement an out-of-pocket expense under most plans?
A replacement falls outside the initial orthodontic package the AAO describes, which is why the AAO calls replacements "an out-of-pocket expense" under most plans. The AAO also notes that with proper care retainers can last many years, but like any other device they likely will need to be replaced at some point, which makes the plan's answer worth knowing early. A plan's documents can carry the same answer in their exclusions and frequency limitations.
The practice will help with any insurance forms and paperwork if necessary, and its post on what to do if you break or lose your retainer lays out how a replacement appointment is set up.
What does the AAO say about FSAs and HSAs for a replacement?
The AAO's answer on replacement retainers also says "most plans allow you to utilize Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs) to help reduce the cost," a statement about plans in general rather than a rule of any one account. Whether an account pays for a replacement retainer is decided under the IRS rules and that account's own plan, which the page on FSA and HSA rules for braces or Invisalign walks through. Payment plans are among the options on the practice's financial and insurance page.
Questions to put to your plan about a replacement retainer
MouthHealthy, the American Dental Association's consumer site, says you can call your plan at the telephone number on your identification card or go to its website, and either can answer questions like these:
- Does the orthodontic benefit name retainers, and does it cover a replacement?
- Is a replacement listed as an exclusion, or limited by how often it can be covered?
- Does the plan treat a removable retainer differently from a fixed one?
- Does the benefit for retainers end when active treatment ends?
Questions
Frequently asked questions
Who can confirm whether my plan pays for a replacement retainer?
The plan can: the American Dental Association says payers make specific benefit information available to patients through their websites, benefit booklets and customer service lines. For a plan that comes through work, the American Association of Orthodontists says your human resources department may be able to provide coverage details.
What is the difference between an exclusion and a frequency limitation?
An exclusion, in the American Dental Association's CDT glossary, is a dental service not covered under a dental benefit program, while a frequency limitation, as MouthHealthy, the ADA's consumer site, puts it, means dental plans "may limit how often a particular service will be eligible for coverage." Either term, written into a plan's orthodontic section, can explain why a replacement retainer is not covered even when the first retainers were.
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