Question

Do ACA plans cover orthodontics for children?

Yes, but the orthodontic benefit is very limited. Pediatric orthodontic coverage is available only if medically necessary. Prior review and certification are required. Severe orthognathic problems do qualify (cleft palate, severe occlusion issues, etc.), but misalignment (teeth with a stable occlusion) does not qualify a patient for orthodontic benefits. Medical necessity is required to receive orthodontic benefits. In addition, a waiting period (typically 12 months) is often mandated. There are various payment options. Phase I treatment may be paid in one total fee while Phase II treatment may be divided into multiple payments. 

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