Having OHP does not automatically mean that braces are covered. Orthodontic treatment must meet OHP’s coverage requirements and receive the required authorization. Your dentist will submit a referral to an orthodontist who will evaluate your teeth and bite and submit the necessary information to your dental plan. If treatment is approved, your plan can explain what is covered and what, if anything, you would owe. Always confirm coverage and authorization before starting treatment.
For the most current information, patients should check their OHP coverage letter/member ID card and dental plan, because benefits and authorization requirements can differ by plan.
When are orthodontics covered?
For members under age 21, OHP may cover orthodontics when severely crooked teeth cause problems with the following activities:
- Speaking
- Breathing
- Eating
- Sleeping
Members must have good oral health and any cavities must be treated first before starting orthodontics.
To find out if your child qualifies
See your OHP dentist. The dentist will:
- Do an evaluation of your or your child’s jaw, mouth, or teeth.
- Check for healthy gums and no cavities.
- Send the evaluation to your dental plan for approval. The plan will decide if orthodontic treatment is covered.
Frequently Asked Questions (FAQ)
My child has crooked teeth, but I don't know if it's serious enough to qualify. How will I find out?
The dentist will send the evaluation to your dental plan. The plan will decide if your child qualifies for orthodontic treatment.
What if my child has cavities?
Your child will need to have all cavities treated by the dentist before orthodontic treatment can begin.
Can adults qualify for orthodontic benefits?
The benefit is for OHP members who can begin orthodontic treatment before they are 21 years old.
If my child needs braces but we don't qualify, what can we do?
Ask your dentist or orthodontist about financing options or low-cost programs.
It's been a week and I haven't heard if my child is approved for braces.
The approval process may take a few weeks. You can call the dentist who did the evaluation and ask for an update.