I. Basic coverage of medical insurance
Medicare, or health insurance, is primarily designed to guarantee basic medical care for insured people when they face illness or accidents. It usually covers the costs of medically necessary examinations, treatments, medicines and other expenses. However, the coverage of health insurance is not unlimited, and it is affected by a variety of factors such as policies and budgets.
The Nature of Orthodontics
Orthodontics, such as braces, is mainly about improving the alignment and aesthetics of the teeth rather than treating disease. Therefore, by nature, it belongs more to the category of cosmetic or health care rather than medically necessary treatment.
Three: Differences in health insurance policies
Health insurance policies may vary from region to region. Some regions may reimburse certain dental treatments, but this is usually limited to dental injuries due to illness or accidents. For routine orthodontics, most areas are not reimbursed by health insurance policies.
Four, Other Payment Options
While health insurance may not cover the cost of orthodontics, patients may still be able to pay for it in other ways, such as out-of-pocket expenses and commercial insurance. Some commercial insurance companies offer insurance plans that cover orthodontics, which patients can choose to purchase according to their needs.
In summary:
Braces are usually not reimbursed by health insurance because they fall more under the category of cosmetic or health care than medically necessary treatment. However, the exact reimbursement will depend on the local health insurance policy. For patients who need orthodontic treatment, they can pay for it out of pocket or through commercial insurance.
Legal basis:
The People's Republic of China Social Insurance Law
Article 28 stipulates that:
Medical expenses that are in line with the basic medical insurance drug catalog, diagnostic and therapeutic items, standards of medical service facilities, as well as those for emergency and rescue, shall be paid out of the basic medical insurance fund in accordance with state regulations.