Using Aetna for Orthodontics in Midlothian, VA: Step‑by‑Step

Orthodontist That Accepts Aetna in Richmond, VA

Looking for an orthodontist that accepts Aetna? Horsey Orthodontics is in‑network with many Aetna plans and helps you understand exactly what’s covered before treatment begins. Our team verifies your benefits, outlines expected coinsurance and lifetime maximums, and provides a written estimate so you can choose the right option with confidence. Explore treatment choices like braces or clear aligners and see how Aetna benefits apply.

Quick answer — Yes, we accept Aetna

• Aetna accepted for braces and clear aligners (coverage varies by plan)
• In‑network discounts and out‑of‑network differences explained at your visit
• Complimentary benefits check before your first appointment — request your free consult

What Aetna typically covers for orthodontics

Common plan types

• PPO vs DMO differences
  • PPO: Usually lets you see any orthodontist; in‑network providers mean lower negotiated fees.
  • DMO: Often requires choosing a primary dentist/orthodontist and may have referral rules.
• Child vs adult orthodontic coverage
  • Many Aetna employer PPO plans include comprehensive coverage for children; on some plans, the appliance must be placed prior to age 19.
  • Adult orthodontic coverage is often excluded or limited on many Aetna plans, particularly Medicare Advantage options, which exclude orthodontics in 2025.

For a deeper dive, see our Aetna guides for Richmond and Henrico: Making Your Aetna Plan Work and Using Aetna for Orthodontic Care (Henrico, VA).

Covered treatments (varies by plan)

• Metal and ceramic braces
• Clear aligners (e.g., Invisalign‑type systems)
• Phase 1/interceptive care for kids — learn more about early orthodontics

Key terms to know

• Lifetime orthodontic maximum: The total Aetna pays per member over a lifetime (not per year).
• Coinsurance/percentage paid: The portion Aetna pays (e.g., 50%) up to your lifetime max.
• Waiting periods and exclusions: Some plans require time in the plan before benefits apply or exclude certain services.

Note: Coverage details vary by plan and employer. We’ll confirm your specific benefits before treatment.

In‑network vs out‑of‑network — how it affects your costs

• Negotiated in‑network fees mean lower out‑of‑pocket costs for most families.
• Many PPO plans still pay out‑of‑network benefits, but savings are typically smaller.
• PPO plans typically don’t require referrals; some DMO plans do.
• Pre‑determinations help estimate benefits but aren’t a guarantee of payment.

New to treatment? Review the process step‑by‑step: Orthodontic Evaluations in Richmond, VA.

How we verify your Aetna benefits (simple 3‑step process)

• Share your member ID and date of birth
• We contact Aetna to confirm eligibility, coverage percentage, waiting periods, and lifetime orthodontic maximum
• You receive a written estimate before treatment begins

Prefer to plan your budget early? Check out our orthodontic payment plans or use the payment calculator.

What your out‑of‑pocket could look like (sample scenarios)

Examples are for illustration only. Your fees and coverage will vary by plan, treatment complexity, and in‑network status.

• Example 1 — Child with 50% coverage and $1,500 lifetime max
  • Sample comprehensive braces fee: $5,500
  • Aetna pays 50% up to the $1,500 lifetime max → Insurance pays $1,500
  • Estimated family portion: $4,000 (before any in‑network fee reductions)
• Example 2 — Adult aligner case with coverage vs no coverage
  • Sample aligner fee: $6,000
  • If plan includes adult ortho at 50% with a $1,000 lifetime max → Insurance pays $1,000; patient pays ~$5,000
  • If plan excludes adult ortho → Insurance pays $0; patient pays ~$6,000

HSA/FSA funds can usually be applied to orthodontic treatment.

Braces vs clear aligners with Aetna

• Some plans cover traditional braces more broadly; aligners may have added restrictions.
• If medical‑necessity documentation is required, we submit X‑rays, photos, and charting.
• Retainers: Initial retainers are often included in comprehensive treatment; replacement coverage varies. Learn more about retainers.

Considering aligners? Explore options like Invisalign treatment in Richmond.

Aetna orthodontic FAQs

• Do I need a referral from my dentist?
  • Usually no for PPO plans; some DMO plans may require one. We’ll check for you.
• Are adult braces covered?
  • Adult orthodontic coverage is often excluded or limited on many Aetna plans. Aetna Medicare Advantage plans exclude orthodontics in 2025. Some employer PPO plans may include adult benefits; we’ll confirm your specifics.
• Are retainers covered after treatment?
  • Initial retainers may be included; replacement coverage depends on the plan.
• What if I’m transferring treatment from another office?
  • Benefits are often prorated based on months remaining. We coordinate with Aetna and your prior office.
• What happens if I change jobs or plans mid‑treatment?
  • Coverage can change or end with a new plan. We’ll re‑verify and adjust your estimate.
• How often can orthodontic benefits be used?
  • Orthodontic benefits are lifetime, not annual. Once the lifetime max is used, they don’t reset.

What to bring to your consultation

• Aetna insurance card and subscriber details
• Any past orthodontic records or X‑rays (if available)
• Your goals and questions for braces or aligners

Why Aetna members choose Horsey Orthodontics

• Board‑certified orthodontists and multiple treatment options for every age — see family orthodontics
• Transparent pricing with proactive insurance coordination
• Convenient Richmond‑area locations and flexible scheduling
• Friendly team that handles the paperwork for you

Next steps — book your complimentary insurance check

• Call or request an appointment online for a free consult
• Same‑week consultations often available
• Start with a no‑pressure treatment and coverage review

Proudly serving

Richmond, Henrico, Short Pump, Glen Allen, and nearby communities

Looking for an orthodontist that accepts Aetna? Schedule now to see how your benefits apply to braces, clear aligners, or adult orthodontic treatment.