No. You do not need a referral for orthodontic treatment. If you are an Aetna DMO®plan* member, however, you must see an orthodontist who participates in our network.
* Illinois members: State laws vary with regard to out-of-network benefits. In Illinois, DMO plans provide limited out-of-network benefits. However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Illinois DMO is not an HMO.
Virginia Members: In Virginia, DMO is called DNO (Dental Network Only). DNO (Dental Network Only) in Virginia is not an HMO. To receive maximum benefits, members must choose a participating primary care dentist to coordinate their care with in-network providers.
Not all dental benefits and dental insurance plans include orthodontic coverage. Please see your plan documents for coverage details. You may also call Member Services at the number on your ID card.
It depends upon your specific plan. Some plans have a work-in-progress exclusion. That means the plan will not cover treatment that started when you were covered by another plan.
If your plan does not have a work-in-progress exclusion, we determine your coverage based upon:
No.
If you are an Aetna DMO member, coverage will be determined at the DMO in-network benefit level.
Send us:
When we receive your information, we will send you coverage details specific to your plan.
Freedom of Choice dental plan members can switch between an Aetna DMO® plan* or an alternate plan (either PPO, PDN** or Indemnity plan) on a monthly basis. Here's how orthodontic coverage works:
Switching from DMO to PPO/PDN or Indemnity plan
Switching from PPO/PDN or Indemnity to a DMO plan
* Illinois members: State laws vary with regard to out-of-network benefits. In Illinois, DMO plans provide limited out-of-network benefits. However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Illinois DMO is not an HMO.
Virginia Members: In Virginia, DMO is called DNO (Dental Network Only). DNO (Dental Network Only) in Virginia is not an HMO. To receive maximum benefits, members must choose a participating primary care dentist to coordinate their care with in-network providers.
**In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN).
Yes. Your plan may have one or both of these age limits:
Orthodontic age limit: When the plan includes an orthodontic age limit, braces must be placed on your teeth before reaching your plan's specified age limit.
Dependent age limit: Orthodontic benefits will be available until your dependent reaches your plan's specified age limit. No benefits will be paid after that, even if the treatment is not complete.
Page last reviewed January 5, 2016
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).
This material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.
You are now being directed to the AMA site
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
You are now being directed to the Give an Hour site
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
You are now being directed to the CVS Pharmacy site
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
You are now being directed to the CDC site
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites.
You are now being directed to the CVS Health site
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
You are now being directed to the Apple.com COVID-19 Screening Tool
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
You are now being directed to the US Department of Health and Human Services site
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
You are now being directed to the CVS Health COVID-19 testing site
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
You are now being directed to
The Fight Is In Us site
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites.
Please log in to your secure account to get what you need.
The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, close this message.
Get a link to download the app
Just enter your mobile number and we’ll text you a link to download the Aetna Health app from the App Store or on Google Play.
Message and data rates may apply*
Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?