Orthodontia: FSA Eligibility

Orthodontia is eligible for reimbursement with a flexible spending account (FSA), health savings account (HSA), health reimbursement arrangement (HRA) or a limited care flexible spending account (LCFSA). Orthodontia is not eligible for reimbursement with a dependent care flexible spending account (DCFSA).

What is orthodontia?

Orthodontia is a form of cosmetic dentistry that utilizes wires or plastic corrective trays to slowly reposition teeth over time to ensure that they properly align with adjacent teeth. Braces, as they're commonly known, typically stay on teeth for 2-3 years to correct misalignment issues, and these may be supplemented with permanent or temporary retainers that prevent the teeth from moving after the braces have been removed.

The American Association of Orthodontists recommends that all children have an orthodontic screening no later than age 7, as this will give orthodontists a chance to evaluate the methods needed to correct the bite once the first permanent molars emerge. Early treatment is advised to correct teeth positioning throughout childhood, and promote the healthy development of jaw growth. Adults can also pursue orthodontic care, and the techniques are similar to those used with children. While the vast majority of adults pursue orthodontic care to improve the appearance of their teeth, others look to correct crooked teeth and poor bites that affect oral health and could lead to serious issues like tooth decay/loss and gum disease.

How are orthodontia expenses reimbursed?

Orthodontia expenses are eligible even if payment is made in full and services have not yet been fully incurred (assuming the plan design permits reimbursement of full payment). While reimbursement requirements may vary between benefits administrators, one-time payments are typically the easiest method to be quickly reimbursed for the full amount of out-of-pocket costs not covered by insurance.

However, if an account holder chooses to pay over the length of the treatment, he/she will have to provide important pieces of information to ensure that the amount will be fully reimbursed. These include the date that the braces/orthodontia work was conducted, how much money the account holder's insurance will contribute, how long the treatment will last and the total out-of-pocket cost that will be reimbursed through a FSA, HSA, HRA or LCFSA.

Eligibility Table

Flexible Spending Account (FSA) Limited Care FSA Dependent Care FSA Health Savings Account (HSA) Health Reimbursement Account (HRA)

Eligible

Eligible with Rx

Eligible with LMN

Not Eligible

Specifically Not Covered

Eligible expenses for Limited FSAs can vary. To find out exactly what your Limited FSA covers, contact your FSA administrator.

Legal Information / Regulations

'1.125-5(k)(3)

 


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