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Does Health Insurance Cover Braces?

Most major health insurance plans don’t include dental coverage, and a supplemental dental plan is needed for braces. Health insurance may pay for orthodontic braces if it is deemed medically necessary — meaning the procedure diagnoses, prevents, or treats a disease or injury. Braces are considered medically necessary if your jaw was broken and your teeth need to be repositioned for correct alignment. Restoring proper chewing function would also be a covered service. Your health insurance may also approve claims if the braces treat a covered illness like a cleft lip, TMD or sleep apnea. Keep reading to see how you can get insurance coverage for braces.

Will Health Insurance Cover Invisalign?

Invisalign is a popular alternative to traditional braces that are covered by Medicare, Medi-Cal or a stand-alone dental policy. Many children, teens and adults prefer clear aligners over traditional metal brackets and wires to correct dental issues and improve their smiles. However, the biggest question most patients have is whether their health insurance provider will cover orthodontic care and Invisalign. The good news is that multiple insurers may extend coverage to encompass costs associated with Invisalign and other orthodontic procedures, but it depends on each individual plan. For example, your health plan may include braces, but not Invisalign since the clear aligners are often viewed as a cosmetic treatment and not a dental health procedure. However, this doesn’t mean that you have to pay the entire cost by yourself. Many medical plans will at least cover a portion of Invisalign aligners, which will reduce your financial obligation. If you’re interested in Invisalign for yourself or a family member, contact your insurer directly to understand your coverage options.

Compare Insurance Plans With Coverage for Braces

Does Health Insurance Cover Any Orthodontic Treatments?

If you’re not sure if your health or dental insurance will cover orthodontic treatment, contact your insurer directly. Your health insurance plan may cover orthodontic treatments, including braces. This depends entirely on the type of policy you choose. Depending on your specific policy, you could qualify for the following orthodontic treatments:

  • Retainers
  • Palate expanders
  • Cleft palate or lip corrections
  • Procedures for problems caused by congenitally missing teeth
  • Medically necessary orthodontic treatments

Dental policies for children vary depending on the state you live in. Some states require dental insurance to cover braces for children, but coverage restrictions and limitations may apply. For example, some health plans may cover the cost of braces if the child’s ability to chew is hindered due to an unaligned bite. If you’re certain that you, your spouse or your children will need braces in the future, you may be better off selecting dental insurance or orthodontic-specific insurance than trying to get coverage from a health plan, which will not cover the cost of straightening teeth for cosmetic reasons. Many dental insurance plans also offer discounts for child, teen and adult orthodontic treatment.

Health insurance may pay for orthodontic braces if it is deemed medically necessary in preventing or treating a disease or injury.

Bear in mind that orthodontic procedures and braces may not be covered if you begin treatment before you settle on a dental plan. Therefore, make sure you have a solid dental insurance policy before you even see an orthodontist. When calling to make an appointment, always ask if they accept your plan and how much is covered.

What Options Do You Have if You or Your Child Needs Braces?

The American Association of Orthodontists states that people covered for braces have a dental plan as a benefit from their employer. However, these plans may not fully cover orthodontic treatments, or there may be a lifetime cap. It’s always a good idea to check with your HR or insurance company to understand what your policy covers.

If your current plan does not cover braces or aligners, you have the option to purchase alternative insurance policies that are more specific to your needs. A dental plan that is designed to cover orthodontic services will often include examinations, braces, retainers and after-care treatment. Not many plans will include aligners or braces, so you should shop around until you find the best policy for you and your family.

In some states, Medicaid will cover braces, but there are minimum standards that exist at the federal level. For example, all states must cover at least the following for children:

  • Teeth restoration
  • Treatment to heal and relieve infections and pain
  • Medically necessary orthodontic treatment (which includes braces)
  • Some states may cover braces for adults to treat a medical condition

Some states require dental insurance to cover braces for children, but coverage restrictions and limitations may apply.

Alternative Ways to Pay for Braces

A LendingPoint Virtual Card, Smiles Change Lives, a personal credit card or CareCredit to pay your procedure in installments. Many dentists and orthodontists offer discounts and personal financing that allow you to make monthly payments before the procedure. You can also seek out less costly treatments by going to a dental school to get braces installed by an orthodontist in training. The American Dental Association has a list of dental programs near you.

Can You Use Your FSA/HSA Towards Braces?

Many patients use their FSA or HSA for braces and other dental procedures as long as their dentist or orthodontist has recommended it as a necessary treatment. You can use the money in these accounts to cover co-pays, deductibles and coinsurance. You can get more bang for your buck since the money in these accounts is untaxed, which provides more savings than a checking account or savings account. Plus, since FSA accounts don’t roll over into the new year, you may as well use the funds for orthodontic treatment before they expire.

How Much Are Braces Without Insurance?

Without insurance, braces can be more expensive than you’d expect. The average cost for traditional braces can range anywhere from $3,000 to $7,000. On the higher end, you can expect to pay $8,000 to $10,000. Like any treatment plan, the timeline, procedure and costs all depend on your specific needs and where you go. If you don’t have orthodontic or dental insurance, you can expect to pay for your treatment every month, depending on the extent of your treatment. The average monthly cost for braces without insurance is typically around $200 to $250.

You might be able to save a considerable amount of money if you pick an orthodontic-specific plan. How much you or your child’s braces will cost depends on the following factors:

  • Your age
  • Your location
  • Your plan
  • Type of braces
  • Duration of your treatment
  • Duration of payment plan
  • The skill and expertise of your orthodontist

Your health plan may cover braces, but not Invisalign.

Types of Braces

Without Insurance

With Insurance

Metal braces

$3,000 to $7,500

$1,500 to $3,750

Invisalign braces

$3,000 to $7,000

$1,500 to $3,500

Ceramic braces

$2,000 to $8,500

$1,000 to $4,750

Lingual braces

$5,000 to $13,000

$3,500 to $9,250

Compare Insurance Plans With Coverage for Braces

FAQs

Do you need dental insurance to get braces?

No, you do not need dental insurance for any dental treatment but it may help to pay for treatment. Many dentists and orthodontists offer payment plans to finance braces and there are healthcare credit cards like CareCredit, which offer payment plans with 0% APR the first six months.

Does Medicare or Medi-Cal cover braces?

Generally speaking, most orthodontic procedures are not covered by Medicare part A and B or Medi-Cal unless the braces are medically necessary, such as after an accident or if the teeth hinder chewing.

What are the benefits of braces?

Braces help you talk, and eat, prevent future dental issues, prevent bone erosion and improve your appearance. Straighter teeth are less likely to suffer from gum disease or cavities.

Key Takeaways

  • Private health insurance plans and Medicaid may cover orthodontic procedures and braces for children, adults and seniors if it is medically necessary.
  • Some dentists and orthodontists offer in-house payment plans.
  • Since clear aligners are considered cosmetic, Medicaid will not cover them. However, it will cover traditional metal braces to treat serious issues.

Are You Considering Braces for Your Children or Yourself?

Some health plans can assist families by providing some coverage for medically necessary braces. However, cosmetic procedures will not be covered, so you will need to shop around for affordable dental insurance that meets your coverage needs.

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