How Does Orthodontic Insurance Work?
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Many dental and medical insurance plans provide a limited amount of orthodontic coverage. Typically, a policy will pay for only part of the costs of braces.
Age restrictions are common, and many policies only cover children aged 18 or younger. In addition, you may be denied coverage if your braces aren't considered medically necessary by a dentist.
Does dental insurance cover braces?
Certain kinds of dental insurance will cover some of the cost of orthodontics. It's uncommon for a plan to provide full coverage, so you should expect to pay several thousand dollars yourself. However, that doesn't mean you shouldn't get dental insurance that covers orthodontics since a policy will still save you money.
When shopping for insurance that covers braces, you should keep several key factors in mind.
- Coverage age limits
- Waiting periods
- Your deductible
- Copays
- Coinsurance
- Annual or lifetime maximums
Many plans only cover children up to the age of 18. If you or another adult in your family needs braces, it's a good idea to confirm that your policy includes adult orthodontic insurance.
Many dental insurance policies also come with a waiting period that may last for 12 to 24 months from the day you buy your policy. During this time, your insurance won't cover orthodontics or other types of major care, although it will cover regular checkups and other preventive services.
Waiting periods encourage people to buy dental insurance before they need urgent care.
You can get dental insurance that doesn't come with a waiting period. However, you likely will have to pay higher rates.
Your deductible is the amount you must pay out of pocket before your dental insurance kicks in. Typically, higher deductibles come with lower monthly rates.
Finally, many dental insurance policies include an annual or lifetime maximum payout for orthodontic care. For example, a policy may only pay out $500 a year for a total of three years, or a policy might only pay $1,000 in total or per person.
Orthodontic insurance for adults
Adult orthodontic insurance is relatively uncommon despite adults making up one-quarter of all Americans who use braces.
If you're in the market for dental insurance that covers adult braces, double-check that your policy doesn't limit coverage by age. You can also pay for braces by contributing pretax income to a health savings account (HSA).
How much do braces cost with insurance?
Without dental insurance, you can expect to pay $3,000 to $10,000 for braces. Prices vary based on several factors. For example, traditional braces are typically less expensive than lingual braces, which go on the back of your teeth.
Some factors, like what procedures you need, are outside your control. However, you can often lower your final bill by shopping around. If your dental insurance uses a PPO model, you'll save money by going with an in-network provider.
Types of insurance that cover braces
Both medical and dental insurance may cover braces under certain circumstances. For example, many policies will only pay for braces if you have difficulties chewing or speaking.
If your dental insurance doesn't cover orthodontics, you can expand your coverage with an add-on (called a rider) or with a supplemental insurance policy. You can also get reduced-priced orthodontics care by entering a discounted dental network in exchange for a low monthly or annual fee.
In some cases, you may receive orthodontics coverage through Medicare or Medicaid.
Full-coverage dental insurance
Full-coverage dental insurance covers preventive services, such as regular checkups and tooth cleanings, as well as orthodontics and major restorative work. These policies tend to be more expensive than other forms of dental coverage. However, it might make the most sense financially if you have a family or if you need extensive dental care.
Buying a full-coverage policy through an employer-sponsored group plan is a great way to extend your coverage options while paying affordable rates.
Supplemental insurance and riders
If your dental insurance plan doesn't include orthodontics, you can ask to add coverage for orthodontics to your main policy, which is sometimes called adding a rider.
You can also buy a supplemental dental insurance policy through a company like Aflac. Supplemental insurance plans are separate policies that you can buy to fill in the gaps left by your primary insurance.
Dental discount networks
A dental discount network isn't insurance, but it can help you save on braces or other orthodontics. You pay a small monthly or annual fee to get discounted services from a network of dentists. There's no waiting period with a dental discount network, but you should expect to pay a significant amount of money out of pocket even with the discounted care.
Medical insurance
Many health insurance policies will cover braces for children 18 and under if they're medically necessary. Under the Affordable Care Act (also called "Obamacare"), all health insurance plans are supposed to offer this coverage. However, some exceptions exist, which means some plans might not contain orthodontics coverage.
Do Medicare and Medicaid cover braces?
Medicare and Medicaid may cover orthodontics care if it's determined medically necessary. For example, if your misaligned teeth make it hard to talk or eat, you would probably qualify for braces through Medicare or Medicaid. However, these programs don't cover orthodontics for cosmetic purposes.
Medicare and Medicaid coverage and names vary by state. In California, Medicaid is run under the name Medi-Cal, and it covers medically necessary orthodontics for those aged 13 to 21.
Major orthodontic insurance companies
Major dental insurance providers like Delta Dental and Cigna sell policies that include orthodontics coverage. Delta Dental, the largest provider of dental insurance in America, sells five separate policies that include orthodontics coverage across all 50 states.
Cigna offers just three plans that cover orthodontics. However, its plans have deductibles as low as $50 with lifetime values ranging from $1,000 to $5,000.
Current and former military members should consider USAA dental insurance, which offers low costs and high levels of customer service.
Aflac is a major provider of supplemental orthodontics coverage. If you already have a dental policy, you should consider a supplemental policy from Aflac.
Frequently asked questions
Does dental insurance cover braces?
Some types of dental insurance will cover part of the cost of braces. Consider buying a supplemental insurance policy if your dental insurance doesn't cover orthodontics.
How much are orthodontic expenses?
The cost of braces in the U.S. usually ranges from $3,000 to $10,000, which includes the initial fitting, checkups, removal and the braces themselves. Metal braces tend to be cheaper than Invisalign, ceramic and lingual braces. {"content":"Braces that attach to the back of your teeth instead of the front","icon":"","label":"","triggerText":"lingual braces."}
Are braces covered by medical insurance?
Many health insurance policies cover braces for children up to the age of 18 if they're deemed medically necessary. You will need a dentist to confirm that your child needs braces to receive coverage.
Sources and methodology
Information from the American Dental Association was used to determine the average cost of braces. Orthodontics coverage details for Medicare and Medicaid are from the Centers for Medicare & Medicaid Services (CMS). Information related to essential coverage requirements under the Affordable Care Act (ACA) is from HealthCare.gov.
Editorial note: The content of this article is based on the author's opinions and recommendations alone. It has not been previewed, commissioned or otherwise endorsed by any of our network partners.