Whether you’re considering braces for yourself or your child, cost is likely top of mind. Braces are expensive for most people, which is why it’s important to find out whether part or all of the cost might be covered by your dental insurance. However, determining if and how much of braces treatment may be covered can be confusing.

Does dental insurance cover braces?

If you have children age 18 or younger, insurance companies must offer an option to purchase dental insurance that meets the criteria of the Affordable Care Act (ACA). However, it’s up to you whether you get dental insurance or not. It’s worth noting that dental insurance isn’t required for children and you won’t face a penalty if you don’t have it.

When trying to find the answer to “does insurance cover braces?” keep in mind that coverage can vary from plan to plan. For example, some plans only cover preventive care and partial restorative treatments. At the same time, others may have more extensive coverage.

Some private insurance plans may cover some of the costs of braces, such as the procedure itself. However, they might still require you to pay for certain fees such as co-payments.

When you’re shopping for dental insurance plans, you will want to compare the features and benefits to see if braces are included. You also want to pay special attention to any limitations regarding braces coverage. For example, it may only apply to braces that are needed for certain conditions or up to a specific age.

Braces coverage for children vs. Adults

When asking “Is dental insurance worth it?” braces coverage may be a dealbreaker. Children can have dental insurance coverage by using their parent’s insurance plan. According to the Affordable Care Act, dental insurance is considered an essential benefit for children under the age of 18.

In addition, the out-of-pocket limit for one child is $350 and $700 for two children. This means that dental insurance plans for children must pay for care after you’ve spent these two out-of-pocket costs.

Does dental insurance cover braces for adults?

You’ll be able to use your existing dental health insurance to cover some, if not all, of the dental expenses for your children. However, the same benefit is not given to adults.  Considering that 25% of people in the U.S. with braces are adults, you’re not alone in trying to figure out how to afford braces treatment. You’ll need to shop for the most affordable dental insurance if you’re over the age of 18.

If you’re wondering what insurance covers braces, most medical insurance plans will cover dental care if it’s related to an emergency. For instance, if you were in an accident that required emergency dental surgery, medical insurance might cover these costs. However, most medical insurance plans won’t cover costs for regular or cosmetic dental procedures, including braces.

Braces and other cosmetic procedures will typically need to be covered under a separate dental health insurance plan.

Does Medicaid cover braces?

Medicaid covers medically necessary procedures—in some cases, braces fall under this category for children. Medicaid is a type of federally-funded and state-funded health insurance plan available to people with low incomes. If you fall under a certain threshold, usually the poverty level in your state, you might qualify for Medicaid assistance in your particular state.

For instance, if you live in California and are below the poverty line in California, you should be able to qualify for “Medi-Cal,” which is the Medicaid available in California. If braces are medically necessary for you or your child, then Medicaid will need to cover the costs.

Does an FSA or HAS cover braces?

If you’re considering using pre-tax savings to cover the cost of braces, you might wonder if your Flexible Spending Account (FSA) or Health Savings Account (HSA) can help. An FSA is a tax-advantaged account that allows you to set aside pre-tax dollars for eligible medical expenses, while an HSA is a similar account available to those with a high-deductible health plan. Both accounts can be used to cover a range of medical expenses, including dental care.

Braces are often considered an eligible expense under both FSAs and HSAs, but it’s essential to check with your plan provider to confirm coverage and any specific requirements. Typically, orthodontic treatment like braces is covered because it’s considered a medically necessary procedure to correct dental issues. However, there may be certain restrictions or limitations, so it’s essential to understand your plan’s details.

Alternatives to braces

One popular alternative to metal braces is Invisalign. This option tends to be slightly more expensive than traditional braces, but some dental insurance policies will cover a portion of the cost.

Invisalign is a modern alternative to traditional metal braces, designed to straighten teeth using a series of clear, custom-made, removable aligners. These aligners are virtually invisible and are custom-fitted to the unique shape of your teeth. Gradually, they shift your teeth into the desired position.

The benefits of Invisalign include:

• Aesthetics: Since the aligners are clear, they are much less noticeable than traditional metal braces.
• Comfort: Invisalign aligners are made from smooth plastic and are custom-fitted, making them more comfortable than metal braces.
• Convenience: They are removable, allowing for easier eating, brushing, and flossing.
• Customization: Each set of aligners is custom-made using 3D imaging technology, ensuring a precise and effective treatment.

Invisalign tends to be more expensive than traditional braces due to the advanced technology used in their creation, including the use of 3D imaging and the custom manufacturing process for each set of aligners. Additionally, the material used in Invisalign is a specialized medical-grade thermoplastic.

There are also options like ceramic braces that are more discreet. These may be covered partially by your insurer but the only way to know is to check your specific coverage terms.

Does dental insurance cover Invisalign?

Insurance coverage for Invisalign can vary greatly depending on the specific dental insurance policy. Invisalign, a popular alternative to traditional braces for orthodontic treatment, falls under the category of orthodontic care in most dental insurance plans. Here’s an overview of how Invisalign is or isn’t covered by insurance policies and the reasons behind it:

1. Orthodontic Coverage: Many dental insurance policies include coverage for orthodontic treatments, which typically encompasses both traditional braces and Invisalign. However, the extent of coverage for Invisalign specifically can differ from one policy to another.
2. Coverage Limits and Conditions: Some insurance plans may cover a certain percentage of the cost of Invisalign, or they might have a specific dollar amount allocated for orthodontic treatments. There can also be conditions regarding age limits, with some policies covering Invisalign only for individuals under a certain age, typically for children and teenagers.
3. Lifetime Orthodontic Maximum: Dental insurance plans often have a lifetime maximum for orthodontic treatments. This is the total amount the insurance will pay for orthodontic care over the lifetime of the policyholder. Once this limit is reached, the patient is responsible for all subsequent orthodontic costs.
4. Pre-authorization Requirements: For Invisalign treatment, insurance providers may require pre-authorization. This means the treatment plan needs to be approved by the insurance company before the coverage can be applied.
5. Reason for Treatment: Coverage may also depend on the reason for the orthodontic treatment. Some insurance policies cover orthodontic treatments that are deemed medically necessary, while elective or cosmetic treatments may not be covered.
6. Deductibles and Co-pays: Policyholders should be aware of their deductibles and co-pays. Even if Invisalign is covered, you may still have out-of-pocket expenses such as a deductible or a co-payment.
7. Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs): For costs not covered by insurance, FSAs and HSAs can often be used to pay for Invisalign treatments, offering a way to save on taxes for these expenses.
8. Variability Among Providers: It’s important to note that insurance coverage for Invisalign can vary widely among different insurance providers and plans. Thus, it’s crucial for individuals to review their specific insurance policy or contact their insurance provider to understand the specifics of their coverage for Invisalign.

Given these variables, it’s always recommended to discuss with both your orthodontist and your insurance provider to understand the coverage details and any potential out-of-pocket costs for Invisalign treatment.

What dental services fall within orthodontics?

It’s a good idea to understand the services that are typically associated with orthodontics before you evaluate your dental insurance options. According to the American Association of Orthodontists (AAO), an orthodontist provides procedures to fix teeth that result in conditions such as dental overbites, underbites, and crowded or misaligned teeth. These issues can be fixed by slowly applying pressure on specific teeth to coax them into place without surgery. Often orthodontic treatment involves the following services:

Orthodontists design and fit appliances to realign teeth and jaws to produce and maintain normal function and to improve appearance. Among the most common orthodontic appliances are:

• Braces, which consist of brackets, wires, and bands which are continually tightened over a specific amount of time to straighten teeth. Most braces are metal with colored brackets however they also come in ceramic and clear colors for those who do not want their braces to be noticeable.
• Aligners, which like braces, help to straighten teeth and align them. Aligners, most often Invisalign, are clear trays which fit specifically around the teeth in order to mold them.
• Space Maintainers, which are used to keep space open when baby teeth are lost earlier than normal, so that other teeth do not grow into the space meant for the missing tooth until the adult teeth begin to grow in.
• Removable Retainers, which are plastic or metal appliances molded to fit the mount to either move the teeth slightly or keep teeth from shifting back to their original position after braces or Invisalign are removed.  More often than not, retainers are worn during the night.
• Jaw Repositioning Appliances, sometimes called splints, are used to move either the upper or the lower jaw in order for the jaw as a whole to close more naturally.

Under the Affordable Care Act, federally funded and state-funded Medicaid insurance programs need to cover the costs of dental work if it is medically necessary. Your insurance might be able to cover the cost of braces if the braces are needed for a medical necessity. This can include:

• Malocclusion
• Severe underbite or overbite
• Congenitally missing teeth that require braces to fix
• Trauma
• Craniofacial deformities

What plans cover orthodontics?

In some cases, private individual and family plans offer dental insurance for orthodontic care. Additionally, your employer-sponsored dental insurance may also offer partial coverage.

A number of dental plans may include the following orthodontic services for adults and children:

• Examinations
• Orthodontic treatment
• Retainers
• Pre- and post-orthodontic treatment

Dental insurance may cover a portion of your braces costs, but you’ll likely still have out-of-pocket expenses. When evaluating your insurance, you want to look at:

• Premium – A monthly rate you pay for dental insurance coverage
• Deductible – The amount you pay for dental services before your insurance company begins paying a portion of the expense
• Co-pays – The cost-share amount you pay for covered dental services, usually a flat dollar amount or a percentage of the cost for the service.
• Exclusions – Dental services that are not covered under any circumstance, are not covered until a defined wait period expires, or are not covered if the condition existed before you purchased the dental insurance (pre-existing condition)

What is the average cost of braces with and without insurance?

The cost of braces will depend on several factors, including:

• How long you require your braces
• What material your braces are made of (ceramic, metal, Invisalign)
• Special considerations (lingual braces, etc.)

The average cost of braces starts at around $5,350 for simple metal braces and can go as high as $12,000 for lingual braces.

Braces Type	Average Cost	Cost Range
Metal	$5,350	$1,800-$8,500
Ceramic	$5,500	$2,000-$10,000
Self-ligating	$5,500	$2,500-$8,000
Invisible	$5,700	$1,100-$9,500
Lingual	$12,000	$5,000-$13,000

What are the additional medical costs related to braces?

In addition to the cost of your braces, you might also need to pay for more expenses, such as:

• Additional cleanings
• Tightening and extra dental visits
• Extraction of additional teeth before your braces are implanted, especially with teeth crowding
• Retainers

Use eHealth to find a dental plan that works for you

As you can see, the answer to “does insurance cover braces?” is complicated. At eHealth, we are here to help you find affordable dental insurance coverage that meets your coverage needs.  Working with a number of insurance companies that offer plans throughout the United States, eHealth gives you access to a broad range of dental insurance choices. To learn more about standalone dental plans where you live, simply visit our dental insurance page.

If you are looking for health insurance that includes dental coverage, eHealth works with insurance companies that provide that broader protection.  Simply visit our individual and family insurance page. Whether you are looking for dental coverage for yourself or your entire family, we can help you find the insurance that is right for you. Our customer service staff and licensed agents are available to assist you.

FAQs: Does dental insurance cover braces?

How can I save money on braces and orthodontics?

Use our online tool to shop for the best dental insurance plans that cover the cost of braces. You can save more money if you use dental insurance instead of relying on your regular medical insurance to cover the costs or paying out of pocket.

You can also take your time to shop around for dentists in your area that offer special pricing, certain discounts, or even payment plans. Additionally, if you’re looking to keep your costs as low as possible, consider regular metal braces.

Are there waiting periods for braces coverage?

Yes, some dental insurance plans do have waiting periods before coverage for orthodontic treatment, including braces, becomes effective. Waiting periods can vary depending on the insurance provider and the specific plan you have. It’s essential to review your dental insurance policy carefully to understand if there are any waiting periods and how long they last. Waiting periods typically range from a few months to a year or more before coverage for orthodontic treatment kicks in. Knowing the details of waiting periods can help you plan and budget for your orthodontic care effectively.

Does dental insurance cover braces of all kinds?

Dental insurance plans may cover braces to varying extents, depending on the specific plan and provider. Traditional metal braces are commonly covered by dental insurance plans, although the amount of coverage can vary. Other types of braces, such as ceramic braces, lingual braces, and clear aligners like Invisalign, may also be covered by some insurance plans, but coverage levels may differ. It’s essential to review your dental insurance policy to understand which types of braces are covered and the extent of coverage for each. Additionally, some plans may have limitations or exclusions for certain types of braces, so it’s important to clarify these details with your insurance provider.