How Does Orthodontic Insurance Work?
The orthodontic coverage on most dental plans can help pay for things like braces.
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However, many plans only cover kids and teens under 18. You might not have any coverage if your dentist doesn't think braces are necessary to correct the placement of your teeth.
Does dental insurance cover braces?
Certain kinds of dental insurance will cover some of the cost of orthodontics.
But it's not common for a plan to cover the full cost, so you should expect to pay at least $1,600 out of your own pocket. However, that doesn't mean you shouldn't get dental insurance that covers orthodontics, because 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: 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.
- Waiting periods: 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. You can get dental insurance that doesn't come with a waiting period, but it will likely cost more. If you think you or your child will need braces, it's a good idea to shop for coverage early so you don't have to wait for care.
- Deductible: Your deductible is the amount you have to pay yourself before your dental insurance kicks in. Typically, higher deductibles come with lower monthly rates.
- Copays: A copay is a flat rate, like $20, that you pay per office visit.
- Coinsurance: After you reach your deductible, you'll usually split the cost for dental and orthodontic care with your insurance company. This is called "coinsurance." For example, your insurance might pay 80% of the bill from your orthodontist while you pay 20%.
- Annual or lifetime maximums: Many dental insurance policies include an annual or lifetime maximum payout for orthodontic care. For example, a policy may only pay out $500 each year for a total of three years, or a policy might only pay $1,000 in total or per person. Make sure you choose a policy that has enough coverage to pay for the care you need.
Orthodontic insurance for adults
Adult orthodontic insurance is relatively uncommon despite adults making up about a third 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.
If your plan doesn't cover braces, or even if it does and you just want to save for your share of the cost, you could consider paying for your braces out of a health savings account, also called an HSA. But you can only get an HSA with certain health insurance plans called high-deductible plans, so this won't be an option for everyone.
How much do braces cost with insurance?
Braces cost between about $1,600 and $ 5,000, on average, if you have insurance.
Without dental insurance, you can expect to pay an average of $2,750 to $7,000 for braces.
Prices change based on several factors. For example, traditional braces are typically less expensive than braces that go on the back of your teeth, called lingual braces.
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 is a PPO, you'll save money by going with an in-network provider.
Types of insurance that cover braces
Both medical and dental insurance might cover braces under certain cases.
For example, many policies will only pay for braces if the alignment of your teeth could cause problems with chewing or speaking.
If your dental insurance doesn't cover orthodontics, you may be able to expand your coverage with an add-on, sometimes called a rider, or with a supplemental insurance policy. You might also be able to save money if you can go to a dentist in a discounted network.
In some cases, you can get orthodontics coverage through Medicare or Medicaid.
Full coverage dental insurance
Full coverage dental insurance covers preventive services, like regular checkups and cleanings, as well as major dental care like root canals. They sometimes cover orthodontic treatment like braces.
These policies tend to be more expensive than other forms of dental coverage. Even with the higher cost, a full coverage plan could help you save money if you or your child needs expensive 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 might be able to add coverage to your health policy.
This is called a "rider" or an "add-on."
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. You can get care right away with a dental discount network because's there's no waiting period, but you should expect to pay high bills for dental care 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"), most health insurance plans have to include dental coverage for children. However, some exceptions exist, and coverage for braces is usually only available if the child needs orthodontic treatment for medical reasons. For example, health insurance might cover orthodontic treatment for a child if they have a severe underbite that could affect their ability to chew or speak.
Do Medicare and Medicaid cover braces?
Medicare and Medicaid may cover orthodontics care if it's needed for medical reasons. 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 called Medi-Cal, and it covers medically necessary orthodontics for people age 21 and under.
Major orthodontic insurance companies
Major dental insurance providers like Delta Dental and UnitedHealthcare sell policies that include orthodontics coverage for both adults and kids.
However, HealthCare.gov doesn't offer a filter to only show plans with orthodontic coverage, so it's important to look at the plan details before you buy. It's harder to find a plan that covers orthodontics for adults, but they are available.
You can also consider buying a supplemental policy instead of a full dental insurance plan. Aflac is a major provider of supplemental orthodontics coverage. If you already have a dental policy, you could consider a supplemental policy from Aflac to get coverage for braces.
Frequently asked questions
Is orthodontic insurance worth it?
Orthodontic insurance can be worth it for many people and families, because the cost for braces and other orthodontic treatment can be quite high. Braces can cost between $2,750 and $7,000 if you don't have insurance. If you think you or your children might need braces, it's a good idea to shop for a plan before you need treatment. Most plans won't cover braces for one to two years after you buy them, called a "waiting period."
How many times will insurance pay for braces?
Dental insurance usually has a yearly or lifetime maximum limit that it will pay toward orthodontic care. If you need braces twice and your plan's lifetime limit has already been used up by the first round of treatment, you'll have to pay for the second set of braces yourself. But if you still have coverage left on your annual or lifetime limit, your plan will probably pay toward the cost for a second set of braces.
How can you get braces paid for by insurance?
Most health insurance plans are required by law to cover braces for children who need them for medical reasons. If you or your child needs braces for cosmetic reasons, health insurance is very unlikely to cover them. Your best option is to buy a dental insurance plan with orthodontics coverage or a supplemental orthodontic policy before you or your child needs braces.
Sources and methodology
Info 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). Info related to essential coverage requirements under the Affordable Care Act (ACA) is from HealthCare.gov. Data about the number of adults with braces comes from the American Association of Orthodontists.
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.