Does medical cover braces? That’s one of the most common questions people have before getting braces. It’s also one of the most frequently asked questions by orthodontists, so if you’re curious, you’re in good company! The short answer to this question is yes, your health insurance covers braces. However, it may not cover them in full, and depending on your coverage, you may need to pay some or all of the costs out-of-pocket.
How braces can be covered
Many health insurance plans cover orthodontic treatment, although there are conditions that need to be met. Children with braces will likely have their treatment covered by insurance, as long as it is deemed medically necessary and your family’s policy has a reasonable deductible and max out-of-pocket costs for orthodontic coverage. If you want braces later in life, check with your provider to see if your plan covers adult orthodontics; otherwise you’ll pay for it out of pocket. The cost of braces can vary wildly depending on what type of braces you get and whether or not other components like retainers are required after treatment is complete.
Not everyone has insurance coverage for orthodontic care. And, even if you do have dental and/or medical coverage, you may find that it doesn’t provide enough in terms of dental or medical benefits to cover braces. This is why we put together a list of ways to pay for your orthodontic treatment with or without insurance coverage. Even if you already know how much your insurance plan covers and what costs are out-of-pocket, our tips on payment options can help spread out some of those costs.
Types of orthodontic treatment that are often covered by insurance
Invisalign clear aligners, retainers, and dental insurance may cover braces in certain circumstances. Check with your employer’s Human Resources department or insurer to find out whether you’re covered for orthodontic treatment. If you have health insurance coverage for orthodontics, talk to your dentist about which of these options will work best for you. Before making a decision about what type of treatment to pursue, think carefully about cost as well as benefits.
Orthodontics and your health plan.
Do health insurance plans cover orthodontics? Generally, yes. The majority of major U.S. health insurance companie do offer at least partial coverage for orthodontic treatment, but what’s covere and for how much depends on your plan and any additional riders you may have purchase (or been enrolle in). Here are a few things to know about orthodontic benefits in general
Medicare and dental insurance
Medicare does not cover dental care and many dental plans will not cover orthodontic treatment. But most states have high-risk pools that offer insurance for those with pre-existing conditions. These policies can be expensive, but you may qualify for assistance to help pay for them. Medicaid also covers some orthodontic treatments, depending on your state and income level. Some insurance plans will reimburse you after your braces are remove, but it is hard to predict if your plan will cover post-treatment costs because they vary from policy to policy. If you are concerned about payment after treatment, try to get an estimate of costs before you begin treatment so that you can plan accordingly.
Can I get braces if I have Medicaid?
Medicaid provides free health care to qualifying individuals, so if you have Medicaid, you may be able to get braces for free. However, even though Medicaid does cover braces for some people, it can be hard to determine if braces are covere under your state’s specific program. Unfortunately, each state runs its own healthcare program and a number of factors go into determining what services are covered.
Should my kids get braces if they have an HMO/PPO/EPO plan?
HMO, PPO, and EPO plans are all types of health insurance policies that help you save money on out-of-pocket costs like doctor visits and prescriptions. So yes—they do cover braces. But whether they’ll pay for everything or even most of your orthodontic treatment is another story. These kinds of plans typically only pay for preventive care like exams and cleanings. So if you’re considering orthodontic treatment as a preventative measure. Then yes—HMOs, PPOs, and EPOs will cover some (if not all) of your new smile.
Dental plan at work
Even if you don’t have a dental plan at work, there are plenty of ways to pay for orthodontic treatments. Depending on your career and how long you’ve been in it. You may qualify for certain discounts off treatment prices that can save you up to thousands of dollars. Talk to your employer or do some research online; chances are good that you’ll discover there are affordable options out there.
Do dental insurance plans cover clear aligners like Invisalign®?
Generally, dental insurance does not cover invisible aligners. However, some dental plans do offer coverage for orthodontic procedures like braces or retainers. It all depends on your policy, so you should check with your provider. To make sure that they’ll cover Invisalign® when you’re ready to schedule a consultation. (Note: In most cases, you can’t buy Invisalign® directly from your dentist—you have to go through Align Technology’s online store.) If a plan covers orthodontics and you opt for traditional braces. Be aware that a typical treatment period is 18 months.