Thinking about getting braces but dreading the price tag? You’re not alone. Braces can do wonders for your smile, but they’re not exactly cheap. 

The big question is, does your dental insurance have your back? 

In this guide, we’ll break down how insurance works for braces, what plans typically cover, and how to know what’s actually included before you commit.

Does dental insurance cover braces?

Many dental plans cover braces, especially for kids. However, coverage can vary. Check with your insurance provider to see if you’re covered and what portion they’ll pay.

Key Takeaways

• Dental insurance coverage for braces varies depending on the plan and age of the patient.
• Many dental insurance plans cover orthodontics for children, but may not cover adult braces.
• It’s important to review your dental insurance policy to understand the specifics of what is covered and any exclusions.

Types of Dental Insurance That Cover Braces

Dental insurance plans differ greatly in terms of what they cover. 

Some plans may cover the full cost of braces for children, while others may only offer partial coverage or no coverage at all for adults. 

Here's a look at the types of dental insurance plans that may cover braces:

PPO (Preferred Provider Organization) Plans

PPO dental insurance plans typically offer the most comprehensive coverage for orthodontics. 

These plans usually cover a portion of the cost of braces for both children and adults, though the amount covered can vary. 

PPO plans allow you to visit any dentist, though you’ll receive the best coverage if you visit a dentist in-network.

What’s covered: A portion of the cost of braces, often 50% or less, depending on your policy.

Important tip: Be sure to confirm whether the orthodontist is in-network to maximize your benefits.

HMO (Health Maintenance Organization) Plans

HMO dental insurance plans often provide more limited coverage for orthodontic treatments, including braces. 

These plans tend to have lower premiums but require you to choose a primary care dentist. 

With an HMO plan, if your orthodontic care is covered, you may have to get a referral before seeing an orthodontist.

What’s covered: Some plans offer limited coverage for braces, while others may exclude orthodontics entirely.

Important tip: Verify with your HMO provider to understand what is covered and whether a referral is required.

Indemnity Plans

Indemnity dental plans offer more flexibility than PPO or HMO plans. These plans typically allow you to visit any dentist, and the insurance company reimburses you for a percentage of the cost. 

Indemnity plans are less common today but can be ideal if you prefer more freedom of choice.

What’s covered: A percentage of orthodontic care, often up to a set limit.

Important tip: Since indemnity plans often cover a percentage, you will need to pay out-of-pocket for the remaining costs.

When Does Insurance Cover Braces?

Dental insurance coverage for braces often depends on several factors, including the age of the patient and the severity of the orthodontic issue. 

Here's a breakdown of when you can expect insurance to cover braces:

Braces for Children

Most dental insurance plans cover braces for children, especially if they are deemed medically necessary. 

Insurance providers typically cover orthodontic care for children under the age of 18, as this is when teeth are still growing and developing. However, coverage amounts can vary.

Coverage: For children, insurance may cover anywhere from 50% to 80% of the cost of braces.

Important tip: Some plans may have a lifetime maximum benefit for orthodontic treatment, so make sure to check your plan for any caps.

Braces for Adults

Coverage for adult braces can be more complicated. Many dental insurance plans don’t cover adult orthodontics or limit the amount of coverage available. 

However, some PPO plans may still offer partial coverage, especially if the braces are medically necessary.

Coverage: Some plans offer limited coverage for adult braces, typically between 10% and 50%.

Important tip: If your plan does not cover adult braces, you may want to look into other financing options, such as payment plans with the orthodontist.

Medically Necessary vs. Cosmetic Braces

Dental insurance typically only covers braces if they are deemed medically necessary. 

If the braces are for cosmetic reasons or for minor teeth alignment, insurance may not cover the treatment. 

Medically necessary braces are usually recommended for issues such as severe overbites, underbites, or misaligned jaws that affect oral health.

Coverage: Medically necessary braces are more likely to be covered than cosmetic ones.

Important tip: Talk to your dentist or orthodontist to see if they can provide documentation to support the medical need for braces.

What Is the Average Cost of Braces Without Insurance?

If you do not have dental insurance that covers braces, you may be wondering how much you’ll have to pay out of pocket. 

The cost of braces can vary depending on the type, location, and length of treatment. On average, braces cost between $3,000 and $7,000 for traditional metal braces. 

Invisalign, a popular alternative to traditional braces, typically costs between $3,500 and $8,000.

Frequently Asked Questions (FAQs)

1. Will dental insurance cover the full cost of braces?

Dental insurance typically covers a portion of the cost of braces, but the amount depends on your specific plan. For children, coverage can range from 50% to 80%, while adult coverage is more limited.

2. Are braces considered a medical necessity?

Braces are considered a medical necessity if they correct significant dental issues, such as severe overbites or underbites. Cosmetic braces for minor alignment may not be covered by insurance.

3. Can I get braces with my existing dental insurance?

Many dental insurance plans cover braces, especially for children. For adults, coverage may be more limited, but some PPO plans still offer partial coverage. It’s best to check your specific policy.

Conclusion

Dental insurance can significantly reduce the cost of braces, but the level of coverage depends on the specific plan you have. 

While many plans cover braces for children, coverage for adults can be more complicated. 

It’s important to fully understand your insurance plan’s benefits and consult with your orthodontist to make sure you’re getting the most out of your coverage. 

If your insurance doesn’t cover the full cost, there are still options available, including financing plans, to make orthodontic treatment more affordable. 

Whether you’re a child or an adult, investing in braces can improve both your dental health and appearance, and understanding your insurance options will help you manage the cost.