Braces and Insurance Coverage

Does Insurance Cover Braces?

Most dental insurance plans don’t cover orthodontic treatment for people over 18, but many at least partially cover children under 18. You’ll need to check with your insurer to be sure.

If your child needs braces, consider checking the fine print of your plan. Your insurer may provide coverage if your child has a medical need for braces.

Keep in mind that medical insurance and dental insurance are separate. Some medical insurance providers also provide dental plans, but you’ll still have two different policies.

What Does Dental Insurance Cover?

Dental insurance policies generally provide different levels of coverage for various service categories:

• Complete coverage for preventive services — Routine checkups, cleanings, and exams
• Partial to full coverage for basic services — Fillings, root canals, and non-surgical tooth extractions
• Partial coverage for major services — Wisdom tooth removal, crowns, dentures, and other restorations

Orthodontic treatment, such as braces, is a separate category. Cosmetic treatments, such as veneers, won’t be covered by dental insurance. If you or your child don’t have a medical need for braces, then your insurance provider may also classify them as cosmetic.

What’s Considered an Orthodontic Service?

If you do have orthodontic coverage under your dental plan, you can expect it to provide at least partial coverage for:

• Initial evaluations and exams

• Tooth extraction to treat dental crowding

• Braces themselves

• Any other orthodontic devices, such as headgear, spacers, or retainers

• Office visits during treatment

Some dental insurance plans may also cover clear aligner treatments like Invisalign.

How Does Dental Insurance Work?

Your insurance company will cover different dental procedures’ full or partial costs as you pay a monthly premium.

To understand what you’ll have to pay out of pocket, you’ll need to check the following:

• Premium — The monthly fee for your plan
• Deductible — The total amount for the year you must spend on dental care before the insurance starts to pay
• Co-pay — Your plan may require paying a fixed fee for certain services before it covers the rest of the cost
• Annual maximum — The total amount your plan will cover per year; once your insurance provider has paid this amount, it won’t pay more
• Out-of-network costs — Seeing a dentist or orthodontist outside the network of your insurer may require you to pay additional costs

Here are other things to keep in mind:

• Insurance often has a waiting period before your provider covers certain services
• Insurance may not cover things like braces if someone gets them before purchasing the plan

How Much Do Braces Cost?

The cost of braces can vary widely depending on the following:

• The type of braces
• Your specific orthodontic needs
• Your age
• Your location
• Insurance coverage

Here are some price ranges you can expect for different types of braces (before insurance):

• Traditional metal braces — $3,000 to $7,000
• Ceramic braces (clear braces) — $4,000 to $8,000
• Lingual braces (behind the teeth) — $8,000 to $10,000
• Clear aligners — $3,000 to $8,000

The complexity of your orthodontic issues will also significantly impact treatment costs. Even traditional braces can cost considerably more if you need to wear them for several years.

Other Ways to Pay for Braces Without Insurance

Even if you don’t have orthodontic coverage, you may still be able to make braces more affordable. Here are some alternative options:

Discount Dental Plans

Rather than dental insurance, discount dental plans work more like a membership program. They provide savings on various dental services and may come with other advantages.

Discount dental plans are fee-based annual plans that you purchase outright. Insurers and separate vendors may offer these plans.

FSA/HSA

Flexible savings accounts (FSAs) and health savings accounts (HSAs) may offer you the possibility of paying for orthodontic care with tax-free funds. Check with your employer for what you can use FSA/HSA funds for.

You can set aside money from your paycheck for an FSA through your employer. You’ll still pay the same amount, but your money will be tax-free.

Like an FSA, you can opt for an HSA if you’re on a high-deductible health insurance plan. You can invest tax-free dollars into your HSA for most medical and dental bills.

Payment Plans

Many orthodontists offer payment plans to help people pay for their braces. Some are very flexible and even interest-free. Ask your orthodontist what your payment options are.

Personal Loans

Personal loans can fund orthodontic treatment like braces_._ Speak with your orthodontist to see if you can get a discounted price to avoid interest charges. You can do this by prepaying a sizable percentage of the braces cost upfront.

Braces Alternatives

Invisalign, at-home clear aligners, and ceramic braces are popular alternatives to traditional metal braces:

Invisalign

Invisalign is the most established and trusted brand of clear aligners (invisible braces or invisible aligners). Aligners are a great option for teenagers and adults who want to straighten their teeth comfortably and discreetly.

Unlike metal braces, you can remove Invisalign trays anytime for eating, cleaning, and brushing. Invisalign can be slightly more expensive than conventional braces. However, some dental insurers cover a portion of the cost.

Before insurance, Invisalign treatment may cost anywhere from $3,000 to $8,000.

At-Home Clear Aligners

At-home aligner brands like Candid are another option for mild to moderate teeth misalignment. These work much the same as Invisalign but without in-person appointments.

Because of the lack of face-to-face professional evaluation, these clear aligners may not be suitable for more complex tooth and jaw alignment issues.

Dental insurance may not cover at-home aligners but can be less expensive than braces. Expect to pay between $1,500 and $3,500 for at-home aligner treatment.

Porcelain Veneers

Veneers are another option for improving the appearance of your teeth. Porcelain veneers are made from thin, durable materials lasting 10 to 15 years.

Porcelain veneers are pricey compared to braces, costing between $925 and $2,500 per tooth. And because they are considered cosmetic procedures, dental insurance doesn’t typically cover them.

Summary

If you have dental insurance, it may offer at least partial coverage for braces. This is especially likely if they are a medical need for your child under 18.

Because dental insurance is separate from medical insurance, you may have to purchase a new plan from the same or another provider. In addition, not all dental plans cover orthodontic treatment, so check to be sure what’s covered for you.

Even without orthodontic insurance coverage, you can save money on treatment with a dental savings plan, an FSA/HSA, or a payment plan. Clear aligners may be a cheaper braces alternative if you or your child have milder alignment needs.