Yes, many dental insurance plans cover braces. Most orthodontic coverage pays around 50% of the treatment cost up to a lifetime maximum, typically between $1,000 and $3,000. However, coverage varies significantly between plans, and some policies only cover orthodontics for children under 18.
Understanding your insurance benefits before starting treatment helps you plan financially and avoid surprises. This guide explains how orthodontic insurance works, what to look for in your policy, and what options exist if you do not have coverage.
How Much Do Insurance Plans Pay for Braces?
Orthodontic insurance benefits work differently than regular dental coverage. Instead of covering a percentage of each visit, most plans pay a set lifetime maximum toward orthodontic treatment.
- Typical orthodontic coverage includes: A lifetime maximum benefit between $1,000 and $3,000 (some plans offer more). Coverage of approximately 50% of the treatment cost up to that maximum. Benefits that apply once per lifetime, not annually like regular dental benefits.
- Example of how coverage works: If your braces cost $5,000 and your plan covers 50% up to a $2,000 lifetime maximum, insurance would pay $2,000 and you would pay $3,000. If your plan covers 50% up to a $1,500 maximum, insurance would pay $1,500 and you would pay $3,500.
Dr. Boris Pinhasov notes that “many insurances have orthodontic benefits. Each plan is different and depends on the benefits that are available.” The only way to know your exact coverage is to review your specific policy or contact your insurance company.
Does Dental Insurance or Medical Insurance Cover Braces?
Most orthodontic coverage comes through dental insurance, not medical insurance. However, there are some situations where medical insurance may apply.
- Dental insurance is the primary source of orthodontic benefits. If you have dental insurance through your employer or purchased individually, check whether it includes orthodontic coverage. Not all dental plans include orthodontics, so verify before assuming you are covered.
- Medical insurance typically does not cover braces for cosmetic reasons. However, medical insurance may cover orthodontic treatment if it is deemed medically necessary. Situations that may qualify include jaw surgery (orthognathic surgery) to correct severe bite problems, orthodontics required after facial trauma or accident, treatment for conditions like cleft palate, and severe functional problems that affect eating, breathing, or speaking.
If you believe your orthodontic needs may be medically necessary, discuss this with your orthodontist. They can help determine if medical insurance might apply and provide documentation to support a claim.
Does Insurance Cover Braces for Adults?
Many dental insurance plans limit orthodontic coverage to children under 18 or 19. Adult orthodontic coverage is less common but does exist.
- If you are an adult seeking braces: Review your dental policy carefully for age restrictions. Some employer plans cover adult orthodontics while individual plans often do not. Coverage amounts for adults may be lower than for children. Some plans have waiting periods before orthodontic benefits become available.
- Options if your plan does not cover adult braces: Look for supplemental dental insurance that includes adult orthodontics. Use a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay with pre-tax dollars. Ask about payment plans at your orthodontist’s office. Consider financing options through third-party lenders.
Adult braces are becoming increasingly common, and more insurance plans are beginning to offer coverage. If your current plan does not cover adult orthodontics, it may be worth exploring other options during your next open enrollment period.
Does Insurance Cover Braces for Kids?
Children typically have better orthodontic insurance coverage than adults. Most dental plans that include orthodontic benefits cover dependent children up to age 18 or 19.
- What to know about kids’ coverage: Most plans cover orthodontics for dependent children automatically. Coverage usually begins when permanent teeth start coming in, typically around age 7 to 12. Some plans require pre-authorization before treatment begins. The lifetime maximum applies once, even if treatment spans multiple calendar years.
- Family plans: If you have a family dental plan, orthodontic benefits often apply to each covered child individually. This means if you have two children who need braces, each may have their own lifetime maximum to use.
- Timing considerations: Some families wait until their child is older to use orthodontic benefits, thinking they will get more value. However, early treatment when recommended can prevent more complex problems later. The best time for braces is when your orthodontist recommends it, not when it seems financially optimal.
Does Medicaid or CHIP Cover Braces?
Medicaid and the Children’s Health Insurance Program (CHIP) may cover braces for children in certain circumstances, but coverage requirements vary by state.
- Medicaid orthodontic coverage: Most state Medicaid programs cover orthodontics only when deemed medically necessary. Cosmetic treatment is typically not covered. Medical necessity usually requires documentation of functional problems, not just crooked teeth. Each state has different criteria for what qualifies as medically necessary.
- CHIP coverage: CHIP programs also vary by state. Some states offer more generous orthodontic benefits than Medicaid. Coverage may be available for moderate to severe orthodontic needs.
- How to find out if you qualify: Contact your state Medicaid or CHIP office for specific coverage criteria. Ask your orthodontist if they accept Medicaid or CHIP. Request a pre-authorization evaluation to determine if treatment would be covered.
If Medicaid or CHIP does not cover your child’s orthodontic needs, many orthodontic offices offer payment plans to make treatment affordable for all families.
How to Check If Your Insurance Covers Braces
Before scheduling your consultation, take these steps to understand your orthodontic benefits.
- Step 1: Find your dental insurance information. Locate your insurance card and policy documents. You need the name of your insurance company, your policy or group number, and the phone number for member services.
- Step 2: Call your insurance company. Ask these specific questions: Does my plan include orthodontic benefits? What is the lifetime maximum for orthodontics? What percentage of treatment does the plan cover? Is there an age limit for orthodontic coverage? Is there a waiting period before I can use orthodontic benefits? Do I need pre-authorization before starting treatment? Are there any network restrictions?
- Step 3: Get it in writing. Ask for a written summary of your orthodontic benefits. This document will be helpful when discussing treatment costs with your orthodontist.
- Step 4: Bring your information to your consultation. At BP Smiles, the team verifies insurance benefits for every patient. Bring your insurance card and any benefit information you have gathered. The office will confirm your coverage and explain exactly what your plan will pay.
What If Your Insurance Does Not Cover Braces?
If you do not have orthodontic insurance or your coverage is limited, several options can help make braces affordable.
- Payment plans: Most orthodontic offices offer monthly payment plans that spread the cost over the length of treatment. At BP Smiles, flexible payment arrangements are available with little to no interest, making treatment accessible for families at all budget levels.
- Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA): If you have access to an HSA or FSA through your employer, you can use pre-tax dollars to pay for braces. This effectively gives you a discount equal to your tax bracket, often 20% to 30% or more.
- Third-party financing: Companies like CareCredit and LendingClub offer healthcare financing with promotional interest-free periods. These options provide more time to pay than typical in-house payment plans.
- Dental discount plans: Some discount plans offer reduced rates on orthodontic treatment for a monthly or annual membership fee. These are not insurance but can provide savings for families without coverage.
- Using multiple resources: Many families combine options. For example, you might use partial insurance benefits, pay a portion from an FSA, and put the remainder on a payment plan.
How BP Smiles Helps You Maximize Insurance Benefits
At BP Smiles Orthodontics, we make understanding and using your insurance benefits easy.
Dr. Boris Pinhasov and his team work with most major dental insurance plans. The office staff verifies your benefits before treatment begins so you know exactly what to expect financially. They handle claim submissions and paperwork so you do not have to.
“Everyone deserves our best, all the time,” says Dr. Boris Pinhasov. “We believe finances should not prevent anyone from getting the orthodontic care they need.”
For patients without insurance or with limited coverage, BP Smiles offers flexible payment plans tailored to your budget. The practice accepts HSA and FSA payments and can discuss financing options during your free consultation.
Dr. Boris Pinasov is a board-certified orthodontist and a Diplomate of the American Board of Orthodontics with 20 years of experience serving Queens families. The practice has earned over 170 five-star Google reviews from patients who appreciate the transparent approach to treatment costs.
Located at 208-09 Union Turnpike in Flushing, BP Smiles offers free consultations where you will receive a complete treatment plan with clear pricing. Evening and Sunday appointments are available to fit your schedule.
Frequently Asked Questions
How long does orthodontic insurance last?
Orthodontic benefits are typically a lifetime maximum, meaning you can only use them once. Unlike regular dental benefits that reset each year, orthodontic benefits do not renew. Once you use your lifetime maximum, you cannot get additional orthodontic coverage from that plan.
Can I use two insurance plans for braces?
Yes, if you have coverage under two dental plans, you may be able to coordinate benefits. The primary plan pays first, and the secondary plan may cover some of the remaining cost. This can reduce your out-of-pocket expense, though coverage limits still apply.
Does insurance cover Invisalign?
Many dental insurance plans that cover braces also cover Invisalign and other clear aligners. Coverage amounts are usually the same as for traditional braces. Check your specific policy to confirm.
What is a lifetime orthodontic maximum?
This is the total amount your insurance will pay for orthodontic treatment over your lifetime. Once you reach this maximum, the plan will not pay any additional orthodontic benefits. Maximums typically range from $1,000 to $3,000.
Do I need pre-authorization for braces?
Some insurance plans require pre-authorization, meaning you must submit treatment plans to the insurance company for approval before starting. Your orthodontist’s office can handle this process for you. Pre-authorization helps confirm your coverage before you commit to treatment.
