Braces can be a significant investment in your dental health and overall well-being, especially for children and teens. Many people wonder whether dental insurance can help cover the high cost of orthodontic treatment. The answer is: sometimes — but it depends on your specific insurance plan.
In this blog, we’ll break down how dental insurance works with braces, what types of plans may cover orthodontics, and what to consider before starting treatment.
Understanding Dental Insurance for Braces
Dental insurance typically falls into two main categories:
- Basic Dental Insurance – Covers preventive care (cleanings, exams, X-rays) and some basic procedures like fillings.
- Comprehensive Dental Insurance – May include coverage for major procedures, including orthodontics like braces or clear aligners.
Not all plans include orthodontic coverage, and those that do may have specific limitations.
What Does Orthodontic Coverage Include?
If your dental plan includes orthodontic benefits, it may help pay for:
- Traditional metal braces
- Ceramic braces
- Lingual braces (braces behind the teeth)
- Clear aligners (such as Invisalign)
- Retainers (in some cases)
However, coverage may only apply to children under 18, and adult orthodontic coverage is often more limited.
How Much Will Insurance Cover?
Coverage for braces varies, but here’s a general idea:
- Most dental insurance plans with orthodontic benefits cover 25% to 50% of the total cost.
- Plans often come with a lifetime maximum benefit for orthodontics — commonly around $1,000 to $3,000.
- You’ll usually be responsible for the remaining balance.
Example:
If braces cost $5,000 and your plan covers 50% up to a $2,000 lifetime maximum, you’d receive $2,000 in benefits and pay $3,000 out of pocket.
Waiting Periods and Pre-Approval
Some dental plans have a waiting period (typically 6 to 12 months) before orthodontic benefits kick in. Others may require:
- A pre-treatment estimate
- A referral from a general dentist
- Documentation proving medical necessity
Always review your policy before starting treatment.
What About Medicaid or CHIP?
If you or your child qualifies for Medicaid or CHIP (Children’s Health Insurance Program), orthodontic treatment may be covered if it’s deemed medically necessary. Coverage and eligibility requirements vary by state.
Alternatives If Insurance Doesn’t Cover Braces
If your dental insurance doesn’t include orthodontic coverage, consider these options:
- Dental Discount Plans – Offer reduced fees from participating orthodontists.
- Payment Plans – Many orthodontists offer monthly installment plans with little or no interest.
- Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) – Can be used to pay for braces with pre-tax dollars.
Final Thoughts
Dental insurance can help cover the cost of braces, but it’s essential to understand the limits, requirements, and exclusions of your plan. Before committing to orthodontic treatment, contact your insurance provider to confirm:
- Whether orthodontics are covered
- What percentage is paid
- The lifetime maximum
- Age limits and waiting periods
Braces are a long-term investment in your smile, and with the right coverage and planning, you can make them more affordable.
