Getting braces offers more than just aesthetic pleasure. Braces can help some people build their confidence or add to their personalities. They are also known to assist in oral hygiene and preventive care.
However, the average cost of braces is between $3,000 and $8,000 depending on factors such as the level of misalignment, the causative factor, and the modifications needed.
This begs the question: does health insurance cover braces? In this article, we will answer that question in all its forms and set you up with the best financial solution for your orthodontic journey.
Does Health Insurance Cover Braces?
Knowing what health insurance covers is very important in our everyday life and planning. Standard health insurance typically does not cover braces. But don’t stop reading yet.
Some health insurance plans cover part of the cost of braces depending on the causative factor. If a dentist or an orthodontist states that the braces are medically necessary, there’s a better chance of your insurance covering most of the cost.
Here are a few scenarios when braces could be deemed medically necessary;
- The misalignment causes obstructive sleep apnea or breathing difficulties
- The misalignment causes difficulty in speaking, chewing, or eating
- The misalignment was caused by trauma
- The misalignment involves the jaw
In more inconsequential cases, it is better to look for specified dental insurance plans that have orthodontic benefits in them.
What is Dental Insurance?
Dental insurances are insurances that cover dental treatments or procedures. They can be a part of health insurance plans as add-ons but mostly you would find standalone dental insurances.
Dental insurance lowers out-of-pocket expenses for expensive dental procedures and they could cover:
- Preventive dental care such as routine checks and X-rays
- Dental procedures such as tooth extraction and tooth filling
- Orthodontic treatments
In more optimized circumstances you can find insurance schemes that group dental services with other useful services such as dental, vision, and hearing plans.
Does Dental Insurance Cover Braces?
Because dental insurance plans can include orthodontic treatments, there is a better chance of finding plans that cover braces either fully or partially.
However, the rate at which it will be covered could have some specifications. Here are the most common factors involved in the coverage;
- Age: Most plans cover children under the age of 18 years of old
- Deductibles and co-pays: Insurances that cover braces usually have a limit, which means you would have to cover other out-of-pocket medical expenses.
- Type of Plan: Most basic insurance plans do not cover orthodontic procedures. However, they can be found in other plans such as employer-sponsored plans or high-tier individual plans.
- Medical Necessity vs. Cosmetic Treatment: Just like for health insurance, braces that are medical necessities are given priority or the only ones covered in some plans
- Waiting Periods & Coverage Limits: If you are lucky enough to find dental insurances that cover braces they may include added discomforts such as really long waiting periods or lifetime maximums limiting the amount to be covered.
Does Health Insurance Cover Braces for Children?
Children are the most common beneficiaries of health insurance for braces. Dental plans for children usually have an extension for orthodontic services which includes braces.
The reason for this is that under the Affordable Care Act (ACA), pediatric dental care is considered an essential health benefit in many plans, and this sometimes includes medically necessary orthodontics like braces. Aside from that, it serves as preventive care for worse structural problems developing.
Does Health Insurance Cover Braces for Adults?
For adults, answering the question “Does health insurance cover braces?” is a bit tricky, so let’s break it down.
Assured Cases
As an adult looking to use braces, you should definitely find insurance plans to cover it if any of the following is the case:
- The misalignment was caused by a trauma
- The braces would be treating a particular disease, injury, or related symptoms e.g. Temporomandibular Joint Disorders (TMD), obstructive sleep apnea, breathing difficulties, etc.
- The braces would rectify significant functional or structural issues with the teeth or jaw. (This will be confirmed by a dentist or orthodontist)
Likely Cases
A situation that is commonly 50-50 among insurance plans is the consideration of young adults. Some health insurance plans cover braces for adults between the ages of 18 and 21. This is regardless of the reason (i.e. Even if it is a cosmetic procedure).
Unsure Cases
The rarest of cases where health insurance would cover braces is for adults over the age of 21 years who the procedure has not been deemed medically necessary for.
Although rare, a few insurance plans partially cover orthodontic plans for adults. However, there would be inclusions of clauses such as spending limit, pre-authorization, utilization of specific clinics, or very long waiting periods.
Alternative Coverage and Cost Management Options
If your health or dental insurance doesn’t fully cover braces, there are still ways to make orthodontic treatment more affordable. Here are some other options to finance your braces:
Flexible Spending Accounts (FSA) & Health Savings Accounts (HSA)
If you have an FSA or HSA through your employer, you can use pre-tax dollars to pay for orthodontic treatment, reducing your overall costs.
Dental Discount Plans
Unlike insurance, dental discount plans provide reduced rates on orthodontic care through a network of participating providers. These plans require an annual membership fee but can lead to significant savings.
Payment Plans & Financing
Many orthodontists offer in-house financing or partner with third-party lenders to provide monthly payment options with little to no interest. This spreads the cost of braces over time, making them more affordable.
Nonprofit & Charitable Programs
Some organizations provide orthodontic treatment at a reduced cost or even free for qualifying children from low-income families.
By exploring these options, you can find a way to make braces more affordable, even if insurance doesn’t fully cover the cost.
How to Find The Right Health Insurance for Braces
As has been covered in this article, there are health insurances that cover braces. Their coverage is dependent on several factors such as age, medical necessities, and type of plan.
Depending on what category you fall into, finding the right health insurance for braces can be a very difficult task. The best option for you is to find top insurance brokers to do the running around for you and come up with the best options to solve your problem.
Using insurance brokers over insurance agents guarantees that the options you get will not be limited to a particular insurer. Brokers will go through multiple insurance providers with multiple plans using the details you provide, to find a plan tailored just for you.
IQ Financial Group: The Right Insurance Brokers For The Job
To solve your insurance-seeking issues, IQ Financial Group is the best solution for you. Not only are we an insurance brokerage company. We are experts with years of experience and successful deliveries.
Since 2002, we have helped individuals, families, and businesses find the right insurance plans and providers for them. To find out about health insurance plans (if any) that could cover your braces payment contact us today to skip the long search and explore the available options.
