What dental insurance actually covers braces in the US?

Most Americans want to achieve that picture-perfect smile but aren't able to afford it, and are left wondering, Does dental insurance cover braces? While the answer isn't always straightforward, it can save people thousands of dollars, and money can be spent wisely when they know the ins and outs of orthodontic insurance coverage.

This guide will cover insurance that typically pays for braces treatment, including how reimbursement for braces treatment works, as well as the coverage options available for kids and adults. We'll also cover Medicaid coverage for braces.

Understanding dental insurance and orthodontics

Dental insurance often works differently from health insurance. Most typical dental plans are geared toward preventive and routine services, such as cleanings, checkups, and fillings. When it comes to orthodontic care, such as braces, coverage depends on whether your plan includes orthodontic benefits, which are optional add-ons.

What are orthodontic benefits?

Orthodontic benefits are extra features you can add to a dental insurance plan that help cover treatments like braces or aligners. These are commonly found in:

• Employer-sponsored dental plans.

• Individual dental policies that include orthodontic coverage.

• Government-backed programs like Medicaid (for those who qualify).

Average cost of braces with insurance

Here is the breakdown of the average braces cost with insurance:

Does dental insurance cover braces for children?

For children under 18, many family or group dental insurance plans do include orthodontic benefits. These benefits typically cover 50% of the cost, with a lifetime maximum per child often ranging from $1,000 to $3,000.

Coverage typically applies to:

• Traditional metal braces

• Ceramic braces

• Lingual braces

• Clear aligners (with pre-approval)

To qualify, the child often needs to demonstrate medical necessity, such as difficulty chewing, speaking, or jaw alignment issues.

How to find dental insurance that covers braces for kids?

When it comes to your child's dental health, securing insurance that includes coverage for braces is one of the smartest long-term choices you can make. Many children eventually need orthodontic care to fix bite problems, jaw misalignment, or crowded teeth—issues that can impact their ability to chew, speak clearly, and even their self-esteem. The sooner you plan for these needs, the more choices you'll have, and the more money you'll save.

Insurance for adult braces: Is it covered?

For adults, insurance for braces is more limited. Only a few dental plans with orthodontic benefits include adult braces, and even then, coverage is often reduced or restricted.

Here's what adults should know:

• You may need a premium or upgraded plan for any orthodontic coverage.

• Clear aligners (like Caspersmile) might not be covered.

• Most plans have a waiting period (typically 6-12 months) before benefits apply.

• Reimbursement is generally 25-50% and is subject to lifetime limits.

If you have insurance through your job, ask if adult orthodontics are included or if you can add them through a separate rider.

Medicaid coverage for braces: Who qualifies?

Does Medicaid cover braces? Here is the breakdown, but only in specific cases.

For kids and teens

In most states, Medicaid will pay for braces for individuals under 21 if the treatment is medically necessary. This includes serious dental issues such as overbites, underbites, or trouble chewing and speaking.

For adults

Medicaid rarely covers braces for adults. Exceptions are made in some states, usually in situations involving jaw surgery or traumatic injury.

To qualify, you'll need:

If you think you or your child may be eligible, ask your provider to submit a pre-authorization request to Medicaid.

Braces treatment reimbursement: How does it work?

Braces treatment reimbursement is not automatic. To receive reimbursement for orthodontic care:

• Get a pre-treatment estimate from your orthodontist, detail the total cost, and the expected length of treatment.

• Submit the treatment plan to your insurance provider for a pre-determination of benefits.

• Your insurance provider will respond with how much of the treatment they'll cover, what is excluded, and how to submit claims.

• As treatment progresses, either your orthodontist will bill the insurer directly, or you'll need to submit paid receipts for partial reimbursement.

Be sure to ask your orthodontist's office if they assist with filing claims—it can make the process much easier.

How to get braces covered by insurance?

Dealing with insurance can feel like a maze, but here are a few steps to help:

Choose the right insurance plan

Before signing up, make sure the dental plan you choose includes orthodontic coverage. Check what's included, who qualifies, and what you'll have to pay out of pocket.

Get a pre-treatment estimate

Your orthodontist can develop a personalized treatment plan along with a detailed cost estimate. Submit this to your insurance company to find out ahead of time what they'll cover.

Understand lifetime maximums

Orthodontic benefits usually have a lifetime cap per person. Once you hit that limit, your plan won't pay anything more for braces.

Use flexible spending accounts (FSA) or health savings accounts (HSA)

Even if your plan only pays part of the cost, Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) let you use pre-tax money to help cover orthodontic expenses.

Ask about payment plans

Don't have coverage? Or not enough? Many orthodontists offer payment plans or partner with financing companies to help you manage the cost.

Know your coverage before starting your braces journey

Navigating what your dental insurance covers for braces can be tricky, especially in the U.S., where coverage varies widely between plans. The key is to understand the specifics of your policy. Many dental insurance policies do provide orthodontic benefits for children, typically covering around 50% of treatment costs up to a predetermined lifetime maximum.

However, when it comes to adults, coverage is far less common and only available through upgraded or specialized dental plans that include orthodontics. Medicaid can also help in certain cases, particularly when it comes to medically necessary orthodontic treatment for kids and teens.

FAQs

Does insurance cover braces in the USA? +

Yes, many dental plans cover braces, especially for children, often paying 50% of the cost up to a set lifetime limit.

How much do braces cost in the USA with insurance? +

With insurance, you may pay $2,000-$4,000 out of pocket, depending on coverage, treatment type, and plan limits.

Does Blue Cross dental insurance cover braces? +

Some Blue Cross dental plans include orthodontic benefits, but coverage varies by state and plan type. Check your policy for details.

Is it worth getting insurance for braces? +

Yes, if your plan includes orthodontics. It can save thousands, especially for kids, but always compare coverage vs. total treatment cost.

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