Yes, many dental insurance plans cover braces, typically paying 50% of the cost up to a lifetime maximum of $1,000 to $3,000. However, coverage varies significantly depending on your specific plan. Some insurance policies cover orthodontic treatment for children only, while others exclude braces entirely. Understanding your coverage before starting treatment helps you plan financially and avoid surprises.
This guide explains how orthodontic insurance coverage works, what to expect from your plan, and how to make braces affordable even if your insurance coverage is limited.
How Much Does Insurance Pay for Braces?
Most dental insurance plans that include orthodontic coverage pay approximately 50% of the treatment cost, up to a lifetime maximum. This lifetime maximum is a cap on how much your insurance will ever pay for orthodontic treatment, regardless of how many times you need braces.
Common lifetime maximums range from $1,000 to $3,000, with $1,500 being typical for many plans. If your braces cost $5,500 and your plan covers 50% up to a $1,500 lifetime maximum, your insurance would pay $1,500 and you would pay the remaining $4,000.
Some employer-sponsored plans offer higher lifetime maximums of $2,500 or even $3,000. If you are choosing between insurance plans during open enrollment, compare the orthodontic lifetime maximums to find the best coverage.
What Type of Insurance Covers Braces?
Not all dental insurance includes orthodontic coverage. You need a plan with a specific orthodontic benefit to receive coverage for braces.
Dental insurance with orthodontic rider: Many dental plans offer orthodontic coverage as an add-on or include it in higher-tier plans. Check whether your plan includes orthodontics or if you need to add this coverage.
Standalone orthodontic insurance: Some insurers offer separate orthodontic policies specifically for braces and Invisalign coverage.
Medical insurance: Traditional medical insurance rarely covers braces because orthodontic treatment is considered dental care. However, medical insurance may cover jaw surgery if it is medically necessary and performed in conjunction with orthodontic treatment.
If your current dental plan does not include orthodontic benefits, you may be able to add coverage during your next open enrollment period. Keep in mind that many plans have waiting periods of 12 to 24 months before orthodontic benefits begin.
Does Insurance Cover Braces for Adults?
Many insurance plans limit orthodontic coverage to children and teenagers, typically those under age 19. If you are an adult seeking braces, your coverage options may be more limited.
Some plans do cover adult orthodontics, but they may have lower lifetime maximums or higher out-of-pocket costs compared to coverage for children. Employer-sponsored plans are more likely to include adult orthodontic benefits than individual plans purchased on the marketplace.
If your plan does not cover adult braces, consider these alternatives:
- Adding orthodontic coverage during open enrollment if available
- Using FSA or HSA funds to pay with pre-tax dollars
- Taking advantage of payment plans offered by your orthodontist
At Brace Central Orthodontics, we treat many adult patients and offer interest-free payment plans to make treatment affordable regardless of insurance coverage.
Does Insurance Cover Braces for Kids?
Insurance plans are more likely to cover braces for children than for adults. Most plans that include orthodontic benefits cover dependent children up to age 19, and some extend coverage to age 26 if the child is still on the parent’s plan.
The same coverage terms typically apply: 50% of costs up to a lifetime maximum. Because this maximum applies per person, each child on your plan has their own separate lifetime maximum for orthodontic treatment.
If you have multiple children who need braces, you may want to stagger their treatment to manage out-of-pocket costs across different budget years.
Does Medicaid Cover Braces?
Medicaid coverage for braces varies by state and depends on medical necessity. In New York, Medicaid may cover braces for children if the orthodontic treatment is deemed medically necessary, not just cosmetic.
To qualify for Medicaid coverage, the child typically needs to have a severe malocclusion that affects their ability to eat, speak, or causes significant dental health problems. Mild crowding or spacing for purely cosmetic reasons usually does not qualify.
Your orthodontist can evaluate whether your child’s case might qualify for Medicaid coverage and help you navigate the approval process.
Does Insurance Cover Invisalign?
Most insurance plans that cover braces also cover Invisalign at the same benefit level. From an insurance perspective, Invisalign is considered orthodontic treatment just like traditional braces.
The same lifetime maximum applies whether you choose braces or Invisalign. If your plan has a $1,500 orthodontic maximum, that amount applies to whichever treatment you select.
Check with your insurance company to confirm Invisalign is covered under your specific plan, as some older policies may only cover traditional braces.
How to Check If Your Insurance Covers Braces
Before starting orthodontic treatment, verify your coverage by contacting your insurance company directly. Ask these specific questions:
- Does my plan include orthodontic benefits?
- What percentage of orthodontic treatment does my plan cover?
- What is my lifetime maximum for orthodontics?
- Is there a waiting period before orthodontic benefits begin?
- Does coverage apply to adults, children, or both?
- Is Invisalign covered the same as traditional braces?
- Do I need pre-authorization before starting treatment?
Request this information in writing so you have documentation of your benefits. Your orthodontist’s office can also submit a pre-treatment estimate to your insurance company to determine exactly how much will be covered.
Can You Use FSA or HSA for Braces?
Yes, you can use Flexible Spending Account (FSA) or Health Savings Account (HSA) funds to pay for braces. This allows you to pay for orthodontic treatment with pre-tax dollars, effectively saving you money.
FSA funds must be used within the plan year (some plans offer a grace period or limited rollover). If you know you are getting braces, you can contribute extra to your FSA that year to cover your out-of-pocket costs.
HSA funds roll over year to year with no expiration, so you can save up over time for orthodontic treatment. HSAs are available if you have a high-deductible health plan.
Using pre-tax dollars can save you 20% to 30% on your orthodontic costs depending on your tax bracket.
What If Your Insurance Does Not Cover Braces?
If your insurance does not cover braces or your coverage is limited, you still have options to make treatment affordable.
Payment plans: Most orthodontists offer monthly payment plans that spread the cost of treatment over time. At Brace Central Orthodontics, we offer interest-free payment plans with low monthly payments.
Orthodontic discount plans: Some dental discount plans offer reduced rates on orthodontic treatment in exchange for an annual membership fee.
Tax deductions: Orthodontic treatment may be tax-deductible as a medical expense if your total medical expenses exceed 7.5% of your adjusted gross income.
Timing treatment strategically: If you can add orthodontic coverage during open enrollment, waiting until benefits begin can significantly reduce your costs.
Affordable Braces at Brace Central Orthodontics
At Brace Central Orthodontics, we believe everyone deserves a beautiful smile regardless of insurance coverage. We accept most major dental insurance plans and will work with you to maximize your benefits.
For patients with limited or no insurance coverage, we offer interest-free payment plans that make treatment affordable. Our team will provide a complete breakdown of costs and payment options during your free consultation.
Dr. Polina Ingberman has over 25 years of experience and is board-certified by the American Board of Orthodontics. She graduated first in her class from NYU College of Dentistry and completed her orthodontic residency at Columbia University. Dr. Ingberman and her team treat children, teenagers, and adults with braces, ceramic braces, and Invisalign.
Our Brooklyn office is located at 2468 Coney Island Avenue in the Gravesend and Sheepshead Bay neighborhood. We offer flexible scheduling including after-school and evening appointments.
Call 718-998-1888 or contact us online to schedule your free consultation. We will verify your insurance benefits, explain your coverage, and provide a personalized treatment plan with transparent pricing.
Frequently Asked Questions
How much do braces cost without insurance?
Without insurance, braces typically cost $3,000 to $7,000 depending on the complexity of your case and the type of braces you choose. At Brace Central Orthodontics, comprehensive treatment averages $5,500 with interest-free payment plans available.
Is there a waiting period for orthodontic insurance?
Many dental plans have a waiting period of 12 to 24 months before orthodontic benefits become active. This prevents people from adding coverage only when they need braces. Check your specific plan for waiting period requirements.
Can I get braces covered by two insurance plans?
If you have dual coverage through two insurance plans (for example, your own employer plan plus coverage as a dependent on a spouse’s plan), you may be able to coordinate benefits. The combined coverage cannot exceed 100% of the treatment cost, but it can help reduce your out-of-pocket expenses.
Does insurance cover braces if I had them before?
Your orthodontic lifetime maximum is a one-time benefit. If you used your lifetime maximum on braces as a teenager, your insurance will not cover braces again as an adult. However, some plans reset the lifetime maximum after a certain number of years, so check with your insurer.
Disclaimer
Medically reviewed by Dr. Polina Ingberman, Orthodontist.
This content is for educational purposes only and is not intended as medical advice, diagnosis, or treatment. Please consult a qualified healthcare provider for personalized recommendations.