Do Insurance Cover Braces?

Braces have become increasingly common among many individuals in recent years. Braces can help to adjust and straighten teeth, enhancing dental health and appearances. However, the cost of braces can be expensive, which is why many individuals wonder if their insurance will cover the cost of orthodontic treatment.

Types of Insurance that Cover Braces

The extent to which your insurance will cover braces depends on the type of insurance you have. Some insurance types that cover braces include:

Employer-Sponsored Insurance

Employer-sponsored insurance is one of the most common types of insurance that covers braces. Most insurance companies that offer employer-sponsored insurance will provide orthodontic treatment coverage as part of the dental insurance benefits package. The amount of coverage will vary, but employees can typically expect the insurance to cover at least a portion of the cost of braces, up to a certain dollar amount.

However, it’s important to note that employer-sponsored insurance plans may have stipulations or limits on orthodontic treatment coverage, so it’s always best to check with your insurance provider to determine what is covered and what you will be responsible for paying out of pocket.

Medicaid

Medicaid is a government-provided healthcare program for people with low income. Medicaid will cover orthodontic treatment, including braces, for children under the age of 21 in most states. However, the amount of coverage will vary depending on the state and the individual plan. Some states may require additional documentation or approval before coverage is provided.

Medicare

Medicare does not typically cover orthodontic treatment, including braces. However, there are some cases where Medicare may provide coverage for orthodontic treatment if it is deemed medically necessary. In these cases, a physician must provide documentation and request prior approval before treatment can begin.

Individual Insurance

If you have individual insurance, the extent of orthodontic treatment coverage will depend on the individual plan. Some plans may offer partial coverage for braces, while others may not cover them at all. It’s always best to check with your insurance provider to determine what is covered and what you will be responsible for paying out of pocket.

FAQs about Braces and Insurance Coverage

Q: How much will insurance cover for braces?

A: The amount of coverage for braces will depend on the individual insurance plan. Most insurance plans will cover at least a portion of the cost of braces, up to a certain dollar amount. However, employees may need to pay a portion of the cost on their own, depending on the plan.

Q: What if my insurance doesn’t cover braces?

A: If your insurance plan does not cover braces, there are other options available to help with the cost. For example, some orthodontists offer payment plans or financing options to make the cost of braces more manageable. Additionally, you may be able to claim the cost of braces as a tax deduction.

Q: How do I know if I am eligible for Medicaid coverage for braces?

A: Medicaid coverage for braces is typically available for children under the age of 21. The amount of coverage will vary depending on the state and the individual plan, so it’s best to check with your Medicaid provider to determine eligibility and coverage.

Q: Do I need a referral from a dentist or orthodontist to receive insurance coverage for braces?

A: Whether or not you need a referral for braces coverage will depend on the insurance plan. Some plans may require a referral from a dentist or orthodontist before coverage can be provided, while others may not require a referral.

Q: Can I switch insurance plans to get coverage for braces?

A: It may be possible to switch insurance plans to get coverage for braces. However, it’s important to carefully review the coverage options and costs of each plan before making a decision.

Conclusion

If you are considering getting braces, it’s important to understand your insurance coverage options. While some insurance plans will cover orthodontic treatment, including braces, the amount of coverage will vary depending on the plan. If you are unsure about what is covered under your insurance plan, it’s always best to check with your provider to avoid any unexpected costs.