Whether you’re thinking about getting braces for yourself or your child, cost is likely to be the most important thing. Braces are expensive for most people, so it’s important to find out if your dental insurance can cover some or all of the cost. however, it can be confusing to determine if and to what extent braces treatment can be covered.
will insurance cover the brakes?
If you have children under the age of 18, insurance companies must offer an option to purchase dental insurance that meets the criteria of the Affordable Care Act (ACA). however, it is up to you to obtain dental insurance or not. It’s worth noting that dental insurance isn’t required for children, and you won’t face a penalty if you don’t have it.
Reading: What insurance will cover braces
when trying to find the answer to “does insurance cover brakes?” Please note that coverage may vary from plan to plan. for example, some plans only cover preventive care and partial restorative treatments. at the same time, others may have broader coverage.
Some private insurance plans may cover some of the cost of braces, such as the procedure itself. however, you may still be required to pay certain fees, such as copays.
When shopping for dental insurance plans, you’ll want to compare features and benefits to see if braces are included. You also want to pay special attention to any limitations regarding brake coverage. for example, it may only apply to braces that are needed for certain conditions or up to a specific age.
orthodontic coverage for children vs. adults
asking “is dental insurance worth it?” brake coverage can be a deciding factor. children can have dental insurance coverage using their parent’s insurance plan. Under the Affordable Care Act, dental insurance is considered an essential benefit for children under the age of 18.
In addition, the out-of-pocket limit for one child is $350 and $700 for two children. This means that children’s dental insurance plans must pay for care after you’ve spent these two out-of-pocket costs.
You will be able to use your current dental health insurance to cover some, if not all, of your children’s dental expenses. however, the same benefit is not granted to adults. considering that 25% of people in the us. with braces are adults, you’re not alone in trying to figure out how to pay for brace treatment. You’ll need to shop around for the most affordable dental insurance if you’re over 18.
If you’re wondering what insurance covers braces, most health insurance plans will cover dental care if it’s related to an emergency. For example, if you had an accident that required emergency dental surgery, health insurance might cover these costs. however, most health insurance plans will not cover the costs of regular or cosmetic dental procedures, including braces.
Braces and other cosmetic procedures will generally need to be covered by a separate dental health insurance plan.
Does Medicaid cover braces?
Medicaid covers medically necessary procedures; In some cases, braces are included in this category for children. Medicaid is a type of state and federally funded health insurance plan available to people with low incomes. If you fall below a certain threshold, usually the poverty level in your state, you may qualify for Medicaid assistance in your particular state.
for example, if you live in california and are below the california poverty line, you should be able to qualify for “medi-cal,” which is the medicaid available in california. If the braces are medically necessary for you or your child, then Medicaid should cover the costs.
does an fsa or hsa cover braces?
if you want to use pre-tax savings to pay for your braces, you can certainly use your fsa or hsa savings to cover braces costs.
alternatives to braces
A popular alternative to metal braces is invisalign. This option tends to be a bit more expensive than traditional braces, but some dental insurance policies will cover a portion of the cost.
There are also options such as ceramic brackets that are more discreet. these may be partially covered by your insurer, but the only way to know is to check the specific coverage terms.
What dental services are included in orthodontics?
It’s a good idea to understand the services typically associated with orthodontics before evaluating your dental insurance options. According to the American Association of Orthodontists (AAO), an orthodontist provides procedures to fix teeth that result in conditions such as dental overbites, underbites, and crowded or misaligned teeth. These problems can be fixed by slowly applying pressure to specific teeth to snap them into place without surgery. Orthodontic treatment often involves the following services:
- an initial evaluation, which may include x-rays of the jaw and teeth, and treatment planning, as indicated
- extraction of teeth if necessary to correct crowding
- routinely scheduled treatment visits
- orthodontic appliances, including braces and/or retainers
- braces, which consist of brackets, wires, and bands that are continuously adjusted over a specified period of time to straighten teeth. Most braces are metal with colored brackets, however they also come in ceramic and light colors for those who don’t want their braces to show.
- aligners, which like braces, help straighten teeth and align them. Aligners, usually invisalign, are clear trays that fit specifically around your teeth to reshape them.
- space maintainers, which are used to keep the space open when baby teeth are lost earlier than normal, so that other teeth do not grow into the space intended for the missing tooth until the permanent teeth start to grow in .
- removable retainers, which are plastic or metal appliances molded to fit the frame to move teeth slightly or prevent teeth from returning to their original position after braces or invisalign are removed. Most of the time, retainers are worn overnight.
- jaw repositioning appliances, sometimes called splints, are used to move the upper or lower jaw so that the jaw as a whole closes more naturally.
- overbite or severe overbite
- congenitally missing teeth that require braces to fix
- craniofacial deformities
- orthodontic treatment
- pre and post-orthodontic treatment
- premium: a monthly fee you pay for dental insurance coverage
- deductible: the amount you pay for dental services before your insurance company begins to pay a portion of the cost
- Copayments – The cost-sharing amount you pay for covered dental services, usually a fixed dollar amount or a percentage of the cost of the service.
- exclusions: dental services that are not covered under any circumstances, are not covered until a defined waiting period expires, or are not covered if the condition existed before you purchased dental insurance (pre-existing condition)
- how long you need your braces
- what material your braces are made of (ceramic, metal, invisalign)
- special considerations (lingual braces, etc.)
- additional cleanups
- adjustments and additional dental visits
- removal of additional teeth before braces are implanted, especially if there is crowding of teeth
Orthodontists design and fit appliances to realign teeth and jaws to produce and maintain normal function and improve appearance. Among the most common orthodontic appliances are:
Under the Affordable Care Act, state and federally funded Medicaid insurance programs must cover the costs of dental work if it is medically necessary. your insurance may cover the cost of braces if you need them for a medical necessity. this may include:
Which plans cover orthodontia?
In some cases, private individual and family plans offer dental insurance for orthodontic care. In addition, your employer-sponsored dental insurance may also offer partial coverage.
Various dental plans may include the following orthodontic services for adults and children:
Dental insurance may cover some of the costs of braces, but you’ll likely still have out-of-pocket costs. When evaluating your insurance, you want to look at:
What is the average cost of braces?
The cost of braces will depend on several factors, including:
The average cost of braces starts at around $5,350 for simple metal braces and can go as high as $12,000 for lingual braces.
what are the additional medical costs related to braces?
In addition to the cost of your braces, you may also have to pay other expenses, such as:
How can you save more on braces and orthodontics?
Use our online tool to find the best dental insurance plans that cover the cost of braces. You can save more money by using dental insurance instead of relying on your regular health insurance to cover costs or pay out of pocket.
You can also take the time to search for dentists in your area that offer special prices, certain discounts, or even payment plans. Also, if you want to keep your costs as low as possible, consider regular metal braces.
Use ehealth to find a dental plan that works for you
as you can see, the answer to “does insurance cover brakes?” it’s complicated. At ehealth, we’re here to help you find affordable dental insurance coverage that meets your coverage needs. By working with multiple insurance companies offering plans throughout the United States, eHealth gives you access to a wide range of dental insurance options. To learn more about stand-alone dental plans where you live, simply visit our dental insurance page. If you’re looking for health insurance that includes dental coverage, eHealth works with insurance companies that provide that broader protection. just visit our individual and family insurance page. Whether you’re looking for dental coverage for yourself or your entire family, we can help you find the insurance that’s right for you. our customer service staff and authorized agents are available to assist you.