Does Medical Insurance Cover Braces?

Let’s talk about everyone’s favorite topic – insurance!

If you’re staring at a $6,000 orthodontist bill wondering if your medical insurance will save you, keep reading.

Related: Does Medicare Cover Dental Implants

Medical Insurance and Braces

Here’s the bad news upfront: medical insurance typically doesn’t cover braces.

Why? Because they consider it a dental thing, not a medical thing 🙄

Medically Necessary Treatments

BUT… there are some exceptions. Your medical insurance might actually help if you need braces for:

• Severe bite problems causing major pain
• Non-biting accidents that messed up your teeth
• TMJ disorders (that jaw clicking thing)
• Sleep apnea issues from crooked teeth

They might also cover braces if you need:

• Jaw surgery for serious bite problems
• Treatment after facial trauma or injury

Quick reality check though – they’ll probably only cover the part that’s “medically necessary,” not your whole “I want perfect teeth” journey.

Dental Insurance and Braces

Dental insurance is more likely to help with braces! But there are some fun catches:

Watch out for:

• Age limits (most plans only cover kids under 18)
• Lifetime maximums (they cap how much they’ll pay)
• Waiting periods (no instant coverage)
• Pre-existing conditions (they don’t like those)

Medicaid and Braces

For the kiddos:

• Coverage varies by state
• Must be medically necessary
• Usually only for kids under 21

For adults:

• Good luck! (adult coverage is rare)
• Varies by state
• Usually very limited

Alternative Options for Covering Braces

Don’t panic if insurance isn’t helping! You’ve got options:

FSAs and HSAs

• Use pre-tax money
• Like a discount on your braces
• Your future self will thank you

Payment Plans

• Most orthodontists offer these
• Usually low or no interest
• Spread the pain (financial, not dental)

Dental Schools

• Student dentists (supervised!)
• Way cheaper
• Takes longer (but savings!)

Dental Discount Plans

• Not insurance but better than nothing
• Annual fee for discounted rates
• Worth checking out

How to Maximize Your Coverage

Here’s your game plan:

1. Read your policy (boring but necessary)
2. Call your insurance (get everything in writing)
3. Get documentation from your orthodontist
4. Use in-network providers (save that money!)
5. Get a pre-treatment estimate

Conclusion

The truth? Getting insurance to pay for braces is about as fun as… getting braces.

But if you play your cards right, you might save some serious cash through:

• Medical insurance (if you qualify)
• Dental insurance (if you’ve got it)
• Alternative payment options (if all else fails)

My advice? Start investigating your options BEFORE you need braces. Nothing worse than finding out you could’ve saved thousands if you’d just waited for your new insurance to kick in.

And remember – straight teeth are nice, but eating and breathing properly are nicer. If you need braces for medical reasons, fight for that coverage!