Does Dental Insurance Cover Braces for Adults?

It’s hard to match the teeth-moving power of braces. They’re studier and more effective than most other options. But that effectiveness comes at a price. Braces are one of the most expensive orthodontic options, which leads many to wonder whether dental insurance can help reduce the overall cost. And the answer is yes, but only sometimes.

Dental insurance plans sometimes cover braces treatment, although it depends on your specific provider and terms. This guide will help you navigate your insurance details and know what to expect.

Do Orthodontic Benefits Cover Braces?

As a general rule, when a dental plan includes orthodontic benefits, it will cover braces — with some restrictions. Most insurance companies have at least one dental plan that will cover braces for certain individuals. However, you need to examine the terms of any plan you’re considering carefully, as the fine print might exclude you from coverage or offer less help than expected. Below are some key things to look for.

Amount Covered

It’s rare to receive full coverage for any orthodontic treatment. In fact, we aren’t aware of a plan currently offering it. Instead, orthodontic benefits are usually structured to cover a percentage of eligible treatments (50% or less) or have a lifetime limit (either per policy or per person). When policies use the lifetime coverage limit approach, they usually restrict coverage to $3,000 or less.

In-Network vs. Out-of-Network

Dentists and orthodontists get to choose which insurance companies they accept — and the reverse is true as well. When a doctor and your insurer have a partnership, the doctor is in-network; if not, they’re out-of-network. In-network doctors are covered at higher rates and their offices will handle all the insurance paperwork for you. Since most insurance companies have large provider networks, you should easily be able to find a provider they partner with.

Age Limits

Unfortunately, many dental plans restrict orthodontic coverage to people under the age of 19. This isn’t always the case, but it can be a major barrier between adults and the braces treatment they need.

Lifetime Maximum

Many plans will also have a maximum amount that they’ll cover for orthodontic treatment over your lifetime. These limits are often somewhere between $1,000 and $3,000, but could be more or less, depending on your plan. For example, if your plan covers orthodontia with a $2,000 lifetime maximum and your braces cost $4,500, you’ll likely need to pay the $2,500 difference.

Waiting Periods

Finally, there will often be a waiting period before you can use your benefits. First, if you go with an employer-sponsored plan, you’ll need to wait from the period of open enrollment until the start of the next calendar year for your policy to take effect. But after that, you may still need to wait anywhere from a few months to a whole year before your orthodontic benefits kick in.

Average Cost of Braces (Before Insurance)

The amount you actually pay for braces depends on several factors, specifically your condition’s severity, your orthodontist’s fees, and even your location. But on average, that price will fall around $4,000–$6,000. Certain cases might fall outside of that range, though.

For example, a very mild tooth gap might close up in just a couple of months, and for less money, while a complicated case of overbite could take much longer and cost much more. And the price depends on the type of braces you choose, too. Aside from traditional metal braces, there are a few other types:

Clear/Ceramic Braces: A less-visible alternative, these use clear or tooth-colored brackets and wires. These often cost slightly more than traditional braces, between $4,000 and $8,000. They’re also not quite as durable as metal braces.

Lingual Braces: These braces are placed behind your teeth rather than in front. They’re much less noticeable but they’re also more expensive, sometimes as high as $8,000–$10,000. Because of their positioning, lingual braces can’t treat quite the same range of conditions.

Self-Ligating (Damon) Braces: These braces use special clasps to hold the archwire in place rather than tiny elastics on each bracket, making them easier to adjust. The makers of Damon braces also claim that they can move teeth faster. Like other specialty braces, these are slightly more expensive, typically around $4,000–$8,000.

Six Month Smiles Braces: Six Month Smiles is a brand of short-term orthodontic treatment that offers both clear aligners and clear braces. These braces are better suited for mild and moderate misalignments, but they’re also slightly cheaper, at $3,500 to $5,000 on average.

If you’re trying to avoid high prices and have a milder misalignment, you might consider at-home teeth straightening services like SmileDirectClub instead. They will deliver a set of clear aligners directly to your doorstep, which makes them cheaper than in-office treatments. Check out our guide to the top 5 home aligner options or learn more about our #1 pick, Byte, in this in-depth review.

How Orthodontic Benefits Work

Insurance coverage can get confusing. Medical and dental coverage are always separate, and then there is the fact that dental plans don’t always cover orthodontics. And even when they do, they often come with restrictions.

You have two options for obtaining dental insurance: getting a plan through your or your spouse’s employer or taking out one on your own. You have two options for obtaining dental insurance: getting a plan through your or your spouse’s employer or taking out one on your own. Once your policy is in effect, you can use it to help pay for covered treatments. Coverage may vary, and you’ll need to meet your deductible before your insurer will step in to help.

How to Get Orthodontic Benefits

You don’t purchase orthodontic benefits separately from dental insurance. Either your policy includes it or it doesn’t. You can get a plan through your employer if they offer one or you can purchase yours independently on the insurance marketplace.

If your employer offers a plan and it’s a good fit for you, this will be the more financially advantageous option. In all cases, the amount you pay toward premiums should be deducted before taxes, saving you money in April. On top of this, most employers will pay part of your premiums, lowering the amount you owe.

At the same time, there are clear drawbacks to relying on an employer for dental insurance. First, you can lose coverage when you leave your job. Second, you typically have to wait for open enrollment to take out your plan and it won’t kick in until January 1st of the next year. Finally, you have to choose from whatever plans your job offers — if they have any at all.

Independent plans ensure you have other choices. You can choose from hundreds of plans, making it easy to find the one that offers the ideal level of coverage for your needs. And there’s no need to wait for open enrollment, either.

Other Ways to Save on Orthodontic Treatment

Maybe you are already locked into a plan, and it either lacks orthodontic benefits or they aren’t quite robust enough to cover the full cost of your treatment. Don’t worry; you aren’t out of luck. There are other ways to make treatment accessible.

Enroll in a Dental Discount Plan: Some insurance companies have subscription-based discount dental plans. You pay a monthly or annual fee and gain access to discounts on certain procedures with designated providers. While these focus more on dental treatments than orthodontic ones, some cover a mixture of both.

Shop Around: If you got a quote from one orthodontist that was more than you can afford, get a second and even third opinion. Dentists and orthodontists set their own rates, so you might find that one is a lot more affordable than another.

Use an HSA or FSA: If you have either of these accounts, you might be able to apply the funds towards your braces treatment. HSAs and FSAs allow you to save pre-tax wages and then use that money to pay for qualifying medical expenses. Just verify with your account administrator first.

Consider Online Clear Aligners: If you are looking to make small changes to your alignment, at-home clear aligners tend to offer the most affordable treatment. They’re speedy, usually taking about six months or less, and are generally at least $1,000 less than in-office options. Most offer financing and accept HSA and FSA funds, and some — like Byte and SmileDirectClub — also partner with certain insurance companies.

Final Thoughts

Braces are the most time-tested and versatile orthodontic treatment out there, but they’re also fairly pricey. If you’re considering braces treatment, you should read over your insurance information — there’s a chance you’ll receive coverage. It all depends on your specific plan. Just be sure to consult your orthodontist and your insurance provider before beginning treatment so you can get an accurate estimate of what you might pay.