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 plan. This guide will help you navigate your insurance details and know what to expect.

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-Litigating (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, $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 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

It’s natural to think that every dental insurance plan includes orthodontia, but this isn’t always true. Some dental insurance plans have orthodontic benefits and some don’t. And even the plans that include orthodontia can come with restrictions.

You can enroll in a dental insurance plan either through your employer or on your own. Once you have insurance, you can use it for whichever treatments it includes (unless there’s a waiting period, but more on that later). Often, orthodontic benefits will cover a certain percentage of your orthodontic treatment or pay up to a certain amount.

Do Orthodontic Benefits Cover Braces?

Many times, orthodontic benefits do cover braces, but it depends on the plan. Typically, the most basic plans won’t include any orthodontic coverage, while the more comprehensive and expensive plans will. Every insurance company outlined above has a plan (or multiple plans) that might cover braces or clear aligners.

This coverage also can extend to other braces types (see above), but to be sure, you should double-check with your dentist/orthodontist and insurance provider.

Amount Covered

Many plans with orthodontic benefits will only cover part of your treatment. Sometimes they will cover up to 50% of your treatment, and other times there will be a lifetime coverage limit of $1,000 – $3,000 (on average), sometimes both. Rarely, if ever, will a plan offer 100% coverage with no limit.

Additionally, there are some restrictions that you should keep in mind as you shop for dental insurance and enroll in a plan.

In-Network vs. Out-of-Network

Each dental plan has a network of dentists that are approved to file coverage claims. If you choose an in-network dentist or orthodontist, you will receive coverage for the treatments outlined in the plan. If you don’t like any of the in-network dentists, you can always go to an out-of-network one. You just won’t get the same level of coverage.

Most insurance providers have fairly sizeable networks, especially if you have a PPO plan, so you should be able to find a good fit. However, if you’re adamant about an out-of-network dentist, you may have to find other ways to manage the costs.

Age Limits

This is one of the most common restrictions on orthodontic benefits. In most cases, plans with age limits will cover orthodontic treatment for people up to age 19, but not for adults. You should always check for an age limit as you examine your insurance plan.

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

Additionally, some plans may have a waiting period before you can use their benefits. These waiting periods can be anywhere between a few months and a full year. So, if you enroll in a plan solely so that you can get braces, be conscious of any potential waiting periods, or you might have to hold off on your treatment for a few months.

How to Get Orthodontic Benefits

Orthodontic benefits typically come as part of your dental insurance package. You will rarely have the option to add orthodontic benefits to a plan that doesn’t normally include them. That said, some companies might offer supplemental orthodontic benefits as an option. Some Blue Cross Blue Shield subsidiaries, for example, allow you to add Class IV (orthodontic) coverage to their plans. But this isn’t usually the case.

Otherwise, if you want to add orthodontic benefits, you’ll need to switch to a plan that includes them. The problem is that you can only change plans during an open enrollment period or if you experience a qualifying life event, which includes:

• Changes in household (marriage, divorce, birth, death)
• Changes in residence
• Loss of health coverage
• Becoming a U.S. citizen

If you have to wait for the next enrollment period and your plan also has a waiting period, you might not be able to get your treatment covered for months.

If you have insurance through your employer, check with the Human Resources office to see if there’s an option with orthodontic benefits, or if the company would be open to sponsoring a different option.

Other Ways to Save on Orthodontic Treatment

If your plan doesn’t include orthodontic benefits and you don’t have any other options, you might be out of luck. But don’t worry, there are still ways to save money on your treatment.

Dental Discount Plans: Certain providers may also offer dental discount plans (or dental savings plans). These are not insurance plans. Rather, they’re like a subscription where you pay a monthly or annual fee and receive discounts on certain procedures or designated dentists. Sometimes these plans include orthodontic treatments.

Shop around: Different orthodontists have different rates. And there’s nothing wrong with getting multiple estimates on braces to compare prices. Just make sure that the orthodontist you choose is in your provider’s network or you might not receive coverage.

Use an HSA or FSA account: These accounts are nice because they allow you to make tax-free contributions that you can use later on health expenses. They’re an option in many employer-sponsored insurance plans. If you have an HSA or FSA, you can use it to pay for your braces.

Consider online clear aligners: If you want to get braces or clear aligners but don’t want to pay such high prices, you might consider getting clear aligners from a provider like SmileDirectClub. They’re a faster and cheaper alternative that can treat mild-to-moderate cases of crowding, spacing, and even some bite issues.

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.