Will My Insurance Cover Braces?

For some people, regular dental maintenance requires a good deal of spending. Most major medical insurance plans likely won’t include dental coverage, and the ones that actually do will probably have ways of including the costs in your premium. 

Dental coverage is usually offered as a supplemental plan. It is a great value plan for those who frequent the dentist or orthodontist regularly in order to maintain their ideal smile. That being said, the expense of braces and orthodontics varies majorly from policy to policy. You need to comb through your insurance coverage to see if braces are a possible option for you. 

What Is Dental Insurance?

Dental insurance is a kind of supplemental insurance that usually covers a part of preventative care, fillings, crowns, root canals, and oral surgery. It could also have limited coverage for orthodontics, periodontics, and prosthodontics, though that’s dependent on the policy you have. You also have the option to purchase standalone dental insurance through your employer, though you cannot purchase a Health Insurance Marketplace dental plan without first purchasing a health plan at the same time. There is no penalty for not purchasing dental insurance.

How Does It Work?

Once you’ve chosen a dental insurance plan, you’ll be able to take advantage of all of the benefits that come with it. If you think you will need braces, you should first look into the cost of orthodontics under your insurance policy. Many plans don’t cover orthodontic treatments for adults but feature partial coverage for children under the age of 18. It’s possible that you may need to buy orthodontics under your policy. Adult orthodontic treatments are often not covered by insurance, but children under the age of 18 may be covered in part. If you want braces covered, you may need to purchase orthodontic insurance in addition to dental insurance.

If you are purchasing health insurance and have children under the age of 18, insurance companies are required by law to offer you ACA-compliant dental insurance. Just keep in mind that purchasing is entirely up to you. It’s also worth noting that the Affordable Care Act (ACA) does not impose any tax penalties on parents who do not provide their children with dental coverage. If you do, you can usually expect your plan to cover the full cost of topical fluoride, sealants, and other preventive dental care for your children. Let’s break down dental insurance into its main components before moving on:

  • Premium: the monthly payment
  • Deductible: out-of-pocket costs for services to get you through the door before your insurance kicks off
  • Coinsurance: the percentage of covered expenses that you pay after your deductible has been paid off
  • Copay: certain dental plans charge a fixed cost for some services

Does Medicaid Cover Braces?

If you are eligible for Medicaid, your child’s braces may be covered if a medical professional determines that they are medically necessary. Make sure you know what percentage of the cost will be covered and how it will affect your lifetime maximum before you buy braces. Remember that once your child reaches the age of 21, he or she will no longer be eligible for this benefit.

Are Braces Tax Deductible?

You’ll notice that the distinction between “medically necessary” and “not medically necessary” has a significant impact on the cost of braces. This time, we’re not debating whether Medicaid will cover the cost of braces; instead, we’re debating whether braces are tax-deductible. Costs associated with dental care are tax-deductible…with conditions…if your insurance plan considers your braces to be medically necessary. To qualify for a deduction, the cost must exceed 7.5 percent of your adjusted gross income. To ensure that you can verify your eligibility, you’ll need to keep detailed records, including receipts for co-pays and check-ups.

What Are Other Financing Plans Available For Braces?

A Flexible Spending Account (FSA) or a Health Savings Account (HSA) can help you cover the cost of certain aspects of your child’s orthodontic treatment, making it more manageable for you and your family. These funds can be used to pay for the installation, maintenance, and removal of your child’s braces if they are deemed medically necessary.

Invisible Aligners Might be a More Affordable Option

Braces typically range in price from $5,000 to $7,000. Children usually have access to some excellent insurance benefits that can assist them in improving their smiles. Adults, on the other hand, do not have the same luck.

Of course, there are less expensive options for adults. A better way to get a great smile without the need for frequent visits to the orthodontist and a lot of upkeep. Clear aligners like Invisalign can straighten your smile while also helping you look your best all year.

Clear aligners are molded to fit snugly to your teeth and to correct overbite, underbite, crowding or spacing without any permanent attachments. 

You can reach us here at mBrace at 469-362-6820 or schedule a free consultation with us here. We’ll be happy to discuss any of your dental and orthodontic needs with you. Get the smile you deserve with us. 


mBrace Frisco Orthodontics