Are Braces Covered by Insurance?

Posted on April 20, 2025

Beverly, MA – One of the most common questions patients ask their orthodontist is, “How can I pay for my orthodontic treatment?” We know that orthodontic treatment is an investment, and one that comes with a price tag. Our team is here to help you understand how you can get the most out of your insurance benefits to help cover the costs of your orthodontic treatment.

Will my insurance cover my orthodontic treatment?

Paying for orthodontic treatment for you or a loved one can be greatly helped if your insurance covers any portion of the treatment cost. Before seeking out treatment, it can be helpful to understand if your insurance does, in fact, cover any portion of orthodontic treatment.

It is also important to note that medical insurance and dental insurance are different. Medical insurance will only cover orthodontic treatment if it is deemed medically necessary. That means for your medical insurance to cover your treatment, you will need a statement explaining why the treatment is medically necessary. This will often include a detailed explanation from your care provider and even images showing why braces are needed.

To be deemed medically necessary, the orthodontic treatment must be required to correct functional problems, rather than simply cosmetic ones. Medically necessary reasons for treatment may include:

1. Breathing difficulties
2. Jaw problems
3. Severe speech impediments

There may also be specific orthodontic conditions that are covered, such as severe malocclusion, underbite, or overbite.

Medicaid plans often provide some level of coverage for orthodontic treatment, especially for children and adolescents. Likewise, some medical insurance companies may provide more comprehensive coverage for younger people whose teeth are still developing. Coverage for adults may be more difficult to find. It may be available for patients who have conditions such as sleep apnea or TMJ disorders that may be able to be corrected through orthodontic treatment.

Additionally, it is important to understand that all policies are different and may have different criteria for coverage. Additionally, some may cover only certain types of treatments, such as traditional metal braces, and not Invisalign.

How can I take advantage of my dental insurance benefits for my orthodontic care?

Dental insurance plans vary widely on what is covered and how much is covered. Some plans offer comprehensive coverage that can include a certain dollar amount or percentage toward the overall cost. Others may only cover certain types of treatments or up to a certain age. Prior to agreeing to treatment, it is important to understand what benefits are included in your dental insurance plan.

If you do not currently have insurance but plan to add it in the future so orthodontic coverage will be included, be sure you understand any waiting periods that may be included. Some plans have a waiting period before they will pay for treatment.

Also, be sure you look for orthodontists who are in-network and who accept your insurance. Not all orthodontist offices accept insurance, and those who do may not accept all insurance plans. Before you schedule your first consultation, it can be helpful to know if the orthodontist will accept your plan.

Things to think about

Orthodontic treatment is an investment in your oral health and self-confidence. We want all of our patients to receive the exceptional care they deserve. Before treatment, here are some things to consider.

1. Will your care be covered by insurance? If so, will you file claims under medical or dental insurance? If your medical insurance does cover medically necessary orthodontic treatment, be sure you have all documentation that your provider will require. This can include a detailed explanation of why treatment is medically necessary, images, and may even include a referral from your dentist.
2. Does your insurance require pre-approval before coverage can begin? This can be the case for some insurance companies so be sure you wait for the pre-approval to kick in before starting treatment.
3. Is your desired orthodontist covered by your insurance? Some orthodontists may be considered out-of-network providers, meaning your insurance may not cover treatment costs. When a provider is in-network it means your insurance provider has already negotiated costs so you’ll typically pay lower fees than if you choose an out-of-network provider. These out-of-network providers can charge more, and sometimes insurance doesn’t cover costs from out-of-network providers. In other cases, you may need to pay for your care upfront and get reimbursed from your insurance company.
4. Does your insurance plan have a lifetime maximum? This can be important to understand if you or a member of your family needs more complicated orthodontic treatment. Some plans have a lifetime maximum, meaning they will only pay a certain amount for your lifetime or while you are covered by that plan.
5. What are your financial obligations after insurance has covered their portion? Be sure you understand all financial obligations before you begin treatment. Most insurance plans will only cover a portion of your treatment, typically up to a certain percentage.

Speaking directly with your insurance provider is the best way to get accurate answers about what is covered by your plan and what you can expect from your coverage.

How to pay for braces

Braces are an investment, with the average cost between $3,000 and $8,000, depending on the treatment type you choose. If you don’t have insurance at all or don’t have a plan that covers orthodontic treatment, it can be daunting to think about covering those costs on your own. However, there are many ways you can pay for braces.

Most orthodontic offices will have flexible payment plans to cover the cost of treatment. At Chelian Orthodontics, we want every patient to receive the care they need, so we work hard to provide payment plans that can fit into any budget. We also accept most major credit cards.

If you have an FSA or HSA account, this can also help. These accounts let you put pre-taxed dollars into savings accounts, which can then be used for approved medical expenses. This includes orthodontic treatment.

If you need additional help covering the cost of your treatment, there are financing options available, as well. CareCredit, for instance, is a credit card available specifically for medical treatments.

You can count on Chelian Orthodontics

At Chelian Orthodontics, we’re here to help. We file all insurance claims as a courtesy for our patients. We can also help you better understand your policy so you can understand your financial obligations prior to beginning treatment. We’re here to help every step of the way. Call our office any time at 603-882-6100.