Does Medicare or Private Insurance Cover Braces? What You Need to Know
Confused between Medicare & Medicaid?
Medicare is for seniors/disability. Medicaid is for low-income/children.
Read our Medicaid Coverage Guide insteadIn my years as an orthodontic consultant, I’ve seen the mix of excitement and “sticker shock” when families hear a braces quote. It’s natural to ask: “Will Medicare or my insurance help pay for this?”
You’re not alone in this worry. This guide explains, in plain language, how different insurance programs handle braces. We’ll break down Medicare, Medicaid, and Private Dental Plans (like MetLife or Delta). The goal is clear: help you get care without burying you in unexpected bills.
Key Takeaways
- Original Medicare (A/B): Almost never pays for braces. Orthodontics is considered “dental” and excluded.
- Medicare Advantage (Part C): May offer coverage. Some plans include a rider with a limit (e.g., $1,000–$3,000 total).
- Private Insurance: Employer plans often cover ~50% for children (up to $1-2K lifetime). Adult coverage is rare.
- Alternatives: FSAs, HSAs, payment plans, and dental schools can lower out-of-pocket costs.
Does Medicare Cover Braces?
Simply put, Original Medicare does not pay for routine braces. Parts A and B consider orthodontics as dental care, which is excluded.
The Exception: If braces are part of treating a serious medical condition (like facial trauma surgery or severe jaw disease), Part B might help pay the medical portion (surgery), but usually not the braces themselves.
Medicare Advantage (Part C) is Different
These are private plans that replace Original Medicare. Some offer an orthodontic rider. Benefits might include:
- A set maximum (e.g., $1,000–$3,000 total).
- Waiting periods (often 6–12 months).
Tip: Use the Medicare Plan Finder to filter for dental benefits.
Dental Insurance & Braces
Most medical insurance (like Obamacare) does not cover braces. You need Dental Insurance (PPO/HMO). Here is the reality of private plans (MetLife, Delta, Cigna):
For Children (<19)
Many plans pay 50% up to a Lifetime Maximum (usually $1,000–$2,000). Once that cap is hit, you pay the rest.
For Adults (19+)
Coverage is rare. Most plans explicitly exclude adult orthodontia. Always check for an “Age Limit”.
Watch Out For Traps:
- Waiting Period: Must be enrolled for 6-12 months before claiming.
- In-Network: Some plans only pay if you see their specific doctors.
- Lifetime Max: It does not reset every year.
How Much Do Braces Cost? (Pre-Insurance)
Before applying insurance, know the raw numbers. Here is a breakdown from our Full Cost Guide:
| Treatment Type | Typical Cost Range |
|---|---|
| Traditional Metal Braces | $3,000 – $7,000 |
| Ceramic (Clear) Braces | $4,000 – $8,500 |
| Invisalign (Aligners) | $3,000 – $8,000 |
| Lingual (Behind Teeth) | $8,000 – $10,000+ |
When Insurance Won’t Pay: Alternatives
If your plan covers nothing, don’t panic. Use these tools:
Payment Plans
Most offices offer 0% interest monthly plans over 12-24 months.
FSA / HSA
Pay with pre-tax dollars. It’s essentially a 20-30% discount.
Dental Schools
University clinics charge 30-50% less for supervised student treatment.
Charity / Discount Plans
Look for “Smiles Change Lives” or dental discount memberships.
Frequently Asked Questions
Does Medicare cover braces?
No, not normally. Original Medicare treats braces as dental care. Only rare trauma cases might qualify for medical coverage.
Does MetLife cover braces?
Usually yes for children (High Option), but rarely for adults. Check your plan for “Orthodontic Rider”.
What if insurance won’t pay?
Use FSA/HSA funds, ask for an in-house payment plan, or visit a dental school clinic.
Conclusion: Don’t Assume a “No”
Getting braces is a big decision. Investigate your coverage now. Call your insurer, check for Medicare Advantage riders, and ask your orthodontist about financing.
Read the Ultimate Insurance GuideSources
[1] Medicare.org – Does Medicare Cover Braces?
[2] Medicare Advantage Plans & Dental Coverage.
[3] Delta Dental – Guide to Lifetime Maximums.
[4] MetLife – Orthodontics for Kids and Adults.
[17] Casasadobes Dentistry – Ceramic vs Metal Cost.
[18] GoodRx – Invisalign vs Braces.