Does Medical Cover Braces? Complete Insurance & Cost Guide
Orthodontic treatment can improve bite alignment, oral function, and long-term dental health. One of the most common questions patients ask is:
Does medical or health insurance cover braces?
The answer depends on several factors, including:
- medical necessity
- age (child vs. adult)
- type of insurance plan
- severity of orthodontic problems
This comprehensive guide explains when braces are covered, how Medicaid and dental insurance work, and ways to make treatment more affordable.
Understanding Braces & Orthodontic Treatment
Braces are orthodontic devices used to correct:
- crooked teeth
- overcrowding
- bite problems (overbite, underbite, crossbite)
- jaw misalignment
- speech or chewing difficulties
Orthodontic treatment improves both oral function and long-term dental health.
Does Medical Insurance Cover Braces?
General Rule
Most standard health insurance plans do NOT cover braces unless they are medically necessary.
Insurance coverage typically depends on:
| Factor | Coverage Impact |
| Medical necessity | High |
| Age (child vs adult) | High |
| Severity of condition | High |
| Dental vs medical policy | Moderate |
| Orthognathic surgery requirement | High |
Braces used for cosmetic reasons are usually not covered.
When Are Braces Considered Medically Necessary?
Insurance may cover braces if they treat serious health issues rather than cosmetic concerns.
Common qualifying conditions
Severe malocclusion
Misaligned teeth that affect chewing or speech.
Jaw misalignment
Structural jaw problems causing pain or functional limitations.
Craniofacial abnormalities
Conditions such as cleft palate or congenital deformities.
Difficulty eating or swallowing
Improper bite causing nutritional challenges.
Speech impairment
Orthodontic issues interfering with speech development.
Insurance providers often require documentation and specialist evaluation.
Does Medicaid Cover Braces?
For Children (Under 18)
Many Medicaid programs cover braces if medically necessary.
Coverage usually requires:
- orthodontic evaluation
- severity scoring system
- prior authorization
- proof of functional impairment
For Adults
Medicaid coverage for adult braces is rare and typically limited to severe medical cases.
Braces Coverage: Children vs Adults
| Coverage Area | Children | Adults |
| Medicaid | Often covered if necessary | Rare |
| Dental Insurance | Partial coverage common | Limited |
| Medical Insurance | Possible for severe cases | Rare |
| Preventive benefit | Yes | No |
Pediatric orthodontics is more likely to receive insurance support.
Dental Insurance vs Medical Insurance
Dental Insurance
Often includes orthodontic benefits.
Typical coverage:
- 25%–50% of treatment cost
- lifetime orthodontic maximum ($1,000–$3,000)
- waiting periods may apply
Medical Insurance
Only covers orthodontics when linked to medical conditions.
Average Cost of Braces With & Without Insurance
| Type of Braces | Average Cost | With Insurance |
| Metal braces | $3,000 – $7,000 | $1,500 – $4,000 |
| Ceramic braces | $4,000 – $8,000 | $2,000 – $5,000 |
| Lingual braces | $8,000 – $13,000 | Limited coverage |
| Clear aligners | $3,500 – $8,000 | Partial |
Costs vary by location, complexity, and treatment duration.
How to Get Braces Covered by Insurance
Steps to Improve Coverage Approval
1. Schedule an Orthodontic Evaluation
A specialist determines medical necessity.
2. Submit Prior Authorization
Insurance approval is required before treatment begins.
3. Provide Supporting Documentation
Includes:
- X-rays
- bite analysis
- functional impairment reports
4. Verify Orthdontic Benefits
Review coverage limits and exclusions.
Affordable Alternatives If Insurance Doesn’t Cover Braces
Payment & savings options
Flexible Payment Plans
Many orthodontists offer interest-free installments.
Health Savings Accounts (HSA/FSA)
Tax-advantaged funds can cover orthodontic expenses.
Nonprofit & Assistance Programs
Some charities provide orthodontic care for children.
Dental Schools
Offer reduced-cost treatment supervised by specialists.
Discount Dental Plans
Provide reduced orthodontic fees.
Benefits of Orthodontic Treatment Beyond Appearance
- improved chewing efficiency
- reduced risk of tooth decay & gum disease
- prevention of jaw pain and TMJ disorders
- better speech clarity
- improved facial balance
- enhanced self-confidence
Common Reasons Insurance Denies Braces Coverage
- treatment deemed cosmetic
- insufficient severity score
- lack of prior authorization
- adult orthodontic request
- policy exclusions
Always confirm coverage before beginning treatment.
Final Verdict: Does Medical Cover Braces?
✔ Yes — but only in medically necessary cases
✔ Children are more likely to qualify than adults
✔ Dental insurance often provides partial orthodontic coverage
✔ Medicaid may cover braces for qualifying children
✔ Alternative financing options can make treatment affordable
Understanding your insurance policy and working with an orthodontic specialist can help you access the care you need while minimizing costs.
Frequently Asked Questions (FAQS)
Are braces ever fully covered by insurance?
Yes, but typically only when deemed medically necessary, especially for children.
Does Medicaid pay for braces?
Medicaid may cover braces for children with severe orthodontic issues.
Can adults get braces covered?
Coverage for adults is rare unless linked to major medical conditions.
How can I reduce the cost of braces?
Use dental insurance, payment plans, HSAs, or dental schools.
Are clear aligners covered by insurance?
Some dental plans offer partial coverage similar to traditional braces.