Does Health Insurance Cover Braces?

Your oral health is of utmost importance. It affects how you efficiently you eat and how you communicate. It can also affect your physical appearance and your self-esteem. As such, many dental health issues are covered by insurance companies, but generally, these issues must be considered essential. Braces, unfortunately, are not considered a necessary dental health expense, and therefore, they generally aren’t covered by health insurance companies.

In most cases, even if you carry dental health insurance, braces are considered a supplemental treatment. As such, you will have to purchase them on your own. But, there are certain rules and regulations that surround orthodontic treatments, including braces. Below, we will exam these rules and regulations and how braces may or may not be covered by your health insurance plan.

Health Insurance Coverage for Braces

health insurance bracesFor children who are under the age of 18, health insurance companies are required to offer an option that allows people to purchase dental insurance coverage that adheres to the criteria that has been set forth by the Affordable Care Act. However, whether or not you purchase this coverage is your decision. If you decide not to purchase dental insurance, you will not suffer a tax penalty under the Affordable Care Act.

With that said, health care policies that cover dental care for children do vary from state to state. Also, dental plans cover different services. For instance, a plan may cover the entire cost of sealants, topical fluoride treatments, and preventative care, but would require the patient to cover the cost of fillings and braces, for example.

In some states, dental insurance for braces is required; however, it depends on the situation if coverage will be granted. For example, in some states, dental insurance will cover the cost of braces only if they are considered medically necessary; they are needed to improve a child’s ability to eat his food properly, for instance.

In regard to adults, insurance companies are not required to offer dental insurance under the Affordable Care Act, despite the fact that more adults are getting braces than ever have before. In some cases, the need for braces for adults may be considered medically necessary; for example, they may help a patient chew better. But in other cases, they are simply used as a way to improve the look of the teeth.

With that said, some dental health plans may cover the cost of orthodontics for adults, but only if braces are considered a necessity. But, if the purpose of braces is solely for cosmetic reasons, then more than likely, the cost will not be covered by an insurance provider.

The Cost of Braces without Insurance

It’s hard to say how much braces will cost without health insurance. The type of treatment needed, the age of the person, and the orthodontic issues vary, which means that the cost of treatment will also vary. However, with that said, it is estimated that the average cost of braces without insurance costs between $3,000 and $7,500. These costs are based on patient reports from the year 2014 for traditional metal braces. The cost could be less, or it could be significantly more. Clear and removable appliances, such as Invisalign, typically cost about 25 to 50 percent more than metal braces.

Are There Payment Options?

There are a variety of ways that you can pay for orthodontic treatments, including braces. Some options that are commonly used include:

  • Financing, which can include personal loans or credit cards. If you decide to pay for braces with these methods, you may be able to get a discounted price and avoid paying interest if you pay a large percentage of the overall cost of braces upfront.
  • Payment plans, which many orthodontists will offer. Typically, patients will have to qualify for payment plans, and the qualifying factors will vary from orthodontist to orthodontist.
  • Insurance plans with a Flexible Savings Account option may qualify you for reimbursement from your orthodontist.

How to Find Out if Your Health Insurance Will Cover Braces

If you carry a health insurance plan, there is a chance that it will cover at least a part of the cost of braces. This is true for patients who are 18 years of age and younger, as well as adults. However, as mentioned, it does depend on your specific insurance plan and what they cover, as well as the nature of the need for braces. For instance, if you are an adult and braces will be used purely for cosmetic gain, then your insurance provider may not cover the cost of the treatment. However, if the patient is younger than 18 and braces are considered medically necessary, than your health insurance may cover the cost of the treatment.

The Bottom Line

Speak to your health insurance provider to find out if braces are covered, and if so, how much of the cost will be covered.

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