Adult Braces Insurance: Does Dental Insurance Cover Braces for Adults?

By Heather Sprague, Licensed Health Insurance Agent · Reviewed by Michael Sprague, Licensed Health Insurance Agent Adult braces insurance is hard to find. Most dental plans that include orthodontics cover it only for children under 19. Still, some plans do cover adults, and there are other ways to lower the cost of braces or clear aligners. Knowing what to look for can save you a lot of frustration. This guide explains how orthodontic coverage works for adults, what limits to expect and how to pay for treatment. For the basics on dental plans, see our guide to dental care coverage. Questions? Call 888-730-6031 for free help from a licensed agent.

Does Dental Insurance Cover Braces for Adults?

Usually not, but some plans do. Orthodontic coverage is often limited to children because it's part of the pediatric dental benefit. Adult orthodontic coverage is more common in some employer plans than in individual plans. So if you want braces as an adult, read the plan's orthodontic section closely. Look for an age limit. If it says "dependent children only" or "under 19," adults aren't covered.

How Orthodontic Coverage Works

When a plan does cover orthodontics, it usually works differently from other dental care:

• Lifetime maximum: The plan pays up to a set amount for orthodontics over your lifetime, separate from the yearly maximum.
• Coinsurance: The plan pays a share, often about half, until the lifetime maximum is reached.
• Waiting period: Many plans require you to be enrolled for 12 months or more first.
• Payment schedule: Plans often pay in parts over the course of treatment.

Because of the lifetime maximum, insurance usually covers only part of the total cost. You'll still pay the rest.

Are Clear Aligners Covered?

If a plan covers adult orthodontics, it often covers clear aligners too, since they treat the same problems. However, some plans only pay for traditional braces. Others pay the same amount for either and leave you to cover any difference. Aligners sold directly to consumers without an in-person orthodontist may not be covered at all. So ask your plan before you order. Looking for a plan that covers adult orthodontics? Call 888-730-6031 and a licensed agent can check the plans in your area.

When Braces Are Medically Necessary

Sometimes braces fix a problem with chewing, speech or the jaw, not just the look of your smile. In those cases, a dental or medical plan may be more likely to help pay. Jaw surgery to correct a severe bite is sometimes covered by medical insurance. Your orthodontist can document the medical need and send it to your plan. Ask for a pre-treatment estimate so you know what the plan will pay.

Other Ways to Pay for Adult Braces

If your plan doesn't cover adult braces, or covers only part, these options can help:

• Use HSA or FSA funds, since orthodontic care is a qualified medical expense.
• Plan FSA contributions around your treatment start date.
• Ask your orthodontist about monthly payment plans.
• Try a dental discount plan, which may offer reduced orthodontic rates.
• Check dental schools for lower-cost treatment by supervised students.

Choosing a Plan if You Want Braces

If you plan to get braces in the next year or two, compare plans on these points: whether adults are covered, the lifetime orthodontic maximum, the waiting period and whether your orthodontist is in network. Because waiting periods are common, enrolling well before you start treatment can help. Some plans also won't pay for treatment that started before your coverage began. Read our main guide to dental insurance for more on plan types.

What If You Already Started Treatment?

Some plans will pay the remaining part of the orthodontic benefit if you switch plans mid-treatment. Others won't cover care that began before you enrolled. Ask the new plan how it handles treatment in progress before you switch. Keep your treatment records and payment history. Your new plan may ask for them.

Retainers and Follow-Up Care

After braces come off, you'll need a retainer to keep teeth in place. Some plans include the first retainer as part of the orthodontic benefit. Replacement retainers often aren't covered. Regular cleanings and exams are still important during and after treatment. Those are usually covered as preventive care, even when orthodontics isn't. Questions about dental plan options? Call 888-730-6031 for free help.

Is Adult Braces Insurance Worth It?

It can be, but do the math first. Add up the premiums you'll pay during the waiting period and treatment. Then compare that with what the plan will pay toward braces. If the lifetime maximum is low, the savings may be small. A plan can still be worth it if it also covers cleanings, fillings and other care you need. A licensed agent can help you compare the full value of each plan, not just the orthodontic benefit.

Orthodontic Coverage for Your Kids

If you have children who may need braces, look at family coverage. Child orthodontic coverage is more common, and pediatric dental care is an essential health benefit. Medically necessary orthodontics for children may also be covered by Medicaid or CHIP in some states. So a family dental plan might cover your child's braces even if it doesn't cover yours.

Questions to Ask Before You Enroll

Before you pick a dental plan for braces, get clear answers to these questions. You can ask the plan or a licensed agent:

• Does the plan cover orthodontics for adults, or only for children?
• What is the lifetime orthodontic maximum?
• How long is the waiting period for orthodontic care?
• Are clear aligners covered the same way as braces?
• Will the plan pay for treatment that started before I enrolled?
• Is my orthodontist in the network?

How Employer Plans Compare

Employer dental plans are more likely to include adult orthodontics than individual plans. If you or your spouse can get dental coverage through work, compare that plan's orthodontic benefit first. Open enrollment at work is often the best time to add it. If you buy dental coverage on your own, a licensed agent can help you find the few plans that cover adults. Call 888-730-6031 and we'll check what's available where you live. You can also read our guide on dental care coverage to learn how preventive, basic and major care are covered.

Adult braces insurance: FAQ

Does dental insurance cover braces for adults?

Some plans do, but many cover orthodontics only for children. Check the plan for an age limit.

Is there a waiting period for braces?

Often, yes. Many plans with orthodontic coverage require 12 months or more of enrollment first.

Can I use my HSA for braces?

Yes. Orthodontic treatment is generally a qualified medical expense for HSA and FSA funds.

Next Steps for Adult braces insurance

Adult braces insurance takes some searching, but it can help. Look for plans that cover adults, check the lifetime maximum and waiting period, and use HSA or FSA funds for the rest. Want a licensed agent to help? Call 888-730-6031, Monday through Friday, 9 a.m. to 6 p.m. Eastern, or request a free quote.

Sources

1. IRS Publication 502: Medical and Dental Expenses
2. HealthCare.gov: Dental coverage in the marketplace
3. American Association of Orthodontists

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• Dental care coverage
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• What health insurance covers

Vivna Insurance is a licensed independent agency, not a government website. Our help is free; we are paid by the insurance companies we work with. Coverage options, deadlines and costs vary by plan and state.