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Are Braces Covered by Dental Insurance?


Of all the financial planning you do for your children’s dental health, braces can be the biggest investment.
boy sitting at his desk in school, are braces covered by dental insurance

If it’s time for your child to get braces, the long-term benefits can’t be understated — straight teeth mean chewing with ease, reduced risk of overcrowding (which can lead to cavities and gum disease), and a confident smile. But without dental insurance coverage, your child’s braces can put a big dent in your budget.

The average American spends about $5,000–$7,500 on braces without dental insurance. This price is just for the braces themselves — not including visits to the orthodontist, x-rays or other diagnostic tests.

Are Braces Covered by Dental Insurance?

How do you know if your insurance plan covers your child’s braces? If you have health or dental insurance, check with your provider. Most health plans don’t pay for orthodontic treatment for people over 18 years old, but many will at least partially cover children under age 18.

If your child is nearing the age of braces, it’s a good idea to check out the fine print of your plan. Not all plans are the same, so you want to find the one that you need. There may be plans that cover some costs for braces, see plan details or speak to a representative. 

Things to know about insurance and braces:

  • Dental plans typically don’t cover cosmetic procedures, such as whitening and veneers, but if your child has a medical need for braces (difficulty chewing or jaw misalignment), your plan may provide coverage.
  • All dental plans have an annual cap on services for the year. The cost of your child’s braces may fulfill or exceed your annual cap.
  • Some dental insurance plans also set a waiting period for certain procedures, so make sure you enroll with plenty of time before your child needs braces.
  • Some orthodontic plans won’t cover braces if your child got them before the effective date of the policy, which makes them an out-of-pocket expense. To prevent this, try to keep the same insurance plan throughout your child’s entire orthodontic treatment.
  • You may need to purchase a supplemental orthodontic insurance plan to receive coverage for braces.

Learn ways to help keep your child’s teeth clean when they have braces >

Are Braces Tax-Deductible?

As long as your insurance plan considers braces to be medically necessary (unlike whitening treatment and veneers, which the IRS discounts), dental health care costs are tax-deductible.

Does Medicaid Cover Braces?

If you qualify for Medicaid and your child’s braces are deemed medically necessary, Medicaid may cover them. Be sure to ask about the percentage of coverage and the lifetime maximum.

Does my FSA or HSA Cover Braces?

Funds from a Flexible Spending Account (FSA) or Health Savings Account (HSA) can be used to cover costs associated with the installation, maintenance and removal of your child’s braces (as long as they are medically necessary), and with the tax benefits associated with your account.

 

Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.

Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.
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