Getting Braces Covered by Insurance.

Updated on December 20, 2017
M.T. asks from Boynton Beach, FL
15 answers

My son's dentist says he needs braces as his teeth are way too crowded not allowing new ones to grow in. The orthodontist says it's not medically necessary so insurance will not cover. Anybody had insurance cover and under what circumstances?

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answers from Seattle on

What kind of insurance do you have?
My son has insurance through the state. (DSHS) His teeth were B.A.D. The orthodontist said they were bad, took pictures, did measurements of all of the gaps/flares of his teeth and sent them off to the state to see if they would cover it because it was medically necessary.
DSHS sent back that they would not cover it.
Orthodontist took MORE pictures and measurements and sent it BACK to DSHS.
DSHS decided to cover them.
My amazing orthodontist then covered what wasn't by DSHS (about $1,000)
You could go to another orthodontist and ask them for their opinion as well. If everyone is saying they are not medically necessary and you feel like they are then you need to work out a payment plan.
Good luck.

1 mom found this helpful


answers from Boston on

Braces aren't covered by health insurance. If you have dental insurance then they'll usually pay up to a set amount per lifetime (doesn't start over in the new year like most of the dental benefits) and you have to cover anything over that dollar amount.

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answers from New York on

We had an orthodontia rider on our dental policy that would cover the first $1500 of ortho/braces on a child under 18 (so neither my husband or I could use it - which kind of sucked). Drop in the bucket when braces are routinely $5000-$6000, but better than nothing, I guess.

We put braces on 4 kids, and 2 sets of braces on one of those kids. We probably paid for my orthodontists boat.

Keep in mind that braces are generally not "necessary." If his teeth are that crowded, why aren't they pulling some and putting spacers in? That is usually covered by regular dental.



answers from Oklahoma City on

Fact is that insurance won't cover braces that aren't medically needed, most of the time that's over 30% need. With your orthodontist saying braces aren't even needed you are not going to get braces covered.

You are either going to have to have your regular dentist pull a couple of teeth to open up room for the overcrowding or decide to pay for your child's braces out of pocket.

Most orthodontist have payment plans.

But my question is why would your dentist think your child needs braces but the orthodontist not think it's a problem.

I think I'd sit down with both of them, at different times of course, and ask them to specifically point out why the other person's opinion is so wrong.


answers from Norfolk on

I've almost never heard of braces being covered by insurance unless you have a separate dental rider.
It's one of those things most people just end up paying for out of pocket.

I've also never heard of any orthodontists who would say braces weren't medically necessary.
Crooked messed up teeth are hard to keep clean and that leads to lots of cavities and general rot in the mouth.
Believe it or not - dental problems can lead to heart problems - which is why they ask if you've had surgery before cleaning teeth because if you have - you have to be on antibiotics for some time before they will touch your teeth at all.

See another orthodontist for a 2nd opinion and start saving up for the braces.
Get a 3rd opinion if it makes you feel any better.

Starting braces about in the 3rd grade is not uncommon because when they start that young the jaw bones are still growing and expanders can be used to make more room for their teeth.
When the jaws have enough room - you need braces for a shorter amount of time.

Back in the day (the 70's) expanders hadn't been invented yet.
My teeth were horribly crooked and I spent 7 years in braces and had 8 adult teeth pulled to make everything fit.

Our son spent 6 months in expanders and 2 years in braces was was finished before he completed 6th grade.
He only had to have his wisdom teeth out.
His smile is beautiful and his mouth/teeth are set for the rest of his life.



answers from Anchorage on

Ortho is not covered under medical insurance if that is what you are asking about, expect maybe in very extreme situations. Many dental insurance plans offer a lifetime amount, anywhere from $1000-1700 is what I have typically seen, but anything after that is up to you to pay. I know it sucks but many orthodontists will work with you with payment plans etc to make it more affordable.



answers from Wausau on

Our dental insurance would only cover $1000 per year for braces even if medically necessary.

Our medical insurance covers some types of dental work under certain circumstances, but it specifically excludes orthodontia (braces). You will have to look at your policy to see what is included/excluded.


answers from Springfield on

you need to check with your specific insurance. my child will need braces due to missing adult teeth. so my childs medical insurance will cover it no questions asked. but your individual insurance policy may have a different standard for whats covered.
(all dental, health and vision is covered under my childs policy)



answers from Philadelphia on

Get a second or third opinion from another orthodontist or two, I never heard of this. I’m guessing that orthodontist doesn’t like dealing with insurance companies and just prefers self pay.

FYI...we elect not to have dental insurance and we just self pay for dentist appointments and orthodonic work.


answers from Santa Fe on

Call your insurance company and ask them what they cover. Ours covers a certain portion of braces...about $2000 I think. A lot of insurances are like that. Good luck! Added - this is our dental insurance not our medical insurance.



answers from Miami on

Do you have DENTAL insurance? Orthodontics is covered under most dental policies up to a certain amount.

If you don't have dental insurance, than you are probably out of luck. If you do, call them yourself and talk about braces.



answers from Boston on

Do you have dental insurance? They would cover a portion of the cost of braces. Medical insurance does not since it's not "medical" unless if you have medicaid which may help out.

Good luck



answers from Houston on

No orthodontist wouldn't be covered under medical. It would be covered under dental. Check your dental policy. Most dental policies however will only cover a very small portion of braces. I have not seen a dental policy that covers 100% of braces.


answers from San Francisco on

Our insurance only paid for a small part of ortho care, like ten percent, after a deductible. I think that's standard.


answers from Boston on

Are you talking about medical insurance or dental insurance? They are separate and they cover separate things.

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