Does Dental Insurance Cover Braces? What Adults Need to Know

Braces are not just for teenagers. More adults than ever are seeking orthodontic treatment to straighten their teeth, correct bite problems, or improve their smile. But the cost can be a major barrier. Adult braces typically cost $3,000 to $10,000, and dental insurance coverage for adult orthodontics is limited at best.

This guide explains what adults need to know about dental insurance and braces: which plans cover orthodontics, how much coverage you can expect, the costs of different types of braces, and alternative ways to make treatment more affordable.

How Many Dental Plans Cover Adult Braces?

The short answer is: not many. Only about 30% of dental insurance plans include orthodontic benefits for adults. Most dental plans treat orthodontics as an optional add-on, and when they do include it, the coverage is significantly more limited than what is available for children.

Plans that include adult orthodontics typically cover the treatment at 50% up to a lifetime orthodontic maximum. This maximum is separate from the regular annual dental maximum and usually ranges from $1,000 to $2,000. A few higher-end plans may offer lifetime orthodontic maximums of $2,500 or more, but these are the exception.

It is important to understand that the lifetime orthodontic maximum is a one-time benefit. Unlike the annual maximum for regular dental services, which resets each year, the orthodontic maximum applies over the life of the plan. Once you have used it, it does not renew. This means you get one shot at orthodontic coverage.

What Does Orthodontic Coverage Actually Pay?

Even when a plan covers adult orthodontics, the coverage typically pays a relatively small portion of the total cost. Here is an example to illustrate. Suppose your braces cost $5,000 and your plan covers orthodontics at 50% up to a $1,500 lifetime maximum.

At 50% coverage, the plan would pay $2,500. However, the lifetime orthodontic maximum is $1,500, which caps the plan's payment at $1,500. You are responsible for the remaining $3,500 out of pocket. In this example, insurance covers 30% of the total cost.

For more expensive treatments like Invisalign at $7,000 or lingual braces at $9,000, the insurance payment covers an even smaller percentage. With a $1,500 lifetime maximum, you would pay $5,500 for Invisalign and $7,500 for lingual braces. The coverage still helps, but it is far from covering the full cost.

Types of Braces and Their Costs

The cost of braces varies widely depending on the type of treatment. According to dental industry data, here are the typical price ranges for each type.

• Traditional metal braces: $3,000 to $7,000. These are the most common and least expensive type. They use metal brackets and wires to gradually move teeth into position. Treatment typically takes 18 to 36 months.
• Ceramic braces: $4,000 to $8,000. Similar to metal braces but use tooth-colored or clear brackets that are less visible. They function the same way as metal braces but cost more due to the materials.
• Lingual braces: $8,000 to $10,000. These are placed behind the teeth, making them invisible from the front. They are the most expensive option and require specialized training, so fewer orthodontists offer them.
• Invisalign clear aligners: $3,000 to $8,000. A series of custom-made, removable clear plastic trays that gradually shift teeth. Popular with adults because they are nearly invisible and can be removed for eating and brushing. Not suitable for all orthodontic cases.

The total cost depends on the complexity of your case, where you live, and the orthodontist you choose. Urban areas tend to have higher prices. Complex cases that require longer treatment or additional procedures will cost more. Always get a detailed cost estimate before starting treatment.

Waiting Periods for Orthodontic Coverage

If you find a dental plan that covers adult orthodontics, be prepared for a waiting period. Most plans require you to be enrolled for 12 to 24 months before the orthodontic benefit becomes available. This is one of the longest waiting periods in dental insurance.

The reason for the long waiting period is straightforward. Orthodontic treatment is expensive, and insurers want to prevent people from enrolling in a plan just to get braces and then dropping the coverage. The waiting period ensures that you are a long-term member before accessing this benefit.

Some plans advertise no waiting periods for orthodontics. While these plans exist, they are rare and typically come with higher premiums. Read the plan documents carefully to confirm that there is truly no waiting period and that the orthodontic benefit is not subject to other restrictions.

If you are thinking about getting braces, the best time to enroll in a plan with orthodontic coverage is well before you plan to start treatment. Enroll now, satisfy the waiting period, and then begin treatment once the benefit is active.

Pediatric Orthodontic Coverage Under the ACA

While adult orthodontic coverage is limited, children have more options thanks to the Affordable Care Act. The ACA requires health insurance marketplace plans to cover pediatric dental care as an essential health benefit for children under 19. This includes medically necessary orthodontics.

The key phrase is medically necessary. The ACA does not require coverage of orthodontics for cosmetic reasons. For a child's braces to be covered, a dentist or orthodontist must determine that the treatment is needed for dental health, not just appearance. This typically includes severe malocclusion, significant overbites or underbites, and other conditions that affect function.

Adults do not have the same ACA protections. Adult dental coverage is not considered an essential health benefit under the ACA, and orthodontic coverage for adults is entirely optional. If you are over 19, you are on your own when it comes to finding orthodontic coverage.

Affordable Alternatives to Insurance for Adult Braces

Given the limited insurance coverage available, many adults look for other ways to make braces more affordable. Here are several options that can significantly reduce your out-of-pocket costs.

Orthodontist Payment Plans

Many orthodontists offer in-house payment plans that allow you to spread the cost over 12 to 24 months. These plans often have no interest or low interest, making them one of the most accessible financing options. You make a down payment when treatment begins and then pay monthly installments. Ask your orthodontist about available payment plans before committing to treatment.

Dental Schools

Dental schools with orthodontic residency programs offer braces at 30% to 50% below private practice prices. The treatment is provided by orthodontic residents who are already licensed dentists completing advanced training in orthodontics. All work is supervised by experienced faculty orthodontists. Appointments may take longer and scheduling can be less flexible, but the quality of care is generally excellent. Check if any dental schools near you have an orthodontic clinic that accepts adult patients.

Health Savings Accounts and Flexible Spending Accounts

If you have a health savings account (HSA) or a flexible spending account (FSA) through your employer, you can use pre-tax dollars to pay for braces. Orthodontic treatment is a qualified medical expense for both HSAs and FSAs. Depending on your tax bracket, using pre-tax dollars effectively saves you 22% to 37% on the cost. With braces costing several thousand dollars, this tax savings can be substantial.

Dental Discount Plans

Some dental discount plans include orthodontic services in their fee schedules. Discounts on braces through these plans typically range from 15% to 30%. While this is less than what insurance might cover, the advantage is that there are no waiting periods and no lifetime maximums. A 20% discount on a $5,000 treatment saves you $1,000, which is comparable to what some insurance plans would pay.

Third-Party Financing

Companies that specialize in medical and dental financing offer payment plans that can spread the cost of braces over several years. Some offer promotional periods with no interest if you pay within a set timeframe. Be careful to read the terms, especially the interest rate that applies after any promotional period ends. Third-party financing can make braces accessible if you do not have savings or insurance, but the total cost may be higher due to interest.

How to Find a Plan That Covers Adult Braces

If you want to find a dental plan that includes adult orthodontic coverage, you will need to do some targeted searching. Start by reviewing plan documents carefully. Look specifically for the term orthodontic benefits and check whether the plan covers adults, not just children. Many plans that advertise orthodontic coverage only provide it for dependents under age 19.

When comparing plans, pay attention to the lifetime orthodontic maximum, the coverage percentage, and the waiting period. A plan with a $2,000 lifetime maximum and a 12-month waiting period provides significantly more value than a plan with a $1,000 maximum and a 24-month wait.

Employer-sponsored dental plans are more likely to include adult orthodontic benefits than individual plans. If your employer offers dental insurance, check whether orthodontics are included. Some employers offer a choice between a basic dental plan and a more comprehensive plan that includes orthodontics at a higher premium.

Whether you use insurance, a payment plan, a dental school, or a combination of approaches, the cost of adult braces is manageable with the right strategy. Start by getting a full cost estimate from an orthodontist, then explore your coverage and financing options. Planning ahead can save you thousands of dollars on treatment that improves both your dental health and your confidence.

Is It Worth Buying Insurance Just for Braces?

This is a common question, and the answer requires some math. Suppose you find a dental plan that costs $45 per month and includes adult orthodontic benefits with a $1,500 lifetime maximum and a 12-month waiting period. Over the 12-month waiting period, you pay $540 in premiums before you can use the orthodontic benefit.

Once the benefit is active, the plan pays up to $1,500 toward your braces. Subtracting the $540 in waiting-period premiums, your net benefit is $960. You will also continue paying premiums during treatment, which typically takes 18 to 24 months. At $45 per month for 18 months, that is another $810 in premiums. Your net savings after all premiums is about $150.

In this scenario, buying insurance specifically for braces provides modest savings. The calculation changes if the plan has a higher orthodontic maximum, a shorter waiting period, or a lower premium. It also helps if you use the plan's other dental benefits during the waiting period and treatment period, getting value from preventive and basic coverage along the way.

The bottom line: buying dental insurance solely for orthodontic coverage can provide some savings, but the net benefit is often modest after factoring in premiums and waiting periods. The insurance becomes a better deal when you also use it for other dental services. For many adults, a combination of a payment plan, tax-advantaged accounts, and a dental school may be more cost-effective than insurance alone.