Does Medicare cover braces?

If you need orthodontic care such as braces, you may be facing a bit of sticker shock. Traditional metal braces typically fall between the $3000 and $7000 range. Ceramic and lingual braces can go as high as $8000 to $10000 in some cases. If you’re over 65 and currently enrolled in Medicare, you might be wondering if the federal government’s healthcare plan can offer you financial assistance.

The answer is usually no. Medicare does not provide coverage or reimbursement for routine dental services like cleanings, tooth removal, and the like. On top of that, braces are typically classified as a cosmetic expense and thus unnecessary for your overall health. There are rare exceptions, however, as Medicare has provided coverage for dental splints and wiring if said services were needed after jaw surgery.

Some Medicare Advantage Plans (also known as Medicare Part C) do cover routine dental services. The vast majority, however, do not include coverage for braces and orthodontics. Your best bet for obtaining orthodontic financial assistance is supplementary insurance from a third-party provider. Much like Medicare, though, it is highly unusual to find a company or a plan that offers orthodontic coverage for adults. If you can obtain a doctor’s recommendation for braces, usually as a way to help chew food, your chances of finding coverage will increase. Most insurance providers take Medicare’s view of braces, though, and classify them as a cosmetic and therefore optional procedure.

Alternative treatments

You might also consider clear aligners or clear aligner treatment (sometimes called Invisalign) as an alternative to braces. The costs are similar, but some private dental insurance plans do cover clear aligners even though they do not cover braces. Clear aligners involve an orthodontist or a dentist making a mold of the patient’s teeth and then a digital tooth scan. A computerized model suggests stages between the current and the desired teeth positions, and clear aligners are then created for each phase of the treatment. Aligners are usually worn for 20 hours per day for two weeks, which slowly moves the teeth into the desired position. The total average treatment time is just over 13 months.

It’s worth noting that some scientific studies have questioned the effectiveness of clear alignment treatments, but thus far insufficient evidence has been found to conclusively determine the effectiveness of clear alignment.

Whatever you decide in regard to your orthodontic coverage, be sure to consult with your doctor, orthodontist, or dentist before committing to a specific treatment program. You’ll need to consider the costs for examinations, braces, retainers, and any necessary pre- or post-orthodontic office visits when selecting a coverage plan.

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