No, Medicare generally does not cover braces. Original Medicare (Medicare Part A and Part B) does not provide coverage for routine dental services, except if an accident or medical condition requires medically necessary dental work. Medicare Advantage (Part C) often offers additional benefits not covered by Original Medicare and may cover orthodontic braces and other dental services.
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The Importance of Orthodontic Care
Prioritizing dental and orthodontic care can help prevent issues impacting your quality of life and overall health. Orthodontic problems, which involve misalignment or irregular positioning of teeth and jaws, can lead to several medical problems, including:
- Difficulty chewing or eating, which can negatively impact digestion
- Wear on your tooth enamel, which can lead to tooth decay
- TMJ
- Facial pain and discomfort
- Sleep apnea
- Chronic headaches
- Trouble speaking
For older Americans on a limited budget, maintaining oral health is crucial for limiting potentially expensive medical issues down the road. Addressing orthodontic problems through treatment, such as braces, aligners, or other orthodontic interventions, can help mitigate these potential medical issues and improve oral health.
Types of Braces
Conventional
Conventional braces are the traditional type you likely think of when you picture braces. They involve brackets placed on each tooth connected by wires or bands.
Self-Ligating
Self-ligating braces look and function very similarly to conventional braces, with the difference being that they do not require bands.
Lingual
Lingual braces work just like conventional braces. However, they are fixed to the back of your teeth instead of the front.
Aligners
Aligners are clear trays custom-made to fit your mouth. You’ll get new trays every few weeks, slowly changing the alignment of your teeth.
Limitations On How Original Medicare Covers Braces
Original Medicare generally does not cover braces or other dental or orthodontic work. The exception to this, however, is when the service is deemed medically necessary by your doctor. While coverage is rare, it may happen when an accident, medical condition, or injury has caused a medical need to correct an improper bite.
Medigap Coverage of Braces
Medigap, or Medicare Supplement plans, do not cover braces or other dental work. These plans help beneficiaries cover out-of-pocket costs such as deductibles, copays, or coinsurance for services covered by Original Medicare. Medigap may help cover some of the costs of an emergency hospital stay in which you get orthodontic work done, but it would not provide coverage for braces.
How Does Medicare Advantage Cover Braces?
Medicare Advantage (MA) may cover braces and other dental services. Medicare Advantage is an alternative to Original Medicare, sold by private companies. These plans must offer the same coverage as Original Medicare and often provide additional benefits such as dental, vision, and hearing coverage and prescriptions. Many MA plans include dental coverage for services such as the following:
- Braces and other orthodontic work
- Dental exams
- Cleanings
- Fillings
- Tooth extractions
- X-rays
Because private insurance providers sell these plans, coverage details will depend on your chosen plan. If dental coverage is important to you, opting for Medicare Advantage over Original Medicare may be beneficial.
How Much Do Braces Cost With Medicare?
Medicare generally does not cover braces, meaning you would be responsible for 100% of the costs, which can run anywhere from $3,000 to $10,000 depending on the type of braces and length of wear.
Medicare Part A may provide some coverage if your braces are installed in an emergency orthodontic procedure and involves a hospital stay. You would pay a $1,632 deductible for days 1-60 (additional fees incur the longer you’re in the hospital), and Medicare Part A would cover the rest of the associated inpatient fees. It’s unlikely that Medicare would cover the actual orthodontic services. Medigap plans may help with out-of-pocket costs related to the hospital stay.
Medicare Part B may provide coverage if the service falls under outpatient care. Again, the braces must be deemed medically necessary due to an accident or disease. Medicare would pay 80% of the associated costs after you pay your $240 deductible. You would be responsible for your deductible, monthly premiums, and 20% of the service cost.
How Much Do Braces Cost With Medicare Advantage?
The cost of braces with Medicare Advantage varies because the private insurance companies that sell these plans set their rates and coverages. MA plans must provide the same coverage as Original Medicare. Therefore, if your braces are deemed medically necessary and Original Medicare approves coverage, Medicare Advantage would also cover the braces.
However, because this situation is unlikely, you will likely have to rely on the additional dental benefits provided by your MA plan. Your out-of-pocket costs will include your premium, deductible, and whatever your plan does not cover for the braces. The extent of dental coverage depends on your specific Medicare Advantage Plan, so review your policy for more information.
Medicare-Covered Alternatives to Braces
Because Original Medicare generally does not cover dental or orthodontic services, it does not provide coverage for braces alternatives such as Invisalign. However, if you have a Medicare Advantage Plan, that policy may cover Invisalign or other similar aligner treatments.
Veneers are also sometimes considered an alternative for misaligned teeth, but Medicare will not provide coverage because this is usually considered a cosmetic procedure.
How to Find Coverage For Braces
If you want braces and cannot get coverage through Medicare, there are alternate options, such as the following:
- Private dental insurance: Private dental plans may offer coverage for orthodontic services. You must purchase these plans through a private insurer, and coverage details vary by policy.
- Medicaid: If you have a limited income and are eligible for Medicaid, you may be able to get braces covered. Medicaid typically requires the service to be deemed medically necessary to qualify for coverage.
- Dental discount plans: Dental discount plans involve paying a monthly or annual fee for discounted dental services. The coverage details of these plans vary, but many provide coverage for orthodontia.
- Community health centers: Community health centers or local nonprofits may offer dental services, such as braces, at a reduced rate for eligible people.
- Payment plans: Some dentists may offer payment plans for patients paying out of pocket. Talk to your dentist about payment options.
Putting It All Together
Original Medicare will generally not pay for braces or other dental or orthodontic services. You may be able to find coverage through a Medicare Advantage Plan or find alternate financial help through private insurance, Medicaid, or dental discount plans.
Good oral health is an essential part of your overall wellness. Poor teeth alignment can cause issues with digestion, speech, jaw pain, and more. If you need braces or other orthodontic services, and Original Medicare will not cover it, consider Medicare Advantage and find a plan that provides your desired dental coverage.