What Are Braces?

When your teeth grow, shift, or get used to a specific bite position, it can complicate how you chew food, maintain oral hygiene, or affect your self-esteem. Uneven spacing, poor alignment, or an over/underbite can be corrected by braces, which are dental tools used to correct overbites, underbites, and straighten teeth. 

When you wear braces, your teeth slowly straighten into the desired position and align so your bite is normal. Braces are typically put on teenagers but adults can also wear them. There are many options and types of braces available to you. 

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Types Of Braces

Some types of braces available today include:

  • Conventional braces. These braces help reposition your teeth by attaching metal or ceramic brackets to every tooth, held together by a wire and bands. This is the cheapest and fastest form of dental realignment, but they are highly visible. 
  • Self-Ligating braces. These braces look and function similarly to conventional braces, but no bands are required – they utilize clip-style brackets which allow the wire itself to be tightened.
  • Lingual braces. These braces are placed behind the teeth, making them barely visible. They function similarly to conventional braces but are much more expensive because of their installment and adjustment difficulty.
  • Aligners. Aligners, commonly referred to as Invisalign, are clear plastic molds customized to fit over your teeth. This eliminates the need for conventional braces to realign your teeth by getting new sets of molds every few weeks. This is the best option in cases of severe misalignment. 


Does Medicare Cover Braces?

Medicare does not generally cover braces, however, there are some exceptions. If the need for braces has occurred due to an accident, injury, or disease, Medicare can offer coverage. Your condition must require a restorative orthodontic procedure for the correction of teeth that has occurred due to accident, injury, or disease. The patient is only eligible for Medicare coverage if braces are considered medically necessary to prevent complications or discomfort due to improper bite.

If you require a surgical emergency orthodontic procedure, which involves a hospital stay, the costs of the procedure will be covered by Medicare Part A. The coverage only includes expenses related to diagnostic procedures, doctor’s visits, and bed charges. This may not include costs related directly to the procedure or braces. Original Medicare has limitations to the circumstances in which the braces recipient would be eligible for the coverage. 

It is best to check whether a Medicare Advantage Plan offers expanded dental benefits, as most Medicare Advantage plans provide coverage for additional expenses like dental or vision care, along with the coverage from Original Medicare. Because Medicare Advantage plans are offered by private insurers, it is best to find a plan that suits your needs and offers the coverage you require. Make sure to always check the available coverage, copayments, limits, and deductibles. 


How To Get Medicare Coverage of Braces

Some Medicare Advantage and/or stand-alone-private dental insurance plans may help cover dental services like braces. Original Medicare does not cover dental services, but Medicare Advantage may lower your out-of-pocket costs. To receive this coverage, you need to enroll in a Medicare Advantage plan that has this coverage or get a private dental insurance plan.


Medicare Advantage Plans For Braces Coverage

Some Medicare Advantage Plans may be able to provide braces coverage if your specific plan offers dental coverage. Some Medicare Advantage plans may cover:

  • Exams
  • Cleanings
  • X-rays
  • Crowns
  • Fillings
  • Bridges
  • Root Canals
  • Implants
  • Tooth Extractions

Since Medicare Advantage plans are sold privately, coverage is determined by the policy and varies greatly. Your braces may be covered if the plan you choose provides dental coverage, but that coverage may limit you on the kind of braces you can choose, so it is best to call your insurance provider for more information.


How Much Do Braces Cost?

Braces cost between $3,000-$10,000, but this cost depends on various factors, including:

  • Where you live. Different states have different prices.
  • Your age. Typically, teenagers can get cheaper braces than adults. 
  • The adjustments you need. The type of braces you require depends on how much your teeth need to be realigned – the more severe the fix, the higher the cost.
  • The type of braces you get. With so many different types of braces available, costs will vary depending on the level of adjustment and visibility you want/need.
  • How long do you need your braces on? Braces require a few months to years to work, so if you require braces for longer, you will require more checkups and maintenance costs.

Prices of different braces include:

  • Standard metal braces: $3,000-$7,500
  • Ceramic braces: $2,000-$8,500
  • Invisalign: $3,000-$7,000
  • Lingual braces: $5,000-$13,000


Does Medicare Cover Invisalign?

Medicare does not cover the cost of Invisalign. Invisalign is a clear, removable set of aligners which are custom-fit to your teeth and are ideal for severe cases of misalignment. Invisalign costs between $2,800 to $5,000 on average. Medicare Advantage can cover dental benefits such as aligners, so it is best to check your plan’s benefits and what your insurer offers.

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Medicaid For Braces

All states must provide dental coverage to children under Medicaid. States must pay for braces and orthodontics under Medicaid if they are deemed medically necessary. Some states view children as anyone younger than 18, but others cover people up to 21 years of age.

For your treatment to be determined medically necessary, you must be experiencing the following dental issues:

  • Malocclusion
  • Craniofacial abnormalities
  • Misaligned teeth in conjunction with another medical condition
  • Malocclusion deemed to be severely impacting physical and emotional wellbeing 
  • Congenital conditions like cleft palate or missing teeth
  • Overjet and reverse overjet of specific measurements
  • Crossbite in the back of the mouth which prevents teeth from being aligned 

Generally speaking, it is difficult to determine whether you and your loved ones will be covered for braces. To find out if your state provides coverage for braces and dental care, consult CoverageHaven to compare plans and find one that is right for your needs. Additionally, check out our blog on Medicare vs Medicaid to figure out which is the correct option for you.