Does Medicare or Medicaid Cover Orthodontics?

For most adults, the answer is no. Original Medicare doesn't cover orthodontic treatment, and Medicaid only covers it in limited cases, usually for children with a medically necessary, severe misalignment. Adult orthodontic coverage through Medicaid is rare, and it varies from state to state. So unless your case is medically necessary, you'll likely pay out of pocket or rely on private dental insurance.

Does Dental Insurance Cover Orthodontics?

If you have dental insurance, you might get some coverage for braces or clear aligners. It depends entirely on the specific plan. And there's one catch that surprises a lot of adults: many plans cover orthodontics only for dependent children, and exclude adults completely. So the first thing to check is whether your plan covers adult orthodontics at all.

Even when a plan does cover orthodontics, it's usually a separate benefit from routine dentistry, which typically means cleanings and minor procedures like fillings. Some plans include orthodontics automatically, others offer it as an add-on, and some leave it out entirely. The only way to know for sure is to check with your insurance provider.

If your plan covers braces and clear aligners, great. Just know that the amount covered varies. Most plans pay around half, while you cover the rest. Plans also tend to have a separate lifetime maximum for orthodontics, often around $1,000 to $3,000. Unlike the annual maximum that resets each year, this lifetime limit doesn't, so once you reach it, you'll pay for everything else out of pocket. It's also worth knowing that in-office clear aligners like Invisalign are usually covered the same as braces, while at-home, direct-to-consumer aligners often aren't covered at all.

If you're reading this and thinking, "I better enroll in a plan before I start treatment next month," slow down a bit. Most plans have a waiting period, often 6 to 12 months, before you can access their orthodontic benefits, so you can't enroll and start getting coverage right away.

How to Access Dental Insurance Coverage

This can vary based on the insurer. In many cases, your orthodontist's office will handle much of the paperwork, submitting a pre-treatment estimate before you begin and filing claims as treatment progresses. Choosing an in-network provider usually keeps your out-of-pocket costs lower. Either way, you'll typically need to provide some information, including:

• Your treatment plan: Your orthodontist will provide a plan or timeline for your braces or aligners treatment.
• An itemized statement: This should include the prices and dates for each treatment you want to submit for coverage.
• The treatment code: The CDT code for your treatment. Comprehensive orthodontic treatment for adults is billed under D8090, whether you choose braces or aligners.
• Your provider's NPI: Your orthodontist's unique National Provider Identifier.
• Your insurance details: The plan will confirm your eligibility using your member ID and plan information.

Check with your insurer to find out which documents and information they need, and when.

How Much Do Braces and Clear Aligners Cost?

What often makes coverage worth it is the total cost of orthodontic treatment, because it can be pricey. Traditional metal braces typically cost $4,000 to $10,000, while ceramic braces run a bit more, and lingual (behind the teeth) braces tend to be the most expensive of all.

Invisalign can also cost up to around $10,000, though some dentists offer cheaper treatments for simpler misalignments. It depends primarily on the complexity of your case, but your dentist's rates, your location, and a variety of other factors can also contribute.

However, Invisalign isn't the only brand of clear aligners out there, and others might offer more appealing prices. For example, Linea offers in-person care and full clear aligner treatment for flat rates of $1,995 for mild cases, $2,995 for moderate cases, and $3,995 for severe ones. Plus, because they're administered in person, they can receive coverage from dental insurance just like Invisalign.

Other Ways to Manage Orthodontic Costs

Dental insurance is one of the more common ways to make braces or clear aligner costs more manageable, but it's not the only way, and for many adults it isn't an option at all. Here are a few other reliable approaches.

1. Use an FSA or HSA: Orthodontic treatment is a qualified medical expense, so you can pay for it with pre-tax dollars through a Flexible Spending Account or Health Savings Account. Depending on your tax bracket, that can save you roughly 20 to 30%, which makes it one of the most useful options for adults.
2. Consider payment plans and financing: Many orthodontic offices offer financing that breaks the total cost into manageable monthly payments, sometimes interest-free. Healthcare credit cards like CareCredit, and buy-now-pay-later services like Affirm, Klarna, and Afterpay, can also help spread out the cost, though some charge interest.
3. Shop around: Each dentist and orthodontist sets their own rates, based on their fees, location, and overhead costs, so it pays to get quotes from a few local options. Dental school clinics are worth a look too, since they often provide orthodontic treatment to adults at reduced rates, with the work done by supervised students or residents. (Charitable "free braces" programs exist as well, but most are limited to children and teens.)
4. Consider a more affordable aligner option like Linea: As we mentioned, Linea has flat-rate prices that often beat Invisalign and braces. With similar hands-on care, regular oversight, and quality clear aligners as Invisalign, it's a safe and versatile option for many adults seeking straighter teeth. To get started, complete their smile quiz and their care team will help you find a provider near you.