Medicare does not pay for braces in most cases
Original Medicare (Part A and Part B) does not cover orthodontic treatment, including braces, for adults. Medicare considers braces a dental service, and dental care is not included in the standard Medicare benefit package. The only exception is if you need braces as part of treatment for a covered medical condition — for example, if jaw surgery is medically necessary and braces are required before or after that surgery as part of your recovery plan.
If you are enrolled in a Medicare Advantage plan (Part C), some plans do include limited dental coverage, but orthodontics is rarely part of that benefit. You will need to check your specific plan's coverage details, because what one plan covers varies widely from another.
Key Takeaways
- Original Medicare does not cover braces or other orthodontic treatment for any age.
- Medicare Advantage plans sometimes include dental benefits, but orthodontics is typically not covered even when dental care is.
- If braces are medically necessary as part of jaw surgery or another covered procedure, Medicare may pay for the braces themselves as part of that treatment.
- Standalone dental insurance plans and dental discount programs are the main routes to reduce the cost of braces outside Medicare.
When Medicare might cover braces as part of another treatment
Braces can be covered by Medicare if they are deemed medically necessary as part of a covered procedure. The most common scenario is orthognathic surgery — jaw surgery to correct a severe bite problem or jaw misalignment that affects your ability to eat or breathe. If your doctor determines that braces are required before surgery to prepare your teeth, or after surgery as part of your recovery, Medicare may cover the braces as part of the surgical treatment plan.
To get coverage in this situation, your surgeon or orthodontist must document that the braces are medically necessary, not cosmetic. Your doctor will need to submit this documentation to Medicare before you begin treatment. Even then, Medicare covers only the braces themselves — not the full orthodontic care — and only if they are directly tied to the covered medical procedure.
What Medicare Advantage plans might cover for dental care
Some Medicare Advantage plans include dental benefits as an added feature. These plans may cover routine cleanings, X-rays, and fillings. However, most plans that include dental benefits do not cover orthodontics, because braces are considered a specialized and costly treatment. A few plans in certain areas may offer limited orthodontic coverage, but this is uncommon.
If you have a Medicare Advantage plan and want to know whether it covers any orthodontic care, call the plan directly or check your plan's Summary of Benefits and Coverage document. This document lists exactly what dental services are covered and what you would pay out of pocket. The coverage and costs vary by plan and by year, so you cannot assume that because one plan covers something, another plan will too.
Standalone dental insurance and discount programs
If you need braces and do not have coverage through Medicare or a Medicare Advantage plan, you have two main options outside Medicare: standalone dental insurance and dental discount programs.
Standalone dental insurance is a separate policy you purchase on your own. These plans typically have waiting periods before they cover major services like orthodontics — often 6 to 12 months or longer. You pay a monthly premium, and the plan covers a percentage of the cost after you meet a deductible. Because of the waiting period, this option works best if you plan ahead rather than need braces when ready.
Dental discount programs (sometimes called dental savings plans) are membership programs that give you a discount on dental services at participating dentists. There is no waiting period, and you pay a yearly membership fee — typically $80 to $200 — in exchange for discounts of 10 to 60 percent on services including orthodontics. These programs do not involve insurance; they are negotiated discounts between the program and the dentist. If you need braces soon, a discount program may be faster than waiting out an insurance waiting period.
How to find out what your specific plan covers
The only way to know for certain whether your coverage includes any orthodontic benefit is to contact your plan or review your plan documents directly. If you have Original Medicare, you can call Medicare at 1-800-MEDICARE (1-800-633-4227) and ask whether braces would be covered in your situation. Have your medical details ready — for example, if you are having jaw surgery, mention that.
If you have a Medicare Advantage plan, call the plan's customer service number on your insurance card. Ask specifically whether orthodontics or braces are covered, and if so, what percentage the plan pays and whether there are any waiting periods or limits on the number of months of treatment. Ask for the answer in writing if possible, so you have documentation.
If you are considering a Medicare Advantage plan during open enrollment and want dental coverage including orthodontics, use the plan finder tool on Medicare.gov to compare plans in your area. Filter by plans that include dental benefits, then call each plan to ask about orthodontic coverage specifically.
Out-of-pocket costs for braces without insurance
The cost of braces varies widely depending on the type of braces, the complexity of your case, and your location. Traditional metal braces typically cost between $3,000 and $7,000 for the full treatment. Clear aligners (like Invisalign) often cost $3,500 to $8,000. Ceramic braces fall somewhere in between. These are the full retail prices before any insurance or discount.
If you are paying out of pocket, ask your orthodontist about payment plans. Many orthodontists offer monthly payment options that let you spread the cost over the treatment period, which is usually 18 to 24 months. Some practices offer discounts if you pay in full upfront. Getting quotes from multiple orthodontists in your area can also help you find more affordable options.
Frequently Asked Questions
Can I get braces through Medicaid instead of Medicare?
Medicaid is a separate program from Medicare. Medicaid coverage for braces varies by state — some states cover orthodontics for children under certain conditions, but coverage for adults is rare. If you think you may be may be able to access for Medicaid, contact your state's Medicaid office or call 211 to find out what dental services are covered in your state.
Will Medicare pay for braces if my dentist says they are medically necessary?
Medicare's definition of medically necessary is narrow. Braces are covered only if they are part of treatment for a covered medical condition, such as jaw surgery. If your dentist recommends braces for bite problems or crowding that do not involve a covered medical procedure, Medicare will not pay. Your doctor would need to document that the braces are required as part of a covered surgical or medical treatment.
Do all Medicare Advantage plans cover dental care?
No. Some Medicare Advantage plans include dental benefits and some do not. Even among plans that do include dental coverage, orthodontics is typically excluded. You must check your specific plan's coverage details. During open enrollment, you can compare plans on Medicare.gov or call plans directly to ask about their dental and orthodontic benefits.
What is the difference between a dental discount program and dental insurance?
Dental insurance involves a monthly premium, a deductible, and coverage percentages, but usually has a waiting period before covering major services. Dental discount programs charge a yearly membership fee and offer when ready discounts with no waiting period, but they are not insurance — you pay the discounted price directly to the dentist. For braces, a discount program may be faster if you need treatment soon.
Can I use a Health Savings Account (HSA) to pay for braces?
If you have an HSA through a high-deductible health plan, you can use HSA funds to pay for braces. Orthodontic treatment is considered a may have access to medical expense. However, this only works if you have an HSA available — most people on Medicare do not, because Medicare enrollment makes you ineligible for an HSA.