Orthodontic Coverage: What You Should Know
Orthodontic treatment is an investment in both your smile and your health. While many people expect to pay out of pocket for braces or aligners, insurance can significantly reduce your overall costs—if you have the right type of coverage.
Unlike general dental insurance, which usually covers routine care like cleanings and fillings, orthodontic benefits vary widely between plans and providers. Some include generous coverage for children, others for adults, and many require specific steps to unlock the full benefit.
In this blog, we’ll break down what orthodontic insurance typically covers, how it applies to both braces and clear aligners, and what steps you should take to maximize your benefits.
Does Dental Insurance Cover Braces?
It can—but it depends on your plan.
Most standard dental insurance plans include an orthodontic benefit only for dependents under age 18. However, more insurance providers are expanding their offerings to include adult orthodontics due to rising demand.
Coverage for braces may include:
- A lifetime maximum orthodontic benefit (typically between $1,000 and $3,000)
- A percentage of the treatment cost (often 50%) up to the plan’s maximum
- Some coverage for diagnostics, such as X‑rays or digital scans
- Pre‑authorization requirements or waiting periods
It’s also worth noting that orthodontic coverage is often separate from general dental coverage, meaning you may need to purchase a plan that includes orthodontics or add it as a rider.
What About Clear Aligners—Are They Covered?
Yes, many insurance plans that cover braces will also cover clear aligners up to the same lifetime maximum.
However, there are exceptions. Some plans still consider clear aligners to be “cosmetic” and may offer lower reimbursement rates or exclude them altogether.
To verify whether aligners are included in your coverage:
- Contact your insurance provider directly
- Ask for details about the orthodontic benefit and whether it applies to aligners
- Check if there's a difference in coverage for in‑network vs. out‑of‑network providers
- Get a pre‑treatment estimate from your orthodontist
Keep in mind that if your plan covers orthodontics, you’re usually free to choose between braces and aligners based on your needs and preferences.
Understanding Lifetime Maximums and Percentages
Unlike annual dental benefits that reset each year, orthodontic insurance usually has a lifetime maximum. This is the total amount your plan will pay toward orthodontic care per person.
For example:
- If your plan has a 50% benefit up to a $2,000 lifetime max, and your total treatment cost is $5,000…
- Your insurance would pay $2,000 (50% of the cost up to the limit).
- You’d be responsible for the remaining $3,000.
Once the lifetime maximum has been reached, insurance will not cover additional orthodontic treatment—even if it’s years later.
What Factors Affect Orthodontic Coverage?
Several factors can influence how much your insurance will contribute toward braces or aligners:
- Type of plan — Employer‑sponsored plans may differ from individual or family plans.
- Age of patient — Some plans cover only children, while others include adults.
- Type of treatment — Traditional braces, clear braces, and aligners may be covered differently.
- In‑network vs. out‑of‑network — Seeing a provider in your plan’s network may increase your benefits or lower your costs.
- Waiting periods — Some plans require you to be enrolled for a certain period before starting treatment.
Always review your Summary of Benefits or contact your insurance provider to clarify what’s included.
Other Payment Options if Insurance Doesn’t Cover Orthodontics
If your insurance doesn’t offer orthodontic coverage—or if you’ve already used your lifetime maximum—don’t worry. Many orthodontic practices offer flexible payment options to help make care more affordable.
These may include:
- Monthly payment plans with 0% interest
- In‑house financing through your provider
- Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) that can be used tax‑free
- Family discounts for multiple patients in treatment
Combining insurance coverage with these options can dramatically lower your out‑of‑pocket cost.
Tips for Maximizing Your Insurance Benefits
Want to make the most of your orthodontic coverage? Here are a few smart steps to follow:
- Confirm your benefits before starting treatment
- Ask your orthodontist to submit a pre‑treatment estimate
- Understand your plan’s lifetime maximum
- Stay in‑network if possible
- Consider supplemental or upgraded dental plans during open enrollment
- Use your FSA or HSA funds before they expire
Taking these steps ahead of time can save you hundreds—or even thousands—over the course of your treatment.
Choosing an Orthodontist Who Understands Insurance
Because orthodontic insurance can be tricky, it’s important to choose a provider who’s experienced in working with insurance plans. A knowledgeable office will help you:
- Confirm your benefits
- Submit claims and pre‑authorizations
- Explain your financial responsibilities clearly
- Offer payment options for what insurance doesn’t cover
You shouldn’t have to navigate insurance on your own. The right team can simplify the process and help you make confident financial decisions.
Get Expert Guidance from Albrechtsen & Fanelli Orthodontics
At Albrechtsen & Fanelli Orthodontics, we work closely with patients and their insurance providers to maximize orthodontic benefits for braces and aligners. Whether you’re exploring treatment for your child or yourself, we’ll walk you through your options and build a plan that fits your goals and budget.
Schedule a free consultation today to get started on your journey toward a straighter, healthier smile—with or without insurance.