Braces can change how a child eats, speaks and cares for their teeth, but the price tag stops many families before they start. The good news is that help exists for some children and some adults. Coverage depends on your state, your plan and the reason braces are needed. Here is how to sort out your options and what to ask.
Does your child qualify through Medicaid or CHIP?
Medicaid and the Children's Health Insurance Program (CHIP) cover dental care for eligible children. Orthodontics is a special case. These programs usually pay for braces only when they are medically necessary, such as for a severe bite problem that affects chewing or speech, or for a condition like cleft lip or palate. Braces that are mainly about appearance are generally not covered.
Rules vary by state. Some states use a scoring form to decide whether a child qualifies, and many require the orthodontist to get approval before treatment starts. Approval can take a few weeks, and the orthodontist may need to send X-rays and photos with the request. If a request is denied, ask how to appeal. Start by asking your child's dentist for a referral, then check with your state Medicaid or CHIP office about which orthodontists accept the plan.
Families sometimes earn too much for Medicaid but still qualify for CHIP, so it is worth checking even if you were turned down in the past.
What about adults?
Adult orthodontic coverage is much harder to find. Medicaid adult dental benefits vary by state, and braces for adults are rarely included. Original Medicare generally does not cover routine dental care, and Medicare Advantage plans seldom include braces.
Some private dental plans have an orthodontic benefit, but many limit it to children, set a lifetime maximum, or have a waiting period. If you have a plan through work, read the orthodontic section of your benefits summary or call the insurer.
Try a dental school orthodontic clinic
Dental schools with orthodontic residency programs often treat patients at lower fees. Orthodontic residents provide care while experienced faculty supervise the treatment plan. Expect a screening visit first, since programs choose cases that match what residents need to learn, and there can be a wait.
Treatment may take longer because appointments are scheduled around the school calendar. There may also be separate fees for records such as X-rays and models. Adults can often be seen at these clinics too, though programs differ on who they accept, so ask. Call the school and find out how it works before you apply.
Community clinics and local programs
Sliding-fee community health centers and health department clinics mostly provide exams, cleanings and fillings. Some can refer you to an orthodontist who accepts Medicaid or CHIP, or to a program that offers reduced fees. Braces themselves are not offered at every center, so ask for a referral to a local orthodontist who is willing to work with your budget.
Some local charities and nonprofits also help families with braces. Ask your dentist, school nurse or local health department if they know of any near you, and call ahead to learn what income limits or application steps apply.
Payment plans that make the cost manageable
Many orthodontic offices break the cost into a down payment and monthly payments, and some offer no-interest plans of their own. Before you agree, ask these questions:
- What is the total cost, and what does it include?
- Are retainers included, or is that a separate fee?
- Is there a fee for broken brackets or missed appointments?
- What is the monthly payment, and is there a down payment?
- Do you offer a discount if I pay in full?
A health savings account (HSA) or flexible spending account (FSA) can often be used for orthodontic costs. Check your plan's rules. If you use outside financing, read the interest terms carefully.
Braces or aligners?
Traditional metal or ceramic braces work for a wide range of cases. Clear aligners suit some people, but they are not right for every bite problem and only work if they are worn as directed. Cost depends on how complex the case is, how long treatment lasts, and where you live. Braces also take more effort to keep clean, so plan for regular dental checkups and cleanings during treatment, and ask whether retainers are part of the price.
Be careful with programs that skip an in-person exam. A dentist or orthodontist should check your teeth, gums and bite before any treatment, so problems like decay or gum disease get dealt with first.
Does your child need braces now?
Orthodontic groups recommend a first check-up around age 7, not because braces start then, but so problems can be spotted early. Many kids wait several years before treatment begins. Ask the orthodontist whether the treatment is needed now, could wait, or is mostly cosmetic.
A second opinion is fair, and many orthodontists offer a free or low-cost first visit. Confirm that when you book. Also ask how long treatment is expected to last and how many visits to plan for, since a longer plan usually means a higher bill. Writing your questions down before the appointment helps.
Find affordable orthodontic help near you
A local dentist or clinic is often the best first stop for a referral. To compare options where you live, find local dentists by state or check affordable dental offices by region. Call ahead to ask about fees, insurance and Medicaid or CHIP acceptance, and what paperwork to bring. A dentist or orthodontist can tell you what your child needs and what it may cost.