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Does Insurance Pay For Braces?
By Limestone Hills Orthodontics
Does Insurance Pay for Braces in Austin, TX? Everything You Need to Know
When it comes to braces, insurance plan can feel confusing. The good news is that many dental insurance plans do help cover some of the costs. However, the amount they cover often depends on your specific plan. In general, insurance covers braces that are medically necessary, such as fixing severe bite issues. For braces or aligners used for cosmetic purposes, coverage may be more limited.
If you’re wondering, “Does insurance pay for braces?” this guide breaks down everything you need to know about braces, their costs, and how insurance can help.

How Much Do Braces Cost Without Insurance?
Braces can be expensive without insurance. Here’s an overview of average costs:
- Traditional Metal Braces: $3,000 to $7,000
- Clear Ceramic Braces: $4,000 to $8,000
- Lingual Braces (behind the teeth): $8,000 to $10,000
- Invisalign or Clear Aligners: $4,000 to $8,000
The cost depends on the type of braces, the complexity of the treatment, and how long it takes to correct your teeth alignment.
How Much Do Braces Cost With Insurance?
If you have insurance, your out-of-pocket expenses can drop significantly. Most dental insurance plans cover around 50% of the total cost of braces. Here’s what you might pay after insurance:
- Metal Braces: $1,500 to $3,500
- Clear Aligners/Invisalign: $2,000 to $5,000
Some insurance plans also set a lifetime coverage limit for orthodontics. This limit is commonly between $1,000 and $3,000. So, while insurance doesn’t eliminate costs, it helps greatly reduce them.
Steps to Make Sure Insurance Covers Your Braces
If your dental insurance offers orthodontic coverage, here’s how to get the most out of it:
1. Check Your Insurance Plan
Speak with your provider to understand your policy details. Ask questions like:
- Does the plan cover the type of braces I want?
- Is there partial or full coverage for Invisalign?
- Are there specific age restrictions for coverage?
2. Pre-Treatment Approval
Many insurance companies require pre-authorization before they cover braces. Your orthodontist can submit a cost estimate and treatment plan for approval.
3. Explore Payment Plans
If your plan doesn’t cover the full cost, many orthodontists offer payment plans. Monthly payments make it easier to budget for any remaining cost.
Types of Dental Insurance Plans
Not all dental insurance plans are the same. Here’s a quick overview of the most common types:
- DHMO (Dental Health Maintenance Organization): Lower cost but requires you to see dentists in the network only. Coverage for braces is usually limited.
- PPO (Preferred Provider Organization): More flexibility; you can choose any orthodontist, but staying in-network lowers out-of-pocket costs.
- EPO (Exclusive Provider Organization): Balanced option. You must see network orthodontists but often pay lower fees.
- Dental Discount Plans: Not insurance, but these plans offer discounts on braces and other treatments.
Medical vs Dental Coverage
Understanding the difference between medical and dental insurance is important:
- Medical Insurance: Covers general health needs like surgery or hospital stays. It may cover braces only for jaw-related medical conditions or severe misalignment.
- Dental Insurance: Focuses on oral health. This includes cleanings, fillings, and often braces (especially for children under specific criteria).
Most dental policies are designed to help with preventive care and orthodontic treatments, making them the go-to option for braces coverage.
Important Insurance Terms to Know
When planning orthodontic treatment, keep these common insurance terms in mind:
- Deductible: The amount you must pay before insurance covers the cost.
- Copay: A fixed fee you pay for services (e.g., each orthodontist visit).
- Annual Maximum: The highest amount your plan will pay in one year.
- Lifetime Maximum: The total amount your insurance will cover for braces during your lifetime.
Understanding these terms helps you better prepare for your orthodontic expenses.
Who Qualifies For Braces Coverage?
Not all brace treatments qualify for insurance coverage. Eligibility depends on these factors:
- Age Restrictions: Many policies only cover braces for children or teens under 18. However, some plans now offer limited adult coverage.
- Pre-Authorization: Your orthodontist must submit a treatment plan for approval before work can begin.
- Medical Necessity: To qualify for coverage, braces must often correct functional issues like difficulty chewing or severe bite alignment problems.
Cosmetic treatments, like fixing minor tooth gaps, may not be covered. Confirm these details with your provider.
Can You Save Money Without Insurance?
If dental insurance is not an option, you still have ways to reduce the cost of braces:
- Flexible Spending Account (FSA): Use pre-tax money from your FSA to pay for treatment.
- Health Savings Account (HSA): Like an FSA, but with a higher yearly limit.
- Payment Plans: Many orthodontists allow you to pay for braces over the course of treatment.
- Dental Schools: Dental schools offer reduced-cost braces under the supervision of licensed professionals.
- State Programs (Medicaid/CHIP): These programs can fully cover orthodontic care for children if braces are medically necessary.
In-Network Providers: Why They Matter
Choosing an orthodontist within your insurance provider’s network offers several benefits:
- Lower Costs: In-network providers negotiate reduced fees with your insurer.
- Insurance Support: They handle documentation and claims for you.
- Extra Discounts: Some plans offer additional savings for in-network services.
Sticking to network options ensures you maximize your insurance benefits while keeping costs low.
Why Choose Our Orthodontic Office in Austin, TX?
At our Austin clinic, we are committed to giving you the perfect smile with affordable, high-quality care. Here’s why our patients trust us:
Experienced Specialists
Our team has years of experience treating patients with braces, Invisalign, and other orthodontic solutions. We know how to achieve the best results.
Personalized Plans
Every patient’s smile is unique. At our office, we create custom treatment plans tailored to your goals, dental needs, and budget.
Flexible Payment Options
We offer multiple payment plans, making it easy to afford treatment, whether or not you have insurance.

Book a Free Consultation Today!
Come see us in Austin, TX, for a free consultation! During your visit, we’ll assess your teeth, go over your treatment options, and discuss how we can help you achieve a straight, confident smile. Scheduling is simple—give us a call or visit our website to book a time that works for you! Our friendly team is ready to answer your questions and guide you every step of the way.
About the Authors
Dr. Rodrigo Viecilli – Orthodontist in Austin, TX
Frequently Asked Questions
Can insurance cover braces?
Insurance covers 50% of the cost, but rarely 100%. Most plans also have a maximum payment cap, so check with your provider.
How do people get braces for free?
Programs like Medicaid or CHIP may cover braces for children if deemed medically necessary. Dental schools and local charities may also provide low-cost options.
Is it worth it to get dental insurance for braces?
If you or your child need braces, dental insurance can save you money. Compare the cost of premiums against coverage to see if it’s worth it.
Does Dental Insurance Cover Orthodontics?
Whether dental insurance covers orthodontics really depends on your specific plan. Some dental insurance plans do offer coverage for orthodontic treatments like braces or Invisalign, especially for children, but coverage for adults can be more limited.