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Last Updated on 22 November 2019

Does health insurance cover braces?


Does health insurance cover braces
Key Points
  • There are different types of braces, but they usually range in cost from $5,000 to $9,000.
  • Medicare does not cover braces, but health insurance can provide benefits that can reduce out of pocket costs.
  • Most funds impose a 12-month waiting period before you can claim on orthodontic treatments, including braces.

 

What are braces and when do you need them?

Braces are a common orthodontic treatment used to realign your teeth and/or jaws. They can be used to correct a range of situations, from crooked teeth to overbites or underbites.

Traditionally, braces are made of wire and metal and fixed to the front of your teeth. These days, there are a few other options that are less conspicuous, like clear braces, aligners or even ‘hidden’ braces, attached to the back of your teeth.

Braces are usually associated with teenagers, though they are increasingly common among adults. As a child or teenager, your teeth and jaws are still growing, making it a prime time for braces.

Braces can help guide your teeth and jaws into alignment, and they can be effective whether you’re a child, teen, or adult. Age isn’t the only factor when it comes to braces: you’ll have to do a bit of work to maintain that straight smile.

What to expect after braces come off

You can expect to wear braces from six months to two years, depending on the type you choose and the depth of treatment needed. Once the braces come off, you’ll probably need to wear a retainer.

The retainer may be fixed to the back of your teeth, or it may be removable. Each of the styles has their pros and cons. Speak to your orthodontist for more information on which one might be best for you. Your orthodontist will give specific details on how often your retainer should be worn, but it’s not likely to come with an end date.

Though it may sound daunting to wear a retainer for the rest of your life, the reality is that if you don’t, your teeth may naturally start to move out of place. Whether you wear braces or not, your face will change as you age, but you’ll want to preserve the new positioning of your teeth. The good news is that most retainers are relatively unobtrusive and far less noticeable than braces.

As you can see, the process of getting braces is ongoing, which means that the costs can add up. Next, we’ll look at how much braces cost and if they’re covered by health insurance.

How much do braces cost?

The cost of braces can vary depending on factors like:

  • Type of braces
  • Treatment plan
  • Your treatment provider
  • The way your teeth and jaw respond to the braces

The more complicated or lengthy your treatment, the more it’s likely to cost. The same goes for the type of braces you choose, as different materials come with a different price tag. Remember that the cost of your braces includes initial consultations, the treatment itself, and the follow up appointments.

Here is a general price range for different types of braces, based on an 18-month treatment plan, according to Orthodontics Australia:

  • Metal and ceramic braces: $5,000 – $9,000
  • Lingual braces: $9,000+
  • Clear aligners: $3,500 – $9,000

Braces don’t come cheap! But with such a wide price range, it’s worth investigating your options to determine what’s best for you.

When choosing your treatment provider, you’ll have to decide whether you want to see a dentist or an orthodontist. An orthodontist specialises only in orthodontics.

Both dentists and orthodontists have dental degrees, but an orthodontist has an additional 3-year orthodontic degree. They specifically practice orthodontics, while a general dentist does not.

Although some dentists may offer braces, they may not have the level of experience or training that an orthodontist does. It is sometimes cheaper to go to the dentist, but you’re often not getting the same expertise—keep this in mind when you’re deciding on a course of treatment.

Does health insurance cover braces?

Braces are not covered by Medicare, which leaves many people wondering if they can get covered through health insurance. Fortunately, the answer is yes, depending on your policy.

To start with, you’ll need to have an extras policy in place, as braces aren’t covered through hospital policies. Next, you’ll need to look at the level of coverage to be sure it includes braces.

Most extras policies include general dental, but they don’t all stretch to cover orthodontics. For this, you’ll usually need to look at medium to comprehensive levels of cover. Check that orthodontics are covered, as these services are sometimes listed as exclusions in the policy.

Benefit Limits

Orthodontics usually come with a lifetime benefit limit. This is the maximum amount you can claim for braces and other orthodontic services; once you hit the limit, you won’t be able to get any further cover.

Within these lifetime limits, funds usually offer cover for braces in one of two ways: fixed or accrued benefits.

Fixed benefits stay the same, no matter how long you are with a fund. For example, if your fund sets a $700 annual limit towards orthodontics, you’ll never be able to claim more than $700 in a year.

Accrued benefits increase over time, and are also known as loyalty benefits. Say your policy has a $700 annual limit for orthodontics, but your fund increases that by $100 for every year that you’re with the fund. In three years’ time, you could have an annual benefit level of $1000.

Waiting periods

You’ll need to plan ahead if you want to health cover for braces, because there are waiting periods to consider. Most funds impose a waiting period of 12 months before you can claim on orthodontics.

If you or someone on your plan is likely to need braces, you need to have the appropriate level of cover in place 12 months in advance.

Shopping for orthodontics cover? We can help you get the most for your money. Start by comparing policies from some of Australia’s leading insurers.

Our team of experts can explain the details of different policies, so you won’t miss out on a great deal. Visit Health Insurance Comparison to get started.

Disclaimer: The above information is correct and current at the time of publication


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