Does Medicare Cover Braces and Orthodontic Care?

Medicare Benefits Solutions
Nov 8, 2021

It’s common for orthodontic procedures to correct a person’s bite or align teeth during childhood or adolescence. However, older adults could also find themselves in situations where they require this type of care. Medicare recipients should know how their benefits work and what kind of coverage they can get for orthodontic care or braces. 

Evaluating your orthodontic care needs

Treating any irregularities in your jaw or teeth falls under the orthodontics branch of dentistry. An orthodontist is a dental professional who handles these procedures, and they can look at your needs and tell you what work they recommend. A general dentist may refer you to an orthodontist if they find issues that require orthodontic care as part of the treatment plan. One common reason you’d need this care is that you need reconstructive surgery due to facial tumor removal that requires reconstructive jaw surgery. 

The position of your bite and teeth can also change over time, and this can make maintaining your oral hygiene or chewing your food difficult. An improper bite or uneven spacing in your teeth can wear down your tooth enamel more quickly, and this leaves you more vulnerable to decay or breakage. 

Different braces types

Braces slowly realign your teeth into positions that give you the proper bite while creating even spacing. Even people who had braces as a child may need them again as an adult. However, there are not many more options available to you, and these include: 

• Aligners – These are clear, customized trays that will use stages to realign your teeth over the course of a few months. 
• Conventional – These braces affix ceramic or metal brackets to each tooth that hold bands or wire to your teeth to help reposition the bite and realign the teeth. 
• Lingual – These braces attach to the back of the teeth, and they work just like conventional braces while staying hidden. 
• Self-Ligating – These braces function and look like conventional ones do, but they don’t need any bands to adjust your teeth because they have clip-style brackets that allow the orthodontist to tighten the wires to adjust your bite. 

Medicare coverage and orthodontic care

Usually, Medicare recipients don’t have coverage for this type of care under their Part A or Part B benefits. However, if a disease or accident requires you to have a restorative, orthodontic procedure, it could be considered medically necessary. If this is the case, Original Medicare may cover it at an 80% amount. 

If a surgical orthodontic procedure or emergency requires you to stay in the hospital, Medicare Part A could cover any associated hospital costs, even if your orthodontic procedure-specific costs don’t have coverage. Even though Part A and B under Original Medicare has very limited circumstances where they offer orthodontic care or braces coverage, you could find more dental coverage by going with a Medicare Advantage plan. This plan will give you all of the coverage you get with Original Medicare. However, you also get expanded benefits, and this usually includes dental and vision care. 

Medicare Advantage plans come from private insurance companies, so this can impact how much your premiums and deductibles are, and it can also impact how much coverage they offer and what your total out-of-pocket costs are. It’s a good idea to contact your medical team to get a cost breakdown before you have your treatment. 

Orthodontic care and braces costs

If you have coverage through Original Medicare, they’ll pay up to 80% of the Medicare-approved cost. You’ll be responsible for the other 20%. The price can have a huge range to it, and they usually start at $3,000 and up upwards of $10,000 for the complete treatment.

This is why it’s so important to have coverage. If you are enrolled in a Medicare Advantage plan that includes orthodontic care, double-check what your Medicare plan will help cover before getting treatment.