Does Medicare Cover Braces?

Orthodontic treatment, such as getting braces, can help correct dental issues and improve both the function and appearance of your teeth. However, many people on Medicare wonder about their options for covering these often expensive treatments. In this article, we will analyze does Medicare cover braces, what is available through Medicare Advantage plans, and the alternatives if traditional Medicare does not offer the coverage you need.

What Is Medicare’s Policy on Braces and Orthodontic Treatment?

Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), delivers very limited dental coverage. It does not cover regular dental care, including cleanings, fillings, or most dental procedures. Similarly, does Medicare cover braces under Original Medicare? The answer is no. Medicare does not cover orthodontic treatment like braces for cosmetic reasons or for dental health maintenance.

The only exception is if dental services are required as part of a covered medical procedure, such as jaw reconstruction following an injury. In these rare cases, Medicare might cover related services, but not the braces themselves.

Are Braces Covered Under Medicare Advantage Plans?

Medicare Advantage Plans, also comprehended as Medicare Part C, are an alternative to Original Medicare. These plans are presented by private insurance companies approved by Medicare. They are required to cover all services provided under Part A and Part B, but many also offer additional benefits, including dental coverage.

So, does Medicare cover braces if you enroll in a Medicare Advantage Plan? It depends on the plan. Some Medicare Advantage Plans include dental benefits that may cover a portion of orthodontic treatment. However, this coverage varies widely between plans and may include limitations, such as only covering medically necessary orthodontics, not cosmetic treatments.

What Are the Out-of-Pocket Costs for Braces with Medicare Advantage?

If your Medicare Advantage Plan offers dental benefits that include orthodontic services, it is essential to understand the out-of-pocket costs. These typically include:

• Deductibles: The amount you pay out of pocket before the plan starts covering costs.
• Coinsurance or copayments: A percentage of the cost of braces that you are responsible for.
• Annual coverage limits: Some plans may cap dental benefits at a certain dollar amount each year.

For example, if your plan covers $1,000 per year for dental services, and braces cost $5,000, you would be responsible for the remaining $4,000. Always check your plan’s Summary of Benefits to understand what is covered and your expected costs.

Does Medicare Provide Coverage for Orthodontic Care?

To clarify again, does Medicare cover braces or other orthodontic care under Original Medicare? No. Medicare Part A and Part B do not cover orthodontic care. This includes braces, retainers, and other devices used to straighten teeth or correct dental issues.

Coverage is limited to very specific medical scenarios where dental work is integral to a covered procedure, such as surgery on the jaw or treatment for certain diseases affecting the mouth and jaw.

How Can Medicare Advantage Help Cover Orthodontic Expenses?

If you are interested in orthodontic treatment and want the best chance of getting some financial help from Medicare, a Medicare Advantage Plan with dental benefits is your best option. Here is how these plans can help:

• Expanded dental coverage: Many Medicare Advantage Plans offer dental coverage beyond what Original Medicare provides.
• Orthodontic benefits: Some plans include orthodontic services, which may cover part of the cost of braces or aligners.
• Network discounts: Even if a plan does not fully cover braces, being part of a dental network may offer discounted rates on orthodontic care.

When evaluating Medicare Advantage Plans, compare dental benefits carefully. Look for details on coverage for orthodontic services and review limitations, exclusions, and maximum coverage amounts.

What Are the Alternatives If Medicare Doesn’t Cover Orthodontic Care?

If you discover that your Medicare or Medicare Advantage Plan does not cover the orthodontic treatment you need, here are a few alternatives:

• Standalone dental insurance: You can purchase a separate dental insurance plan that includes orthodontic benefits.
• Dental discount plans: These membership-based plans offer discounted rates on dental services, including braces.
• Payment plans through orthodontists: Many orthodontists offer flexible payment plans to help spread out the cost of treatment.
• Health savings accounts (HSAs) or flexible spending accounts (FSAs): If you have funds in an HSA or FSA, you can use them to pay for orthodontic treatment, though contributions to these accounts must occur before enrolling in Medicare.
  
  

What Are Orthodontic Services, and How Do They Differ from General Dental Services?

Orthodontic services focus on correcting the alignment of teeth and jaws to better oral function and appearance. They include:

• Braces (metal, ceramic, lingual)
• Clear aligners (such as Invisalign)
• Retainers
• Palatal expanders and other devices
  

General dental services, on the other hand, address basic dental needs such as:

• Cleanings and preventive care
• Fillings
• Crowns and bridges
• Extractions

Medicare’s limited dental coverage generally applies to medically necessary procedures, not to orthodontic or cosmetic dental services.

Does Medicare Cover Retainers or Post-Braces Care?

Once braces are removed, most orthodontists recommend wearing a retainer to keep the results of treatment. You may wonder, does Medicare cover braces and also cover post-braces care like retainers? Unfortunately, the answer is still no under Original Medicare.

Similarly, does Medicare pay for braces or retainers under Part B? No. Medicare does not pay for these services unless they are required as part of a medically necessary treatment plan that falls under Medicare’s coverage guidelines.

If you have a Medicare Advantage Plan that covers orthodontic treatment, it may also offer partial coverage for retainers and post-braces care, but again, this will vary by plan.

Conclusion

In summary, the question does Medicare cover braces has a clear answer: Original Medicare does not cover braces or orthodontic treatment unless it is part of a medically necessary procedure. Likewise, the questions does Medicare pay for braces and will Medicare pay for braces can generally be answered with no, unless you have a Medicare Advantage Plan that includes dental and orthodontic coverage.

If you are considering orthodontic treatment, it is important to explore your options. Medicare Advantage Plans may provide limited help, and standalone dental insurance or dental discount plans can offer additional avenues to reduce costs. Always review your coverage carefully and speak with your plan provider or dental professional to understand what is available to you.


Disclaimer: The information provided on this blog is for informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare professional before making any health-related decisions.

 Source: healthcare.gov