Unfortunately, Medicare coverage for dental care is very limited. Medicare also rarely covers orthodontic treatments. Orthodontic services treat dental and jaw alignment issues with braces, clear aligners, retainers, and other devices. 

Medicare won’t cover braces, or any orthodontic service, unless you have an underlying medical necessity. In this guide, we’ll discuss the rare exceptions for coverage under Medicare, how certain Medicare Advantage plans may cover braces, and alternatives ways you can reduce how much braces cost you.

Key takeaways:

  • Medicare doesn’t cover braces unless you need them to treat an underlying health condition. 

  • Medicare Advantage plans often include routine dental coverage, but coverage for braces is more limited. Check your plan details to see if it covers braces.

  • You can explore alternative methods to pay for braces, including a low-cost subscription for aligners, secondary insurance, or private dental insurance.

When does a person need braces?

Braces are a type of orthodontic device that corrects any teeth or jaw misalignment. You may need braces if you have:

  • Crooked teeth

  • An overbite, underbite, or open bite

  • Spacing issues between your teeth

  • Jaw misalignment

In some cases, a person might need orthognathic surgery, which is jaw surgery to correct facial symmetry or ensure proper alignment. Orthognathic surgery is also considered an orthodontic service.

Does Medicare cover braces?

Medicare doesn’t cover braces or any dental services or devices if you need them for aesthetic purposes. Not having routine dental coverage is a big frustration for many beneficiaries, but there are a few exceptions to this limitation.

Exceptions for coverage

Medicare may cover orthodontic devices such as braces, clear aligners (like Invisalign), or retainers if you need them to to correct a severe dental or jaw abnormality that affects your overall health and function. Check out some example situations below.

Jaw and facial trauma from an injury: You may need braces and other forms of orthodontic treatment after experiencing an accident or medical condition that impacted your jaw. Medicare may cover orthodontic services and devices to treat and restore jaw and teeth alignment after an accident.

Severe jaw misalignment: If you have serious jaw misalignment that impairs your ability to eat, speak, or breathe, Medicare could cover the cost of braces to help you fix these issues.

Medical issues like Severe Temporomandibular Joint Disorder (TMJ): TMJ can cause severe pain and tenderness in your jaw joints and surrounding muscle. If you need braces to treat problems that are caused by TMJ, Medicare may pay for them.

Sleep apnea due to dental or jaw issues: Some dental or jaw conditions can contribute to sleep apnea. If you have sleep apnea due to dental or jaw problems, Medicare may cover orthodontic treatments like braces to correct the underlying issues and alleviate sleep apnea symptoms.

Does Medicare Advantage cover braces?

Medicare Advantage plans often do cover routine dental care, but coverage for orthodontic services, like braces, is generally pretty limited. If you have a Medicare Advantage plan, check what dental benefits it covers before scheduling an appointment to receive braces.  

Alternative ways to pay for braces and orthodontic services

Because Medicare doesn’t cover braces if they’re not medically necessary, we’ve explored ways you may be able to get braces at a lower cost.

  • Secondary coverage from Medicaid, VA healthcare, TRICARE, FEHB, private insurance, or employer insurance

  • Private dental packages that cover comprehensive oral care

  • Companies that offer low-cost subscription aligners (like Byte)

Not having orthodontic coverage is frustrating for many Medicare beneficiaries. If you need help finding a Medicare plan that covers dental and orthodontic care, we’re here to help! Call us at 855-900-2427 or schedule a time to chat to get started today.

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