Does Medicare cover orthodontics?

Does Medicare cover orthodontics? Medicare generally doesn’t cover orthodontics, and in fact, there is very little coverage for dental work included with Original Medicare. You may have some coverage for orthodontics if you have a Medicare Advantage health insurance plan that includes dental coverage, but those with Original Medicare will need to purchase a separate dental plan.

To compare rates on Medicare plans that include orthodontics and other dental coverage, enter your ZIP code above.

Does Medicare cover dental care and orthodontics?

Medicare does not include routine dental services, nor does it cover braces or other orthodontic work. Does Medicare cover braces for adults? Unfortunately this is a procedure that isn’t covered, as with most orthodontic treatment. In rare situations, Medicare Part A may cover the hospitalization portion of an emergency that requires dental care, but the dental work itself will be out-of-pocket.

Another exception to the rule is that coverage may be available for dental care that is part of the treatment of a condition such as a cleft palate and is considered to be medically necessary.

If you choose to sign up for a Medicare Advantage plan, you may have dental included at no additional cost. Otherwise, dental insurance plans are available as an add-on to Medicare Advantage or as standalone policies. Dental plans are generally very affordable.

What is the cost of orthodontics with Medicare?

You will pay the full amount of your orthodontic treatments if you have Original Medicare. As noted, some Medicare Advantage plans do include dental coverage, but it is generally for basic services. This wouldn’t include something like the cost of braces, as mentioned above. Some plans may have partial coverage for orthodontics. Overall, Medicare orthodontics will have to be something you research before scheduling an appointment.

Dental plans don’t always cover orthodontics, but when they do it’s generally a portion of the cost, commonly 50 percent, and up to a yearly limit.

Case Studies: Medicare Coverage for Orthodontics

Case Study 1: Orthodontics Coverage With Medicare

In this case study, let’s consider John, a Medicare beneficiary in need of orthodontic treatment. John is enrolled in Original Medicare, which does not cover orthodontics. He explores his options and learns that Medicare Advantage plans may include dental coverage, including orthodontics. John switches to a Medicare Advantage plan covering orthodontics and receives the needed treatment.

Case Study 2: Cost of Orthodontics With Medicare

Sarah is another Medicare beneficiary who requires orthodontic treatment. She has Original Medicare and discovers that she needs to pay the full cost of her orthodontic treatment as Medicare does not cover it. Sarah seeks dental insurance to reduce costs and discovers a plan that partially covers orthodontics, lowering her out-of-pocket expenses.

Case Study 3: Orthodontics Coverage and Dental Insurance

Mark is considering orthodontic treatment and wants to understand his coverage options. He has Original Medicare and knows that it doesn’t cover orthodontics. Mark decides to purchase a separate dental insurance plan that specifically includes orthodontics coverage. Mark’s dental plan allows him to get orthodontic treatment while utilizing his Medicare and dental insurance coverage.

The Bottom Line: Does Medicare cover orthodontics?

Original Medicare doesn’t include dental coverage and has no coverage for orthodontic services. There may be a few exceptions to this rule, but generally, braces are not covered. Some Medicare Advantage plans do include dental care, and the plans are also available for purchase. Orthodontic coverage on dental insurance is generally limited. You will want to ensure that the Medicare company you have will lay out the information in a way that makes it easy to understand your coverage.

To find a Medicare plan that includes orthodontics coverage, enter your ZIP code now.