October 20th 2023
By Ari Parker
In most cases, orthodontic services aren’t covered by Medicare because they’re cosmetic. Learn more about how Medicare handles coverage of orthodontic services.
By Ari Parker
Medicare coverage for dental services is limited and generally only covered if deemed medically necessary. Orthodontic care is a type of dental care, so the same limitations apply.
Many Medicare Advantage plans offer dental coverage that’s closer to the employer-linked dental plans you may be more familiar with. These plans may pay up to a specific amount for certain dental services. To determine if (and how) the orthodontic care you’re seeking is covered by your plan, you’ll need to consult your summary of benefits. Keep in mind that many Medicare Advantage plans require prior authorization, even for covered services.
In this guide, we’ll explore the most common orthodontic services, when they’re needed, and how Medicare handles coverage.
Generally, orthodontic services, including braces, clear aligners, and retainers, are not covered by Medicare unless they’re deemed medically necessary.
Orthodontic care is often considered cosmetic, and full health insurance coverage is uncommon for adults.
Dentists and orthodontists both focus on oral health care but differ in their specialties. Orthodontists go through the same education and training as dentists, then undergo additional education to become experts in diagnosing and treating issues related to misaligned teeth and jaws.
General dentists provide many services, including routine check-ups and cleanings, cavity fillings, and minor oral surgery. They also address issues related to gum health, tooth decay, and oral hygiene. Orthodontic dentists (orthodontists) focus on aligning and positioning teeth and jaws. They use braces, aligners, and spacers to correct issues like overbites, underbites, crowded teeth, and gaps between teeth.
While your orthodontist will determine the care you need, it’s good to understand the different types of orthodontic treatments and what they’re for.
Braces and aligners, like Invisalign, are both used to fix alignment issues. Braces are more commonly used for younger patients and patients with more complex alignment issues. Aligners (clear braces) are more common among adults and those with minor alignment issues. The right choice depends on your orthodontist’s professional opinion and your personal preferences.
Retainers are used as a follow-up to braces to help keep your teeth in their new, correct position. Once braces have done their job to straighten your teeth, your gums, bones, and muscles may not be used to the new structure. Daily activities, like chewing and grinding, can also cause your teeth to move. Retainers help your teeth "retain" their correct positions after they're trained by braces or clear aligners.
Generally speaking, Medicare doesn't cover orthodontic services. This is because most orthodontic procedures are considered cosmetic rather than medically necessary. Orthodontic services may be covered if they're deemed medically necessary or are closely related to other medical services. Medicare Part A will also cover some dental procedures if they're needed in an emergency situation.
Medicare does not cover braces or clear aligners (e.g., Invisalign).
Medicare does not cover retainers.
If you have questions about your Medicare coverage or want to explore your different Medicare coverage options, our licensed Advisors are here to help! Schedule a free consultation or call us at (855) 900-2427 to get your questions answered.
