Does Health Insurance Cover Orthodontics?

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What is orthodontics?

How much do orthodontic procedures cost?

Does Medicare cover orthodontics?

Could my health insurance help pay for orthodontics?

What else can I use my dental extras for?

Where can I find and compare health insurance?

Long story short

Orthodontists aim to straighten your teeth and fix your bite

Your orthodontist may suggest treatments like braces, clear aligners, and plates.

Orthodontic treatments can be quite expensive, but your health insurance could help pay the bill

You’ll need a policy that includes orthodontic cover, though.

Orthodontic health insurance can have benefit limits

These may be annual limits, but they can also be lifetime limits.

What is orthodontics?

Orthodontics is a specialised form of dentistry. Where your regular dentist helps to keep your gums and teeth healthy, an orthodontist’s bread and butter is resolving teeth and jaw problems. This can include: 

• fixing crowded, crooked, or protruding teeth
• correcting underbites and overbites
• reducing excessive spacing between teeth 

An orthodontist’s treatment toolkit features braces, clear aligners, plates, and retainers. A treatment could take anywhere from six months to two years to complete (luckily, you don’t have to spend all this time at the orthodontist’s office). 

You might need to see an orthodontist because of your genetics (not all of us can be blessed with straight teeth), as a result of oral habits (like sucking your thumb as a kid or biting your lip), or due to other dental problems. If you’re planning to get veneers, dental implants, or crowns, seeing an orthodontist to straighten your teeth might be the first step. 

While orthodontic work can be a commitment for you and your wallet, it can also: 

• help you feel more confident about your appearance
• make it easier to care for your teeth – since they won’t be crowding over one another – reducing your risk of tooth decay and gum problems
• be part of an overall treatment plan for jaw problems or obstructive sleep apnoea 

How much do orthodontic procedures cost? 

There’s no sugar coating it (and you probably shouldn’t mention sugar around your orthodontist) – orthodontics can be expensive. The table below gives you an idea of what you might be spending on different treatments, assuming that they’re to straighten your teeth and align your jaw and that they take 15–18 months to complete. 

Source: Orthodontics Australia – Does Health Insurance Cover Orthodontics in Australia? 

The length of your treatment, the type of treatment, and the materials used can all change the final price. After all, your treatment will be customised to suit your needs. If you’ve only got a few teeth that need to be brought in line, your treatment will likely cost less than someone who has lots of crooked teeth and an underbite to sort out. 

Even so, these prices can seem expensive. To put it into perspective, it’s important to remember exactly what goes into your total amount. This can include: 

• pre-treatment assessments
• x-rays, imaging, and custom moulds
• the orthodontic appliances (e.g. braces) themselves
• regular consultations with your orthodontist to monitor and adjust treatment
• post-treatment retainers to keep everything in position once your treatment is finished 

Does Medicare cover orthodontics?

Unfortunately, if you were counting on Medicare to cover some of the costs of your orthodontics, you’re likely to be out of luck.  

Medicare only covers some orthodontics-related services if you meet particular criteria, like having a cleft or craniofacial condition. 

Could my health insurance help pay for orthodontics?

Medicare may not be able to help, but your health insurance could help pay for some of your orthodontics. Ultimately, it depends on your policy. This includes how much they pay – it could range from a few hundred dollars to a couple of thousand. You might even find that your benefits increase over time if you stay loyal to a fund. 

If you’re after orthodontic health cover, you’re unlikely to find it on a basic extras cover policy. Chances are, it’ll come under ‘major dental’ or its own orthodontics insurance category. 

Wherever you find it, be aware that it often comes with lifetime limits, alongside those annual limits. Sub-limits could also apply (meaning your orthodontic benefits count towards what you’re allowed to claim for dental work more broadly).  

Also keep in mind that you’ll usually need to serve a 12-month waiting period to access your orthodontic cover.  

Finally, before you start sending in your claims, you might need to give your insurer a heads-up in the form of a written treatment plan. This will need to come from your orthodontist and include things like how long your treatment will be, the total cost, and how you intend to pay for the work. Thankfully, many orthodontists offer payment plans for their services, so you don’t have to worry about paying it all in one go. 

Helpful tip:

As we get older, it’s easy to forget what happened 10 or 20 years ago. However, health insurers’ memories are long. When they talk about lifetime limits, they really do mean a lifetime.  

Even if you’ve claimed with a different insurer, this will count towards your lifetime limit with any insurer you swap to. You might want to keep this in mind as you look for orthodontics cover. 

Andres Gutierrez

General Manager – Health

What else can I use my dental extras for?

Your dental extras can do so much more than just helping pay for braces and retainers.  

Depending on your policy, you could use your dental extras for general dental and major dental procedures. General dental covers things like regular check-ups, cleans, and simple fillings. Major dental, on the other hand, is for complex fillings, crowns, veneers, bridgework, dental implants, and even dentures. Your policy brochure will give you a better idea what you’re covered for, of course. 

All of these treatments can help keep your teeth healthy, while making it easier for you to eat comfortably and without pain. Not to mention that well-cared-for teeth are beautiful teeth, giving you a self-confidence boost.  

General dental, in particular might be worthwhile if you have braces. While your braces do a great job straightening your teeth, they can make it tricky to keep your teeth clean. Using your general dental extras to get a regular professional clean could keep your teeth in top form. Otherwise, if things go really south, you may need to have your braces removed, any decay treated, and then your braces refitted.  

Where can I find and compare health insurance?

If you’ve always dreamed of straighter teeth or you have a hunch your kids might need braces in a few years, iSelect can help. We make it easier for you to compare a range of health insurance policies online – just use our handy comparison tool – as well as over the phone, on 1800 784 772.