Orthodontic work is more than just cosmetic — misalignment of your teeth can affect your ability to chew and speak, cause chronic jaw pain, and lead to the wearing down of your teeth over time. They can also make it hard to clean your teeth, which can contribute to gum disease over time.¹

You may think of braces as a middle-school rite of passage, but orthodontic work spans all ages. As of 2020, one in three orthodontic patients is an adult.¹

If you, your child, or someone else in your family in considering getting braces, you may be wondering how much it might cost. How much you’ll pay will vary significantly depending on how complex the case is, where you live, and the type of braces you choose

Luckily, if you have dental insurance, some plans will help pay for the cost of orthodontic treatment like braces.

Introduction to orthodontics

The goal of orthodontics is to correct malocclusion, or the misalignment of teeth and/or jaws.

Malocclusion can cause both aesthetic and functional issues, including:

• Difficulty chewing and eating
• Accidental biting of the tongue and cheek 
• Imbalance of the facial features
• Issues with speech and enunciation²
• Crooked teeth that are more difficult to brush and floss effectively, which can contribute to tooth decay and gum disease³
• Jaw pain
• The wearing down of enamel and teeth over time
• Mouth breathing⁴

Though every set of teeth and jaw is unique, there is an ideal arrangement for your teeth and jaw that prevents these problems. Orthodontic treatment can help bring you closer to this ideal arrangement. 

The American Board of Orthodontics recommends that children have their first visit with an orthodontist no later than age 7.⁵ By that age, kids will have some of their permanent teeth, and the orthodontist can get a clear idea of existing or potential issues before they get worse.⁶

A straighter and more functional smile has benefits beyond dental health. Research has found that malocclusion can lower children’s self-esteem, make them targets for teasing, and isolate them from their peers socially.⁷ Correcting these issues can help kids feel more confident.

These positive psychological impacts can happen for adults, as well. One study found that people who underwent orthodontic treatment reported reduced anxiety, a positive change in their self-esteem, and overall improved quality of life.⁸

Your dental insurance coverage, whether you purchased your own plan or have one through your employer, may help you pay for orthodontic care.

Understanding your dental insurance coverage

Getting to know the details of your dental plan will ensure you get the most out of your benefits.

Common types of dental insurance plan include: 

• Dental PPO: A plan where you can choose your dentist, but you may pay more for out-of-network care
• Dental HMO: A plan which only covers care by dentists in a particular network
• Dental indemnity plan: A plan where the insurance company pays a percentage per procedure, and you pay the rest⁹
• Dental savings plan: A non-insurance plan where you pay qualifying dentists a discounted fee directly¹⁰

Many dental insurance plans cover preventive care in full — a cleaning or two, an exam, and a set of X-rays per year, for example. Dental care beyond that, like fillings, extractions, and root canals, is typically covered via cost-sharing like coinsurance, where you cover, say, 20% of the cost and the insurance company pays 80%.¹¹

Orthodontics is a bit of a different category. 

• Many dental plans don’t cover it at all, and many of the ones that do, only cover it for children under the age of 18.
• If your plan does cover orthodontic care, it may be subject to a waiting period, often six months or a year, before coverage kicks in.
• There is often a lifetime maximum the insurance company will pay for an individual person’s care.

Orthodontic treatment options

Some people are lucky enough to be born with an ideal tooth and jaw alignment. But for the rest of us, there are a variety of braces options that can help straighten crooked teeth, create space or reduce space as needed, and align your bite.

• Traditional metal braces are likely what you think of when you hear the word “braces.” The orthodontist will mount metal brackets to your teeth, and metal wires and bands will shift the teeth into place.¹¹
• Ceramic braces, also known as clear braces, work similarly to metal braces, but the brackets are made of tooth-colored ceramic or porcelain, so they’re less noticeable on the teeth. However, they’re also more fragile.
• Lingual braces use traditional metal brackets, but they’re mounted on the back of the teeth.¹²
• Clear aligners straighten teeth and correct issues with a series of nearly invisible trays you swap out every few weeks.

The right option for you will depend on several factors:

• The complexity of your case: If you’re dealing with mild crookedness, it’s likely that any of the above options will work for you. But if you have more significant problems, which your orthodontist can tell you, you may need to stick with traditional braces.¹⁶
• Your budget: Traditional metal braces are the most affordable, and lingual braces are the most expensive.
• Your insurance coverage: Your dental plan may specify the types of braces your orthodontic benefit, if you have it, covers.
• Your aesthetic preferences: If you feel strongly that you don’t want people to know you have braces, you may opt for one of the less visible (but more expensive) options.
• Your lifestyle: Once your orthodontist mounts your traditional braces, you just have to keep up with your adjustment appointments every four to 12 weeks and continue brushing and flossing.¹² Clear aligners require a bit more daily commitment, however — you have to wear them at least 22 hours a day, and you have to remove them to eat and drink and brush your teeth before replacing them each time.¹³

Orthodontic treatment for patients with special needs

Patients with intellectual disabilities, developmental disabilities, and sensory issues may need special accommodations for orthodontic care. Ask your orthodontist if they have experience working with patients with similar needs to yours or your child’s.

Understanding the cost of orthodontic treatment

How much your orthodontic care will cost will depend on the age of the patient, the complexity of the case, your insurance coverage (if applicable) and the type of corrective devices chosen. Treatment during childhood can save money in the long run, since an orthodontist can detect existing or future issues early, which can prevent the need for more extensive correction in the future.⁷

Some ways to help with the costs are:

• Payment plans: Many offices will allow you to make a down payment and pay off the remaining cost of treatment over time, often with zero interest.¹⁴
• Special discounts: Ask your orthodontist whether you can save money by paying upfront, being referred by a current patient, or by having multiple family members being treated simultaneously.¹⁵
• Health savings accounts (HSAs) and flexible spending accounts (FSAs): If you have an HSA or FSA, you can use the pre-tax money in these accounts to pay for orthodontic care.¹⁷
• Visit a dental school: Many dental schools have clinics where student dentists — under the observation of licensed faculty — assist with orthodontic care. You help the orthodontists of tomorrow learn, and in return you receive care at a discounted price.¹⁶

If your dental plan covers orthodontics, here’s a look at what the process may be like:

• Ask your orthodontist to submit a preauthorization to your insurance company before beginning your orthodontic treatment. This lays out a plan for your care for the insurance company’s approval so you don’t get a surprise denial down the line (though this still sometimes can happen!).¹⁷
• Once your deductible is met, you’ll then split the negotiated cost of the braces with your insurance company, based on the terms of your policy. 
• The policy likely has a lifetime maximum per person, often between $1,000 and $2,000 dollars. Once the insurance company’s portion of the cost reaches that maximum, they won’t pay anything else toward that person’s orthodontic care.

Maintaining oral hygiene with braces

If you have traditional braces, ceramic braces, or lingual braces, the brackets and wires can make it easier for bits of food to get stuck in your teeth, which can contribute to staining, tooth decay, and periodontal disease over time.⁴

• Brush your teeth after every meal — or at least twice per day — with a fluoridated toothpaste.
• Use a floss threader, a tool which can help you maneuver floss behind the wires and around the brackets, to clean between your teeth.
• You can also use an interproximal or proxy brush, which is a small, soft-bristled brush, to clean around your brackets and behind the wire.

If you opt for clear aligners, you’ll follow a slightly different protocol:

• If you’re eating or drinking anything besides water, remove your aligners first, then brush your teeth before replacing them.
• Remove your aligners to brush and floss each morning and night.
• To clean your aligners, you can clean them with toothpaste, mouthwash, or a denture cleaning solution.

Regardless of the type of orthodontic device you choose, keeping your teeth and gums clean should be a top priority.

In addition to upping your oral hygiene game, you’ll want to avoid damage to your braces. That means:

• Avoiding hard foods, like certain candies and nuts
• Avoiding sticky foods, like caramel and dried fruit
• Wearing a mouth guard when playing sports or doing other activities that could result in a hit to your mouth

Eating these types of foods or sustaining a mouth injury could result in a broken bracket or wire, which is an orthodontic emergency. If this happens to you or your child, contact your orthodontist right away. Keep some dental wax on hand to prevent broken pieces from hurting your lips or gums and use tweezers to bend broken wires if they’re poking the inside of your mouth.¹⁸

Post-treatment care and retention

Once your orthodontist is satisfied with the alignment of your teeth and jaws, they will remove your braces (and reveal your new smile!). But since there will no longer be anything holding your teeth in place, and there can easily be tooth movement.¹⁹

To keep that from happening, your orthodontist will give you a retainer, which is a removable orthodontic device that is custom-made to fit your mouth. You’ll typically be advised to wear the retainer as much as possible for the first four to six months, when your teeth can shift most easily. After that, you’ll typically need to wear the retainer at night indefinitely.²¹

There are two types of removable retainers: Hawley retainers, which are made of molded plastic that fits in the middle of your mouth with metal wire to keep your teeth in place, and clear retainers, which fit precisely over your teeth. There are also fixed retainers, which are permanently bonded to the backs of your teeth. Your orthodontist will advise which is the best type of retainer for your situation.²⁰

To ensure your new smile is permanent, wear your retainer consistently and be diligent about your oral hygiene — failing to brush and floss consistently can lead to periodontal disease, which can cause gum recession and bone loss, which in turn can lead to tooth shifting and loss.²¹

Choosing the right orthodontist

Orthdontists are specialists who have completed four years of dental school, plus two or more additional years of an accredited program so they can specialize in orthodontics.²²

To find an orthodontist, you can ask for referrals from your dentist, check your insurance company’s website, ask friends and family for recommendations, or check the American Association of Orthodontists or the American Board of Orthodontics (ABO).

Many orthodontists offer a free consultation appointment where you can discuss your care needs. You can make a few appointments with different orthodontists to get a feel for their care styles and compare prices.

During this appointment, you can expect the following:

• You’ll fill out paperwork about your dental/health history and your insurance information.
• The orthodontist will do an initial visual exam of your teeth and jaws, plus X-rays, digital scans of your teeth, and other photos.
• You’ll discuss a potential treatment plan, including complexity, timeline, and cost.²³

Here are some questions to ask the orthodontist so you can make informed choices about your care:

• How long have you been practicing orthodontics?
• Are you board certified by the ABO, or do you belong to the American Association of Orthodontists?
• What types of braces and aligners do you offer, and what might you recommend for my situation?
• What insurances do you accept, and do you offer discounts or a payment plan?
• What is the timeframe and cost for treatments like mine?
• What will happen if the treatment time exceeds the original estimate?
• How many appointments will I need throughout the process?

Insurance and orthodontic coverage

To figure out whether your dental insurance covers orthodontic work, you’ll need to consult your plan documents. You’ll typically be able to find these in your benefits portal online, under “Orthodontic Benefits,” or something similar. Things to note when reviewing your coverage:

• Whether your plan covers orthodontic care for all insured people or only for children
• The lifetime maximum the plan will pay for orthodontic care per person
• The coinsurance percentage that explains what you’ll pay and what the plan will pay after you reach the deductible
• Whether there’s a waiting period before you can use orthodontic benefits (some plans require that the coverage be in effect for a certain amount of time before it will pay for orthodontic care)
• Whether the plan covers in-network orthodontists only
• Whether your orthodontist needs to submit a preauthorization to the insurance company before starting care

Insurance plans tend to be strict about limitations on care and other exclusions. Make sure you understand lifetime maximums — they truly are lifelong, so if you have a different plan with the same insurer years from now, you won’t be able to get coverage for orthodontic care. 

Some plans may only cover traditional metal braces, deeming ceramic braces and clear aligners cosmetic and therefore not eligible for reimbursement. 

Many dental plans have a waiting period before orthodontic care is covered, so you can’t just purchase a plan to get braces or start clear aligners. If you’ve already started orthodontic treatment, a new plan may not cover any of the remaining costs for the care. 

Should you get braces?

Getting braces has been found to have a positive impact on physical, mental, emotional, and social health for people of all ages.²⁴

Physical health benefits include:

• Better biting and chewing functionality
• Lowered risk of tooth decay, gum disease, cavities, periodontitis
• Avoidance of more involved orthodontic and dental work in the future

Social and emotional benefits include:

• A more balanced facial structure
• Increased comfort with speaking and other social interactions
• Increased confidence, self-esteem, and mental wellbeing for kids and adults
• A reduction in teasing/bullying for kids and teens

If you think getting braces may be the right choice for you or a loved one, familiarize yourself with your dental plan to ensure that you’re making the most of your orthodontic benefits. 

Visiting your dental insurer’s membership site, like MyBenefits for those with Metlife coverage, can help you understand your benefits so you can see if there are ways to decrease your out-of-pocket costs and reduce the chance of denied claims or surprise bills, and choose the right orthodontic treatment plan for your situation. If you’re a MetLife dental insurance member, you can also find an in-network provider by searching for “orthodonist” under “specialty.”