Does insurance cover braces?

The short answer

Many dental PPO plans include an orthodontic benefit, but it works differently from cleanings and fillings. It's usually a lifetime maximum per person, often somewhere between $1,000 and $2,500, and it often only applies to patients under 19. Some plans cover adults. Some plans have no ortho benefit at all. The only way to know is to check your specific plan, which we do for you.

How orthodontic benefits usually work

• Lifetime max, not annual. If your plan says "$1,500 orthodontic benefit," that's the total it will ever pay for that person's braces, usually paid out over the course of treatment.
• Percentage coverage. Many plans pay 50% of the treatment fee, up to the lifetime max.
• Age limits. Kid-only coverage (under 19) is common. Adult ortho coverage exists but is less common.
• Waiting periods. Some plans require you to be enrolled 6 to 12 months before ortho benefits kick in.
• In-network vs. out-of-network. We accept most PPO plans. We'll tell you exactly how your plan pays with us.

What insurance usually doesn't cover

• Anything above the lifetime maximum (that's where financing comes in)
• Treatment the plan considers cosmetic, on some adult plans
• Retainer replacements after treatment, on many plans
• Texas Medicaid does not cover orthodontic treatment. Here's what to do instead.

Does insurance cover Invisalign?

If your plan has an orthodontic benefit, it almost always applies to Invisalign the same way it applies to braces. Same lifetime max, same age rules. Invisalign cost details.

How it works at Smile 4 Less

1. Bring your insurance card (or a photo, or just the plan name) to your free consultation.
2. We verify your orthodontic benefit while you're here.
3. Your written quote shows the total, what insurance pays, and your monthly payment on what's left.
4. We bill your insurance directly over the course of treatment. You never chase a reimbursement.

No insurance? No ortho benefit? That's most of our patients. Our interest-free in-house financing starts as low as $99 a month. Military and law enforcement families get 10% off. See financing.

HSA and FSA

Braces and Invisalign are qualified medical expenses. You can use a health savings account or flexible spending account toward your down payment or monthly payments, and it's a great way to use an FSA balance before it expires.

Common plans we see in El Paso

Families in El Paso most often bring PPO plans from employers, school districts, the City and County, and military dental programs (TRICARE Dental Program / United Concordia for family members). Bring whatever you have and we'll check it.