Does Medicare Cover Orthodontics?

Australia’s national healthcare system covers quite a bit, everything from office visits to some tests, scans, medicines, mental health treatments, and a range of medical procedures. But unfortunately, that wide scope of coverage doesn’t include most dental or orthodontic treatments. So if you rely on Medicare as your sole health insurance, you’ll have to pay out of pocket for braces or clear aligners.

The only exception is if you have an underlying, previously diagnosed cleft or craniofacial condition. If that condition contributes to your dental or jaw misalignment, Medicare may cover a portion of your orthodontic treatment. To know for sure, ask your dentist or orthodontist if a particular treatment would fall under the Medicare Benefits Schedule.

Does Dental Insurance Cover Orthodontics?

If you have a private health fund on top of Medicare, you might get some coverage for braces or clear aligners. It depends entirely on the specific fund. One that has extras cover may help pay for dentistry and orthodontics.

Just know that teeth-straightening treatments don’t always fall under dentistry. Rather, dentistry typically means routine cleanings and minor procedures like fillings. That said, some plans have separate coverage for orthodontics as well. The only way to know for sure is to check with your insurance provider.

If your health fund covers braces and clear aligners, great! Just know that the amount covered varies based on the fund. Some might cover the full amount, while others might cover half, or less. Additionally, plans often have annual and lifetime limits on orthodontic coverage, and once you hit either one, you’ll need to pay for everything else out of pocket.

If you’re reading this and thinking, “I better go enroll in a health fund before I start treatment next month,” slow down a bit. Many funds have a waiting period of 12 months before you can access their orthodontic benefits, so you can’t enroll and start getting coverage right away.

How to Access Dental Insurance Coverage

This can vary based on the insurance provider. For some, you’ll need to pay up front—or in installments—then file a claim for reimbursement. Others allow you to present your membership card at checkout to automatically apply funds from your account. Either way, you’ll typically need to send the provider some information, including:

• Your Treatment Plan: Your dentist or orthodontist will provide a plan or timeline for your clear aligners or braces treatment.
• Itemized Receipts: These should include the prices and dates for each treatment you want to submit for coverage.
• Treatment Code: The unique insurance orthodontic code related to your treatment.
• Provider number: Your treating dentist will have their own unique provider number.
• ID Info: The health fund will likely need to confirm your membership using your ID number, the cover you’ve chosen, your date of birth, and more.

Check with your health fund provider to know which documents/information they need, and when they need it.

How Much Do Braces and Clear Aligners Cost?

What often makes a health fund worth it is the total cost of orthodontic treatment, because it can be pricey. Traditional metal braces might cost $6,000–$12,000, while clear braces can cost $6,500–$12,500 and lingual (behind the teeth) braces might run $9,500–$15,000.

Invisalign can also cost up to $12,000 too, but some dentists will offer cheaper treatments for simpler, easier misalignments—sometimes around $3,000–$5,000. Of course, it depends primarily on the complexity of your misalignment. However, your dentist’s rates, your location, and a variety of other factors can also contribute.

However, Invisalign isn’t the only brand of clear aligners out there, and others might offer more appealing prices. For example, Linea offers in-person care and full clear aligner treatment for flat rates of $2,698 for mild cases, $3,698 for moderate cases, and $4,998 for severe ones. Plus, because they’re administered in person, they can receive coverage from health funds just like Invisalign.

Other Ways to Manage Orthodontic Costs

Health funds are probably the most popular way to make braces or clear aligner costs more manageable, but they’re not the only way. Here are a few other reliable options.

1. Consider Payment Plans: Some dentist’s offices offer financing that can break the total cost into bite-sized monthly payments. Some of these plans have interest, so you might end up paying more in the long run, but others are interest-free.
2. Shop Around: Each dentist and orthodontist sets their own rates, based on their fees, location, and overhead costs. Get quotes from a few local options to find the best one for your budget.
3. Look at Government-Sponsored Savings: Programs like Give a Smile provide free or discounted orthodontic treatment to lower-income families. However, you have to meet certain eligibility requirements to qualify.
4. Consider Linea: As we mentioned, Linea has flat-rate prices that often beat Invisalign and braces. With similar hands-on care, regular oversight, and quality clear aligners as Invisalign, they’re a safe and versatile option for many adults seeking straighter teeth. To get started, complete their smile quiz and their customer care team will find a provider near you.