Health insurance for braces – is it worth it?

There’s no two ways about it – braces are expensive. If you, or your child, might need braces in the near future, you might be wondering whether taking out health insurance for braces is worthwhile. Here, we crunch the numbers. 

Are braces covered by health insurance? 

Yes, braces are covered by health insurance – but only on high-level Extras Cover policies. Braces fall under the Orthodontic treatment section of Extras Cover, which typically covers not only the cost of fitting and adjusting the braces but also for removing them, and the fitting of the retainer that needs to be worn at night after the braces are removed.  

There are conditions for claiming braces on health insurance. Here’s what you need to consider:  

• Waiting periods: orthodontic treatments usually have a 12-month waiting period before you can claim.  

• Policy limits: your policy will only cover a certain percentage of the orthodontic cost, or up to a money limit. On a Couples, Family or Single Parent policy, there will probably also be limits per person. 

• Gaps: some policies will only pay a certain amount of your orthodontist’s bills, leaving you with a Gap to pay. For example, your policy might pay 50% of each bill, leaving you with the remaining 50% (a Gap) to pay. After you’ve reached your annual limit, you’ll pay the entire orthodontist bill yourself until the limits reset the following year. While you won’t have a Gap on policies that pay 100% of orthodontic charges, there will always be an annual limit – after you’ve reached that, you’ll need to pay the rest of the bill until the following year, when your limits reset.  

How much does health insurance for braces cost? 

We used the healthslips.com.au Calculator to compare the cost of Extras Cover that included braces for a single parent and their children in Victoria. The cheapest policy was $75.49 a month, which pays $600 towards braces per person, up to a lifetime limit of $1,800 per person. The most expensive policy was $391.85 a month, which covered $2,800 of braces costs across the lifetime of the policy, but with a limit of $1,400 per person.  

How much does health insurance for dental treatments cost?

Is health insurance worth it for braces cover? 

The short answer is no. Braces are expensive, and no health insurance policy will cover your orthodontic costs in total. The cost of braces depends on how complex your child’s teeth and jaw problems are, and how long they’ll need to wear braces. As a rough guide, Orthodontics Australia says metal braces cost between $7,000 and $9,000, while clear aligners (such as Invisalign) cost between $8,000 and $10,000. Even with high-level Extras Cover, you will have to pay a substantial amount of the cost of the braces yourself – and remember, the most expensive policy only covers $1,400 towards braces per person.  

So how much will you have to pay for braces if you have health insurance? 

Let’s say you’re quoted a total of $9,000 for braces for your child. Payments are often invoiced as monthly instalments, sometimes via direct debit. Using the cheapest policy from the example above, you will have spent at least $905.88 on cover across 12 months before you can claim (to serve out the waiting period). You’ll then need to retain cover for the duration of your child’s treatment, which is generally at least 18 months. That means you’ll spend a total of $2,264.70 for cover over 30 months that will pay out $1,400 for your braces, and you’ll still face the balance of $7,600 from the orthodontist across the braces treatment period.  

The take-away message: health insurance isn’t worthwhile for braces alone, but if you are claiming other costs that exceed the amount you’ve spent on premiums (e.g. your dental, physiotherapy and optometry costs), your policy may work out well financially overall.  

healthslips.com.au does not provide general or personal advice on any of the policies available. Make sure you take your personal circumstances into account before making a decision, and talk to an expert for financial advice. 

How do I find the best policy for braces? 

To get the best Extras Cover for braces use the healthslips.com.au Calculator. Because we compare every single health insurance policy in Australia, you can be sure you’re not missing out on the best deal for you. And since we don’t have any commercial bias, you can trust our results – and thankfully, you don’t have to sign up to get the information you need to make an informed decision. Try our Calculator and search for a new Extras Cover policy, or compare your current policy against other policies available.  

Trudie McConnochie

Writer and Researcher

Knowledge is power – that’s the guiding principle behind everything Trudie writes, and it’s a philosophy she brings to her work at healthslips.com.au. By breaking down complex information into easy-to-understand blogs and stories, she aims to empower Australians to make the best choices and an informed decision around private health insurance.

Trudie understands firsthand some of the complexity of private health insurance having moved to Australia from New Zealand and having to navigate a vastly different public healthcare system and health insurance structure.

Trudie holds a Bachelor of Communication Studies (journalism major) from the Auckland University of Technology.

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