If you’re looking into braces for your child, one of the first questions that comes up is: Will insurance help cover the cost? In Washington, the answer depends on the type of insurance you have and whether it’s medical, dental, or state-funded like Medicaid.
The truth is, most families aren’t sure where orthodontic treatment falls, and the line between medical and dental coverage can feel blurry. This guide is here to clear things up. We’ll walk you through:
- When medical insurance may apply to braces
- What dental insurance typically covers
- Whether Medicaid can help
- And what to do if your coverage doesn’t go far enough
Does Dental Insurance Cover Braces in WA?
Yes, dental insurance is the most common way to get coverage for braces—especially for children. But the amount of help you’ll get depends entirely on your plan. Most PPO dental plans include some level of orthodontic benefits, but there are a few key things to check:
What Dental Insurance Typically Covers:
- Age restrictions: Many plans only cover braces for patients under 18
- Percentage coverage: Some plans cover 50% of the cost after deductibles
- Lifetime maximums: There’s usually a fixed orthodontic benefit (e.g. $1,500–$2,500 per person)
- Waiting periods: Some plans require you to wait 6–12 months before using ortho benefits
For example, if your plan offers a $2,000 lifetime ortho benefit and your child’s treatment is $6,000, insurance might pay $2,000—and the rest would be out-of-pocket.
Washington Orthodontics is in-network with Delta Dental, which offers orthodontic coverage on many of its PPO plans. We accept most PPO plans out-of-network and can still help you maximize your benefits.
Our team verifies insurance benefits for you and files claims in-house, so you don’t have to handle the paperwork.
If you’re wondering, “Does insurance cover braces for kids?” or “Do I need separate orthodontic insurance?”—the answer usually comes down to the details in your dental plan.
Can Medical Insurance Cover Braces?
In most cases, no—medical insurance doesn’t cover braces. Orthodontic treatment is typically considered a dental service, not a medical one. That means your medical plan likely won’t pay for the cost of braces, even if they’re recommended by a dentist. However, there are rare exceptions.
When Medical Insurance Might Cover Braces:
Medical insurance may step in only if braces are medically necessary due to:
- Severe jaw or bite misalignment that affects speech or eating
- Facial trauma or injury requiring surgical orthodontics
- Congenital conditions like cleft palate
In these cases, your doctor or orthodontist would need to provide supporting documentation, and pre-approval is often required. Even then, full coverage is uncommon—many plans still only cover a portion of the treatment.
If you’re asking:
“Are braces covered by medical?”
“Will medical pay for braces?”
“Does medical cover orthodontics for adults or kids?”
The short answer is: only in special cases. For most families, dental insurance or private payment options will be the main route.
Does Medicaid Cover Braces in Washington?
Medicaid only covers braces in Washington when they’re considered medically necessary—and even then, it’s limited to children. If your child is on Medicaid (also known as Apple Health in Washington), they must meet strict criteria to qualify for orthodontic coverage. This means:
- Severe bite issues affecting chewing or speaking
- Facial or jaw deformities
- Referral from a dentist or orthodontist with documentation
Even if braces are recommended, Medicaid won’t cover them unless those medical necessity standards are met—and approval is never guaranteed.
Important Note: At Washington Orthodontics, we do not accept Medicaid or state insurance for orthodontic treatment. If you’re exploring care through Medicaid, we recommend contacting a provider who specifically partners with Apple Health or DSHS programs.
What If Insurance Doesn’t Cover Everything?
If your insurance doesn’t cover the full cost of braces—or doesn’t cover them at all—you still have options. At Washington Orthodontics, we believe finances shouldn’t stand in the way of a healthy, confident smile.
That’s why we offer flexible payment plans designed to make treatment more affordable for every family. Here’s how we help:
- Interest-free in-house payment plans
- Custom financing options tailored to your budget
- Transparent cost breakdowns before you commit
- Free consultations to walk you through your insurance benefits and out-of-pocket estimate
Whether you’re using dental insurance, going out-of-network, or covering treatment privately, we’ll work with you to find a solution that fits.
How Washington Orthodontics Helps
We know insurance can be confusing and orthodontic coverage is often one of the trickiest parts. That’s why we’re here to guide you through it. Here’s what you can expect from us:
- In-network with Delta Dental: We’re fully in-network with Delta Dental PPO, one of the most widely used dental insurance providers in Washington.
- We accept most PPO plans: Even if we’re out-of-network, we can still work with your plan to help you maximize benefits.
- We verify your insurance for you: No guessing. We’ll contact your provider, break down your coverage, and explain your out-of-pocket estimate before treatment begins.
- We handle claims in-house: You won’t have to file paperwork or wait on the phone—we take care of the insurance process for you.
- We offer flexible payment options: Whether insurance covers part or none of your treatment, we have financing solutions to make braces more manageable for your family.
We’re here to make the process clear, affordable, and stress-free—so you can focus on your child’s smile, not the paperwork. Book your free consultation today!
