Health Insurance for Orthodontics: What You Need to Know

Orthodontic treatments, such as braces, aligners, or retainers, are key to achieving healthy, straight teeth—but they can be expensive. Whether you’re considering treatment for yourself or your child, navigating orthodontic costs can feel overwhelming. Fortunately, the right private health insurance can ease the financial burden and make orthodontic care more accessible.

This guide explains the role of private health insurance in orthodontic care, what’s covered, and how to select the best policy for your needs.

Does Private Health Insurance Cover Orthodontics?

Yes, private health insurance extras can help reduce the cost of orthodontic treatments. However, it’s important to know that:

Orthodontics is considered a premium extras benefit, often only included in mid- to high-tier extras policies. Most policies set annual caps and lifetime limits for orthodontic treatments. Coverage may be percentage-based (e.g., 50–70% of the cost) or capped at a dollar amount (e.g., $800 per year).

What’s Covered:

• Traditional metal braces.

• Clear aligners, like Invisalign (if included in your policy).

• Retainers required after the completion of treatment.

• Partial upfront costs and ongoing fees for adjustments and check-ups.

How Does Extras Cover Manage Orthodontic Costs?

Orthodontic treatments fall under extras cover policies, which offer rebates for treatments not covered by Medicare or hospital insurance. Here’s how it typically works for orthodontics:

Annual Benefits and Lifetime Limits:

Annual Benefit Caps: Insurers set a maximum amount you can claim each year on orthodontics (e.g., $800 per year).

Lifetime Limit: Some policies include lifetime limits for orthodontic claims (e.g., $2,500–$3,000 per person).

If your orthodontic treatment spans multiple years, you’ll often need to claim smaller amounts annually until you reach the lifetime limit.

What Should You Look For in a Health Insurance Policy for Orthodontics?

Choosing the right policy requires careful review of what orthodontic benefits are included. Consider the following factors:

Annual Limits: Look for policies with higher annual caps (e.g., $800 or more) to maximise yearly claims.

Lifetime Limits: A higher lifetime benefit, such as $3,000, allows you to claim more over the course of treatment.

Percentage vs Fixed Benefits: Some insurers reimburse a set dollar amount each year, while others cover a percentage of costs (e.g., 70% of each invoice).

Provider Agreements: Check whether your insurer has agreements with orthodontists for discount rates.

Coverage for Clear Aligners: Not all policies cover treatments like Invisalign—confirm this with your insurer if you’re considering aligners instead of traditional braces.

What types of orthodontic treatments are available and how much do they cost?

The good news is there's a wide range of treatments orthodontists use to help treat issues with misaligned teeth or jaws.

The bad news is they're not cheap and can cost you thousands of dollars in out-of-pocket expenses.

Source: Orthodontics Australia

Some of the most common treatments include*:

Traditional braces: Typically an orthodontist tightens braces every 4-6 weeks and the pressure shifts teeth into the correct position.

Lingual braces: Lingual braces function the same way as traditional braces except they're usually made of gold, which makes them more expensive.

Invisalign: You're usually required to wear Invisalign aligners for around 22 hours a day, and they can be removed to eat, drink and brush your teeth.

Plates: Plates are usually recommended for younger children whose jaws are still growing.

Palate expanders: Palate expanders are used to widen the upper jaw and fix crowding.

How much do braces cost in Australia?

Some orthodontic providers offer limited cosmetic treatments, which focus on enhancing the appearance of your front teeth without doing any work around potential bite issues. These treatments can take around six months in total and might cost between $3,500 and $6,000.

While this approach can give your smile a quick makeover, it doesn’t tackle underlying jaw and bite irregularities. Neglecting these issues could lead to discomfort, complications or even a relapse of the existing problems.

It's important that you speak to a specialist orthodontist before choosing any particular treatment, including clear aligners, so you know whether your preferred option is the right fit, or if the treatment is safe for your long-term oral health.

It’s worth noting that the cost can change quite substantially if additional things like expansion plates, anchorage implants or bite-correcting springs are needed in combination with your braces.

Does health insurance cover orthodontics and braces?

It does, but be aware that orthodontic treatment generally isn't covered under health insurance hospital cover policies. If you're looking for cover for the cost of orthodontic treatment for yourself or your children, you'll usually need to include orthodontics in your extras cover.

Extras cover can be purchased on its own or packaged with hospital cover. In addition to orthodontics, extras cover can include treatments like general dental work, optical, physiotherapy and more. Exactly what's covered and how much you get back depends on the policy and the insurer.

What is an annual benefit limit for orthodontics?

An annual benefit limit is the maximum amount you can claim, per person, for orthodontic treatment in any one year of cover.

Some health insurers set a standard annual benefit limit for the entire policy period, while others accrue an annual benefit limit the longer you are covered by a policy.

Here's an example of what an accrued annual benefit limit could look like, based on a policy with a starting limit of $400, which increases by $200 every year:

• 1st year: $400

• 2nd year: $600

• 3rd year: $800

• 4th year: $1,000

Annual benefit limits that accrue over time are known as 'loyalty limits'.

What is a lifetime limit for orthodontics?

The lifetime limit is the maximum amount you can claim, per person, for orthodontic treatment over your lifetime. For example, a lifetime limit of $2,400 means you can claim up to $2,400.

Lifetime limits usually range from around $1,000 to $2,800, which means there will usually be an out-of-pocket gap payment for orthodontic treatments.

Is there a waiting period for orthodontic treatment with private health insurance?

The standard waiting period for orthodontic treatment is 12 months.

This means you'll need to wait at least 12 months after taking out a health insurance policy with orthodontics cover before you can claim on treatment.

How do you claim on orthodontic treatment?

To make a claim, you'll need to ask your orthodontist for a 'treatment plan'. This plan should outline how long the treatment could take and how you will be paying for the cost of the treatment.

Once you have the treatment plan, you'll need to give it to your health fund to start claiming benefits. There are two ways to pay and claim on treatment:

1. In instalments: Your orthodontist or dentist can process your claim on the spot by swiping your health insurance card using HICAPS (Health Industry Claims and Payments Service). With this method, you only need to pay the out-of-pocket gap amount, if there is one.

2. Upfront: If you pay the full amount upfront, you'll need to give your fund a tax invoice so you can claim back the benefit amount.

What happens if I change health insurance while receiving orthodontic treatment?

If you decide to switch policies while you're in the middle of treatment, some funds may require you to serve the new waiting period (usually 12 months) before you can claim. Not all funds do this -- some will let you continue to claim without serving waiting periods. Where waiting periods will kick in regardless is if you upgrade your existing policy.

For example, if you raise your annual limit from $400 to $500 or you've upgraded from a $2,000 lifetime limit to $2,800 then you'll need to serve your new waiting periods for the higher limits. If you decide to switch policies while you're in the middle of treatment, you'll need to serve the new waiting period (usually 12 months) before you can make a claim.

In most cases, if you've accrued a loyalty limit on your yearly benefit amount, it also won't be carried over to your new policy. This doesn't mean switching is never a good idea: cover options change regularly, and finding a new policy could be more cost-effective in the long run. If you or somebody on your fund is in the middle of treatment, our expert team will try to find a policy that allows you to continue to claim.

Frequently Asked Questions

Does Health Insurance Cover Invisalign Treatments?

Yes, some extras policies cover Invisalign or clear aligners, but not all do. Check the policy details carefully to confirm whether aligners are included and the rebate limits for them.

Do I Need Health Insurance for Child Orthodontics?

Health insurance with orthodontic benefits is especially useful for families with children, as it can offset the significant costs of braces or other treatments while spreading expenses across several years.

What Happens If My Lifetime Limit Runs Out?

Once you reach the orthodontic lifetime limit, you’ll no longer receive rebates for additional treatment costs. However, you can still continue to claim other dental-related benefits under your extras policy (e.g., general check-ups, fillings).

Can I Claim Retainers Through Health Insurance?

Yes, retainers are often included under orthodontic coverage, but they may draw from the same annual and lifetime limits as braces or aligners.

Sources

https://orthodonticsaustralia.org.au/how-much-braces-cost/

https://belmontsmiles.net/blog/the-pros-and-cons-of-ceramic-braces/

https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=75001&qt=ItemID

https://www.pbs.gov.au/info/healthpro/explanatory-notes/front/fee

https://www.health.vic.gov.au/dental-health/access-to-victorias-public-dental-care-services

Australian Dental Association

Private Health Insurance Ombudsman

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Chris Stanley is the sales & operations manager of health insurance at Compare Club. With extensive experience and expertise, Chris is a trusted leader known for his deep understanding of health insurance markets, policies, and coverage options. As the sales & operations manager of health insurance, Chris leads a team of dedicated professionals committed to helping individuals and families make informed decisions about their health insurance needs.

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  Family health cover means your children are covered under the same policy as you.

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