What is orthodontics cover?
Health insurance with orthodontics covers treatments and services for teeth straightening, overbite and underbite corrections and jaw alignment, such as braces, plates, retainers and clear aligners (i.e. Invisalign).
Orthodontic treatment and services are generally covered as part of the extras component of health insurance. This means that you can have cover for braces and orthodontics with either an extras-only policy or a combined hospital and extras policy. It’s important to understand, though, that some extras insurance policies categorise orthodontics separately from other dental categories (i.e. general and major dental), meaning it may have its own separate rules and waiting periods.
How does health insurance with orthodontics cover work?
Orthodontic cover allows you to claim a benefit for specific orthodontic treatment or services, such as braces or Invisalign. The benefit amount you can claim could be a set dollar amount or a percentage of the total cost, up to certain annual and lifetime limits, depending on your policy and provider. Lifetime limits refer to the maximum amount you can claim for orthodontic treatment over your entire life, which applies on a per person basis. Due to the high costs of these treatments, you typically cannot claim 100% of the cost, meaning you'll likely have to pay out-of-pocket no matter what.
Before you can claim any benefit, you'll usually have to serve a waiting period (often 12 months or more). Depending on your provider, your benefits may accrue over time, up to a maximum policy limit. For example, you may start with a $200 annual limit, which increases by $200 each subsequent year until it reaches a maximum of $1,200.
How much would orthodontics cost without health insurance?
The overall cost for orthodontics will depend on a variety of factors, including your chosen orthodontic practice, the duration of treatment, the type of braces you choose and your individual needs. At the time of writing, Orthodontics Australia says this is what you can expect to pay for each type of braces:
- Metal braces: $7,000 - $9,000
- Ceramic braces: $7,500 - $10,000
- Lingual braces: $10,000 - $12,000
- Clear aligners: $8,000 - $10,000
Is there a waiting period for orthodontic cover?
Most health insurance policies generally have a waiting period for orthodontics that you will have to serve before you’re able to make a claim. Based on standalone extras only health insurance policies on Canstar’s Database, the waiting period for orthodontics cover can range from 12 months to 24 months.
But, if you can’t wait, there are specific scenarios where it could be possible to have your waiting period waived, such as:
- Changing to a different policy with a similar or lower level of cover, where you've already served relevant waiting periods with your current provider and
- Special offers to waive waiting periods—although this is rare for orthodontics.
What’s the best health insurance with orthodontics cover?
The best health insurance for orthodontics cover for you will depend on your situation and circumstances. Factors to consider when comparing orthodontics cover include:
- Benefit: You generally can’t claim for the total cost of an orthodontic treatment or service. Instead, you'll be covered for the outlined benefit amount in the policy, which can either be a stated dollar amount or a percentage of the total cost. You can find the exact benefit amount you’re able to claim in the policy’s Private Health Information Statement (PHIS) and terms and conditions.
- Costs: This will vary depending on a variety of factors, but keep in mind that cheapest is not always better. It’s worth thoroughly comparing different policies and reading through the PHIS and terms carefully before committing to a policy.
- Waiting period: Most extras health insurance policies have a waiting period you must serve before you’re able to make a claim. The period for each type of medical service will vary depending on the fund and policy so it’s worth taking this into account, particularly if you require orthodontics or braces cover relatively soon.
- Lifetime and annual limit: Most policies will have an annual limit on how much you can claim each policy year. But orthodontics, in particular, tend to also have a lifetime limit, which limits the total amount you can claim over your lifetime across all insurers.
- Other services and treatments: It’s also worth considering and factoring in what other general health services you might want to include in your policy, such as general dental, optical or physiotherapy.
How to find the right health insurance for orthodontic cover
When comparing health insurance for orthodontics, look closely at annual and lifetime limits, benefit percentages, and waiting periods. Some policies include orthodontics under major dental, while others list it separately with its own rules and caps. To find the right policy for your needs, consider:
- The lifetime limit for orthodontics (some limits don’t reset each year)
- The percentage of treatment costs covered
- Waiting periods before you can claim
- Whether your chosen orthodontist has an agreement with your insurance provider.
Comparing these details side by side can help you find cover that balances value with flexibility.
Why orthodontic cover is worth considering
Orthodontic treatment can be a major investment, with braces or aligners often costing several thousand dollars. Having orthodontic cover as part of your extras policy can help offset these costs and make treatment more affordable.
It may also make budgeting easier for families with children likely to need braces, or for adults considering options like Invisalign. Beyond the cost savings, insurance can provide peace of mind that you’re covered for complex or long-term dental needs.
