The short answer first
- Are braces under Medicare? In most cases, no. Medicare does not cover routine orthodontic treatment such as braces or clear aligners. Limited exceptions apply for hospital-based procedures or complex medical conditions.
- Does private health insurance help pay for braces? Often yes. Many Extras policies include orthodontic benefits, usually with lifetime limits, annual limits, and waiting periods.
How Medicare works with orthodontics
Medicare is designed to support essential medical care. Routine dental and orthodontic treatments sit outside standard Medicare cover. Rare situations where Medicare contributes include:
- Treatment as an inpatient in a public hospital for complex craniofacial conditions.
- Orthodontics bundled with medically necessary jaw surgery.
For typical braces or aligner therapy, even when recommended by a Specialist Orthodontist, Medicare rebates do not apply. Plan as if there is no Medicare contribution.
How private health insurance can help
Extras cover can reduce out-of-pocket costs for braces and aligners. Common features include:
- Waiting periods: Often 12 months before orthodontic benefits start.
- Lifetime limit: A total amount you can claim for orthodontics with your fund. Once used, no further benefits apply.
- Annual sub-limit: A maximum paid each year, contributing toward your lifetime cap.
- Percentage benefit: Some funds pay a portion of each invoice up to the limit.
Most policies apply to both braces and clear aligners like Invisalign®, provided orthodontics is listed as an included category. Always confirm with your fund before starting.
What to check in your policy
When reviewing your cover, ask:
- Do I have orthodontic cover?
- What is the waiting period for orthodontics?
- What are my lifetime and annual limits?
- What percentage of the fee is paid?
- Do benefits apply to both braces and aligners?
- When do my benefits reset - calendar or financial year?
- Are there per-item or per-visit caps?
Request written confirmation from your fund for clarity.
Using item numbers and quotes
Your Specialist Orthodontist will provide a treatment plan with item numbers. Share these with your insurer for an accurate rebate quote. At Modern Orthodontics, we prepare detailed documentation and liaise with health funds to help you avoid surprises.
How to maximise your orthodontic rebates
- Start early with waiting periods: Upgrade Extras cover before treatment begins.
- Time payments carefully: Spread payments across benefit years to increase total rebates.
- Coordinate family cover: Family policies may offer higher combined limits.
- Avoid downgrades during treatment: Downgrading cover can reduce entitlements.
- Claim promptly: Keep records current and track benefits.
- Keep receipts and item numbers: Essential if you switch funds later.
Planning the cost of braces or aligners
Orthodontic fees depend on case complexity and appliance type. At Modern Orthodontics, you will receive a personalised plan with total fees, estimated duration, and a clear payment schedule. We offer:
- Interest-free monthly payment plans.
- Discounts for upfront payments and multiple family members.
- Written quotes with no hidden fees.
How Modern Orthodontics supports you
From your first visit, we provide:
- Easy-to-understand plans and itemised quotes.
- Guidance on contacting your fund and confirming benefits.
- Flexible appointment times, including evenings and Saturdays at Northcote.
- A full range of treatment options: braces, Invisalign®, and in-house aligners.
Our teams at Northcote and Burwood are here to make your journey clear and stress-free.
Common questions, answered
- Are braces under Medicare? Generally no. Only rare hospital-based exceptions apply.
- Does private health insurance cover braces? Often yes, if orthodontics is included.
- How do I maximise rebates? Serve waiting periods, plan payments across benefit years, and confirm entitlements with item numbers.
Next steps
- Book a consultation for a personalised treatment plan and itemised quote.
- Check your Extras policy or call your fund with the item numbers provided.
- Plan your treatment start date around waiting periods and benefit resets.
Why choose Modern Orthodontics
At our Northcote and Burwood clinics, you will be cared for by Specialist Orthodontists using the latest technology. We offer braces and clear aligners with tailored treatment plans, interest-free payments, and supportive care from start to finish.
Summary
Medicare does not typically cover braces or aligners. Private health funds can contribute if orthodontics is included on your Extras policy, subject to waiting periods, annual caps, and lifetime limits. The smartest approach is to confirm entitlements with item numbers, time payments across benefit years, and maintain your cover during treatment.
At Modern Orthodontics, we guide you every step of the way with transparent costs and flexible payment plans - so you can focus on achieving a confident, healthy smile.
Back
