Does Medical Aid Cover Braces?

Medical Medical Aid could cover braces. But how much it covers, and whether you're even eligible, depends on a few key factors like your specific medical aid plan and whether the treatment is medically necessary or purely cosmetic.

Straightening your teeth might not be life or death, but it can make a big difference to your jaw alignment, bite issues, and overall dental health. But here’s the catch: orthodontic treatment in South Africa doesn’t come cheap, and your medical aids might not cover the orthodontic needs of your family.

So, before you go out of pocket for a set of braces, let’s answer the question: does Medical Aid cover braces? We’ll unpack what’s covered, what’s not, and how to avoid footing the entire bill yourself.

The Three Types of Medical Aid Plans That Matter

In South Africa, most Medical Aid plans fall into three broad buckets:

1. Savings Plans

These plans give you access to a pot of your own money to pay for out-of-hospital expenses, dental work included. If you run out, some plans offer a "threshold benefit" that kicks in after you’ve paid a certain amount from your own pocket. Until that threshold is reached though, you're footing the bill.

2. Traditional Plans

These come with fixed annual limits for various categories of care. You might get R5,000 or R10,000 for dentistry in a year, but when braces can cost upwards of R30,000, that allowance disappears faster than snacks at a school fundraiser.

No matter the plan, there’s a good chance you’ll need to cough up some of your own cash. Braces are expensive, and so is the kind of cover that pays properly for them.

3. Hospital Plans

Hospital Plans are designed to cover you for in-hospital treatment. The kind that comes with a hospital bed and a medical file. Unfortunately, orthodontic work like braces doesn’t usually qualify.

Hospital Plans often exclude dentistry unless it’s deemed medically necessary and pre-authorised.

With a savings plan, you are effectively paying for the cost of the braces from your savings account. With a traditional plan, you have a limited defined benefit amount for orthodontics.

Comparing Plan Types: What You Get vs. What You Pay

What’s Usually Covered and What’s Not

When it comes to exclusions, Medical Aids generally draw a line between medically necessary and cosmetic upgrades. If the braces are to correct a genuine problem, like an overbite that affects eating or speech, you’ve got a shot at getting some cover. But if it’s purely about levelling up your smile, you might be on your own.

• Some plans only cover braces done by their preferred network orthodontists.
• You’ll likely need to submit dental records and X-rays to prove the treatment is medically necessary.
• Many schemes only allow one family member per year to begin orthodontic treatment (except in the case of twins).
• Adult orthodontics may be excluded altogether depending on your plan.

The Real Cost of Braces in South Africa

Getting braces is expensive. Depending on the type (metal, ceramic, or invisible aligners) and complexity, costs can range from R25,000 to R60,000 or more.

Even if your Medical Aid chips in, you’ll probably still face co-payments. Some plans only cover up to the medical scheme rate, which is often less than private orthodontists charge.

Getting the Most Bang for Your Buck

Thinking about shopping for a better plan, or trying to figure out whether braces are financially feasible? Here’s how to make sure you’re not taken for a ride:

• Check exactly what your plan covers under dental and specialised dentistry.
• Look out for waiting periods for orthodontics — these can delay your treatment.
• Confirm if you're tied to using network providers.
• Understand what’s paid from savings, what’s covered by benefits, and where you’ll face co-payments.
• Consider a top-up dental insurance product if your current plan falls short.

Premiums for plans with decent dental cover typically start around R4,500 per month for a single person and can climb to over R9,000 for a family of three.

Can Gap Cover Help with Braces?

Most Gap Cover plans in South Africa are designed for hospital-related shortfalls only. In fact, dental hospital admissions are listed as exclusions with most providers. The only time you might get cover is for very specific cases, such as trauma or oncology-related dental treatment in hospital. Even then, there are strict rules, like needing pre-authorisation, using certain network providers, and working within payout limits.

Because braces are considered elective and done out of hospital, they simply aren’t covered. So while Gap Cover won’t help you pay for orthodontics, it’s still a great safety net for unexpected medical costs, like when a specialist charges more than your medical aid rate during a hospital stay.

Compare Medical Aid Plans in Minutes

If you’re thinking about getting braces, whether for your child or yourself, it might be the perfect time to review your cover. A better-fitting plan can save you money in the long run.

Use our free online medical aid comparison tool to compare plans side by side and find one that won’t have you grinding your teeth at the costs.

This article is for informational purposes only and should not be considered financial, legal or medical advice.