Does medical aid cover braces?
Orthodontic cover can depend on your plan, medical necessity, limits, waiting periods and network rules.
Medical Aid Cover for Braces
Does Medical Aid Cover Braces?
Medical Aid could cover braces. But how much it covers and whether you're even eligible depend 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 aid provider 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. You can also explore our hospital plans for alternative coverage options.
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.
Top 3 Medical Aid Plans for Orthodontic Cover
In South Africa, most Medical Aid plans fall into three broad buckets when it comes to orthodontic cover.
1
Savings Plans
How it pays: From your own medical savings or day-to-day pot.
Reality for braces: You're mostly swiping your own card; some plans offer a threshold once you've paid enough out-of-pocket.
Best for: Families who want flexibility and don't mind budgeting for shortfalls.
Watch-outs: Savings run out quickly. Confirm waiting periods and network rules.
2
Traditional Plans
How it pays: Fixed annual dentistry or orthodontic limits, often around R5,000 to R10,000, at scheme rates.
Reality for braces: It helps, but braces costing R25,000 to R60,000 or more will likely outrun the limit.
Best for: Predictable day-to-day benefits with a bit of help on big-ticket items.
Watch-outs: Co-pays, pre-authorisation and network-only rules. Adult orthodontics is sometimes excluded.
3
Hospital Plans
How it pays: In-hospital events only.
Reality for braces: Orthodontics is usually excluded, unless tied to authorised surgery or trauma.
Best for: Premium control when orthodontics isn't on your radar.
Watch-outs: Don't expect routine braces cover here.
4
Reality Check
Braces are pricey — even with solid medical aid cover, expect a shortfall. Some families take out gap cover or use flexible savings to help bridge the gap between what your orthodontist charges and what your scheme pays.
Read more: What to look for when comparing medical aids.
Pro tip: Whatever you choose, get pre-authorisation, use a network orthodontist, and ask for scheme-rate versus quoted-rate in writing.
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Brace yourself for better cover
What Do Braces Cost in South Africa?
Getting braces is expensive. Costs depend on the type of braces, the complexity of treatment and how much your Medical Aid contributes.
1
Metal Braces
Average cost of braces: R25,000–R40,000.
Are they covered by Medical Aid? Partially.
2
Ceramic Braces
Average cost of braces: R35,000–R50,000.
Are they covered by Medical Aid? Partially.
3
Invisible Aligners
Average cost of braces: R45,000–R60,000.
Are they covered by Medical Aid? Rarely, or not at all.
4
Getting the Most Bang for Your Buck
Dental cover typically starts from around R4,500 per month for a single person and can climb to over R9,000 for a family of three.
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 gap cover product if your current plan falls short — it can help bridge the difference between what your orthodontist charges and what your scheme pays.
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Thinking about shopping for a better plan? Compare your options through Hippo and check what each plan covers under dental and specialised dentistry.
Frequently Asked Questions
How much do braces cost in South Africa with Medical Aid?
Even with Medical Aid, you'll likely still pay a significant portion out of pocket. Metal braces cost R25,000–R40,000, ceramic braces R35,000–R50,000, and invisible aligners R45,000–R60,000. Most Medical Aids only cover a portion of these costs, and many plans have annual dental limits of just R5,000–R10,000. So while your Medical Aid helps, expect to contribute substantially to the total cost.
What's the difference between Medical Aid covering braces for medical reasons vs. cosmetic reasons?
Medical Aids draw a clear line here. If braces are needed to fix genuine problems like an overbite affecting eating or speech, jaw alignment issues, or other functional problems, you've got a better shot at coverage. But if it's purely about getting a prettier smile, most Medical Aids won't chip in. You'll need to submit dental records and X-rays to prove the treatment is medically necessary.
Do all Medical Aid plans cover orthodontic treatment?
Definitely not. Hospital plans typically exclude orthodontics entirely unless it's done in-hospital for trauma or medical emergencies. Savings plans make you pay from your own savings pot until you hit a threshold. Traditional plans offer the best coverage with fixed annual limits, but even then, coverage varies widely between schemes. Some plans also have age restrictions, such as GEMS only covering members under 21 on certain options.
Can I use any orthodontist with my Medical Aid?
Not always. Many Medical Aid plans tie you to their network of preferred orthodontists to get full benefits. Go outside the network, and you might face higher co-payments or reduced coverage. Some plans also only pay up to the medical scheme rate, which is often less than what private orthodontists actually charge, leaving you to cover the shortfall.
Are there waiting periods before I can claim for braces?
Yes, most Medical Aids have waiting periods for orthodontic treatment, typically 6 to 12 months from when you join or upgrade your plan. This means you can't sign up for Medical Aid today and start claiming for braces next month. Many schemes also limit orthodontic treatment to one family member per year, except twins, so you'll need to plan accordingly if multiple family members need braces.
Can Gap Cover help with braces?
Most Gap Cover plans in South Africa are designed for hospital-related shortfalls only. 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, with strict rules like pre-authorisation, using network providers, and payout limits. Because braces are considered elective and done out of hospital, they simply aren't covered. Gap Cover is still valuable for other in-hospital specialist shortfalls.
Make an Informed Choice
If you're thinking about getting braces, whether for your child or yourself, it might be the perfect time to review your cover.
1
Review your cover before treatment
A better-fitting plan can save you money in the long run. Visit our medical aid comparison page to see which options give the best orthodontic benefits.
2
Confirm the fine print
Before starting treatment, ask your scheme about pre-authorisation, waiting periods, age restrictions, annual limits, network rules and whether the treatment will be paid at scheme rate or the orthodontist’s quoted rate.
Use Hippo’s 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.
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