Does Medical Aid Cover Braces?

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.

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.

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 – like GEMS only covering members under 21 on certain options.

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.

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.

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.