Yes, Cigna may cover braces, but coverage varies based on your specific plan, your age, and the reason for treatment.
Orthodontic care like braces isn’t just about achieving a straighter smile—it can also help correct bite issues, jaw discomfort, and even improve speech. The catch? It can be expensive. Fortunately, Cigna does offer orthodontic coverage through many of its PPO and DHMO dental plans.
This article breaks down what Cigna typically covers, how much you might pay out of pocket, and what to do if your plan doesn’t include braces. Whether you’re a parent planning for your child or an adult exploring treatment, we’ve got you covered.
Key Takeaways
✔ Cigna PPO plans often cover 50% of braces up to a lifetime max of $1,000–$3,000
✔ DHMO plans offer flat copays but require in-network care and fewer treatment types
✔ Coverage is most common for patients under 19, but some adult options exist
✔ Pre-approvals, documentation, and flexible financing help reduce cost
✔ Humble Memorial Dental supports patients through every step of their orthodontic journey
Why Are Braces Prescribed?
Braces aren’t just cosmetic, they’re a solution to real functional dental issues. Your dentist or orthodontist may recommend braces for:
- Correcting overbites, underbites, or crossbites
- Fixing misaligned, crooked, or overcrowded teeth
- Addressing speech difficulties or jaw strain
- Improving long-term oral hygiene and function
Orthodontic treatment is often considered medically necessary, particularly in children and teens, which helps qualify it for insurance coverage.
Does Cigna Cover Braces? The Short Answer
Yes—but not all plans offer coverage. Typically:
- Cigna PPO plans often include orthodontic benefits
- Coverage is commonly limited to children under 19
- Adult coverage is rare but available under select PPO plans
- Cigna DHMO plans may include braces through set copays and require in-network treatment only
As always, check your Summary of Benefits or call Cigna directly to confirm your plan’s orthodontic benefits.
Cigna PPO Plans: What’s Usually Included?
PPO plans from Cigna tend to offer the most comprehensive orthodontic coverage. Here’s how it typically works:
- Coverage Amount: 50% of treatment cost after deductible
- Lifetime Orthodontic Maximum: $1,000–$3,000 (once per member)
- Pre-treatment estimate: Strongly encouraged
- Eligible Treatments:
- Traditional metal braces
- Ceramic braces (depends on plan)
- Invisalign (in some upgraded plans, especially for teens)
These plans allow you to choose your provider and typically reimburse a portion of the cost regardless of who you visit, though in-network providers save you more.
Cigna DHMO Plans: Fixed Copays and Restrictions
DHMO plans work a little differently. You’ll need to:
- Use an assigned in-network provider
- Follow a fee schedule with fixed copays for braces
- Pre-approval or authorization may still be required
Common Copay Example:
- Child braces: $2,000 total (no insurance billing, just patient responsibility)
These plans are more predictable but offer less flexibility and fewer provider options.
Does Cigna Cover Braces for Adults?
Here’s the tricky part—most orthodontic coverage is for children under 19. Adult coverage is less common, but not impossible. Some PPO plans or employer-sponsored policies include adult orthodontics, especially when the treatment is medically necessary.
If you’re over 19, here’s what to look for:
- Specific mentions of adult ortho coverage in your plan documents
- Whether the lifetime ortho max applies regardless of age
- Coverage for Invisalign or clear braces, which may be partially reimbursed
In most cases, you’ll pay more out of pocket as an adult—but HSA/FSA funds can help.
What Types of Braces Might Be Covered?
Typically Covered:
- Metal Braces: Most commonly included
- Ceramic Braces: Covered under some PPO plans
Sometimes Covered (depends on plan):
- Invisalign: Included in select PPO plans or teen-focused coverage
- Lingual Braces: Rarely covered due to high cost
The more medically necessary the treatment, the more likely it is to be reimbursed.
How Much Do Braces Cost With and Without Cigna?
Without Insurance:
- Metal Braces: $3,000–$7,000
- Ceramic Braces: $4,000–$8,000
- Invisalign: $3,500–$7,000
With Cigna PPO (If Covered):
- 50% covered up to a $1,500–$3,000 lifetime max
- Out-of-pocket: ~$2,000–$5,000 depending on case
With Cigna DHMO:
- Copays generally range from $1,500–$2,500 total
Don’t forget—retainers, X-rays, and adjustments may be billed separately!
Does Age Impact Coverage?
Yes. Most orthodontic benefits under Cigna are designed for dependent children under age 19.
Some exceptions:
- Students under 23 may still qualify under family policies
- Adults must rely on premium PPO plans, employer-sponsored upgrades, or supplemental ortho plans
Always verify age limits and benefits ahead of treatment.
How to Maximize Braces Coverage with Cigna
- Check your Summary of Benefits for ortho eligibility
- Use a pre-treatment estimate to confirm actual coverage
- Choose in-network providers to lower costs
- Use an HSA or FSA for tax-free payments
- Start treatment early in the benefit year and spread over two calendar years if possible
What If Braces Aren’t Covered?
1. Explore Other Treatment Options
- Partial aligners or early interceptive treatment may cost less
2. Consider In-House Payment Plans
- Humble Memorial Dental offers interest-free financing and payment options
3. Upgrade or Supplement Your Plan
- Look for plans during open enrollment with orthodontic benefits
4. Submit Medical Documentation
- Bite issues, crowding, or TMJ-related concerns may qualify for medical necessity
Looking for Braces in Humble, TX?
At Humble Memorial Dental, we help patients of all ages straighten their smiles with comfort and confidence. We:
- Offer traditional, ceramic, and clear aligner solutions
- Accept Cigna PPO and DHMO plans
- Help patients navigate pre-approvals and maximize their benefits
- Provide flexible payment options to make braces more affordable
Book a consultation today to get started on a treatment plan tailored to your needs and coverage.
Final Thoughts
Yes, Cigna can cover braces, but how much depends on your plan, your age, and the type of treatment. PPO plans offer more flexibility, while DHMO plans trade customization for lower costs.
Whether it’s for your child or yourself, understanding your benefits is the key to getting the care you need without unnecessary stress. And remember: your smile is always worth the investment.
