Choosing a medical aid in South Africa that covers braces can be complex due to the varying coverage options and criteria among schemes. Generally, braces are covered if deemed medically necessary for impaired teeth, jaw, or mouth.

The top medical aids that provide coverage for braces in South Africa include Discovery Health, Bonitas Medical Aid, Momentum Health, BestMed Medical Aid, and Fedhealth. Each of these schemes has specific criteria and protocols for orthodontic coverage, typically involving a pre-authorization process and, in some cases, designated service providers.

Discovery Health offers comprehensive options with severe dental and oral surgery benefits, including braces, managed through specific plans. Bonitas Medical Aid provides orthodontic benefits through their dental network managed by DENIS, with coverage subject to managed care protocols.

Momentum Health includes basic and emergency dental care, with limited coverage for specialised dentistry like braces.

BestMed Medical Aid offers preventative dental benefits across their options, with braces covered from higher-tier plans. Fedhealth covers orthodontic treatment through their out-of-hospital benefits and savings components, subject to pre-authorization.

The cost of braces in South Africa can range from R3,000 to R55,000, depending on the type and complexity of treatment. Understanding the specific benefits and requirements of each medical aid scheme can help individuals make informed decisions about their orthodontic needs.

Does Medical Aid Cover Braces?

Many parents of teens or tweens understand the financial burden of orthodontic treatments. Before you prepare to cover the costs, it’s crucial to understand which orthodontic treatments your medical aid plan covers.

Coverage for Braces

Most medical aids in South Africa cover part or all of the costs related to orthodontic treatments like braces if you are on a comprehensive plan. However, the extent of the coverage varies, making it essential to thoroughly review your plan’s policy to determine what’s included, considering dental limits and exclusions.

The Importance of Dental Cover

Annual dental check-ups are vital, yet even routine procedures have become increasingly expensive. Orthodontics, aimed at achieving the perfect smile, can add to these costs. Understanding your medical aid plan’s dental and orthodontic coverage is essential to manage these expenses effectively.

Types of Medical Aid and Their Dental Offerings

According to Alexia Graham, Director of Hippo Advisory Services, there are two main types of medical aid product structures:

Savings Account Products

Out-of-hospital expenses are funded from a savings account, with specialised dentistry being paid from your savings. Once savings are depleted and the member has covered a self-payment gap, a benefit threshold may kick in, offering additional benefits.

Traditional Medical Aid Products

These provide defined annual limits for every medical expense category. However, the limits for specialised dentistry, such as orthodontics, are usually quite limited and often insufficient to cover a year’s worth of treatment.

Both types of medical aid can be expensive and may not offer the best value for money.

Orthodontic Cover Reality

Orthodontic treatments, including braces and regular check-ups, can amount to tens of thousands of rands. Therefore, it’s crucial to investigate medical aid orthodontic inclusions and exclusions. Coverage depends on your specific plan, with higher premiums generally offering more extensive coverage.

For example, Discovery Health pays for orthodontics from available medical savings. If you’re in a self-payment gap, you’ll need to fund the orthodontics yourself until you surpass the threshold, after which the scheme covers orthodontics up to the stipulated rate and within benefit limits.

Braces Exclusions

Plans may require a co-payment, and you’ll need to prove that braces are medically necessary due to impaired function of the teeth, jaw, or mouth. Some plans only cover braces from designated service providers or network orthodontists. Additionally, family coverage may limit orthodontic treatment to one member per calendar year, with exceptions for twins.

Getting Your Orthodontic Cover Straight

Review your plan’s dental cover to see what orthodontic treatments are included for both adults and under-18s. You might need to consider specialised or extra dental coverage or choose a plan with higher medical savings if orthodontic treatment is anticipated for your family.

Choosing the Right Medical Aid Plan

Alexia Graham suggests not selecting a medical aid plan based solely on the specialised dentistry benefit. The average cost for a single person is approximately R4,500 per month, while coverage for a family (member, spouse, and one child) may cost around R9,000 per month, offering expensive cover for limited benefits.

If unsure, consult a medical aid broker to outline the orthodontics cover of each plan. Use comparison tools like medicalreview.co.za’s free online medical aid quotes comparison tool to get the best value for money.