Does Medicaid Cover Braces Overview
The answer is yes, well, sort of. Medicaid coverage for braces requires that the treatment be deemed medically necessary by a qualified dental specialist, based on state-specific Medicaid criteria. This determination is based on specific criteria that demonstrate the treatment is not merely for cosmetic purposes but is needed to address a medical issue or functional impairment.
Medicaid coverage also depends on your state of residence, your age, and whether the condition affects health or function, not just appearance.
Even if an orthodontist recommends Medicaid coverage for braces, final approval must still come from your state Medicaid program.
Because Medicaid is administered by each state, coverage decisions and qualifying criteria for braces vary widely.
Medicaidās coverage for braces is based solely on medical necessity and is not determined by income level.
All states must provide medically necessary dental care for children under Medicaid, including braces when needed under EPSDT guidelines.
Coverage is generally available for children when medical necessity is demonstrated, though approval requires documentation and varies by state. Also, if you want Medicaid to pay for aesthetic braces, you will be disappointed.
When Does Medicaid Cover Childrenās Braces
Federal law requires all states to provide medically necessary dental services for children under Medicaid through the EPSDT benefit; CHIP also includes dental coverage. Some of these benefits include:
1. Routine teeth check-ups.
2. Teeth restoration.
3. Teeth Cleaning.
4. Relief from tooth pain and infection.
Medicaid covers orthodontic services, including braces, for children under 21 through the EPSDT benefit, when deemed medically necessary. The assessment and recommendation typically come from a dental professional rather than a general physician.
However, medical conditions that qualify people for Medicaid coverage for orthodontic procedures vary state by state.
Medicaid usually pays for childrenās braces when required to treat a disease, injury, or a documented handicapping malocclusion.
Dental issues that impair functions like chewing, swallowing, or speaking may qualify for Medicaid-covered braces.
Such problems may include:
1. Jaw problems.
2. Cleft palate or lip.
3. Overjet protrusions.
4. Congenital defects.
5. Severe crossbites, underbites, and overbites.
6. Missing or extra teeth due to pre-existing genetic conditions
When Does Medicaid Cover Adult Braces
Medicaid generally covers orthodontic procedures for children under 21 through EPSDT; adult coverage is rare and limited to severe medical conditions.
However, in the case of braces, adults rarely qualify for Medicaid.
Medical necessity is a critical factor in determining whether Medicaid will pay for braces in adults.
For example, Medicaid may pay for braces in adults with facial trauma, jaw reconstruction, or post-surgical alignment needs.
Adults with medically diagnosed jaw disorders or bite-related health issues may qualify for limited orthodontic coverage.
Medicaid will also pay for teeth repositioning procedures to correct the following conditions:
1. TMD or TMJ (Temporomandibular joint disorders).
2. Sleep Apnea.
3. Handicapping Malocclusions.
When presenting your case for Medicaid to pay for your braces, ensure the data is detailed about a medical condition impacted by problems with the mouth or jaws.
Braces may be approved if the condition causes chronic pain, functional impairment, or contributes to other medical complications.
If a dental condition disrupts basic functions like eating or speaking, Medicaid may approve orthodontic treatment as medically necessary.
What Doesnāt Medicaid Cover
Again, braces are approved for medical reasons only. Orthodontic services that Medicaid typically does not cover include the following:
1. Treatment solely to correct crowded or misaligned teeth for cosmetic purposes.
2. Braces used for aesthetic enhancement without medical justification.
3. Cases where the patient demonstrates poor oral hygiene or non-compliance with dental care instructions.
Medicaid does not cover orthodontic options like Invisalign, ceramic, or lingual braces; it typically covers only standard metal braces.
How Can You Determine If You Qualify for Braces with Medicaid
The AAO (American Association of Orthodontists) has outlined criteria for medically necessary orthodontic care, informing many state Medicaid programs as of 2025.
While individual states administer their Medicaid programs and determine some coverage specifics, federal guidelines set minimum standards, including for medically necessary orthodontic treatment in children.
A free consultation with a Medicaid-participating orthodontist can help determine if your case meets your stateās criteria for coverage.
When approved, Medicaid generally covers the portion of braces treatment that addresses medical or functional need.
However, considering that the out-of-pocket costs for braces typically range from $5,000 to $6,000 in 2025, a third-party dental insurance plan can save you a lot of money.
There are other options you should consider to manage dental expenses if Medicaid doesnāt pay, and they include:
1. Receiving orthodontic care from accredited dental school clinics
2. Applying for zero-interest or extended-payment orthodontic financing
3. Asking your orthodontist about cash discounts or upfront payment savings
4. Using FSAs or HSAs (tax-free medical savings accounts) for eligible expenses
Non-profit programs such as Smile for a Lifetime and Smiles Change Lives may offer reduced-cost braces to eligible low-income children.
Final Thought
To sum up, each U.S. state sets its own Medicaid rules for dental coverage, including eligibility and medical necessity for braces.
You should contact your stateās Medicaid office or a Medicaid-approved orthodontist to confirm if your case qualifies.
US Map for Dental Grants (by State)
Dental Grants by State
See Also
Does Medicaid Cover Dental Implants
Does Medicare Cover Hearing Aids
