Does Medicaid Cover Braces Overview
The answer is yes, well, sort of. Medicaid will pay for your braces only if an approved physician deems these devices necessary.
Medicaid also considers your age and state and why you want to straighten your teeth.
Even if an orthodontist recommends that Medicaid pay for your braces, your local Medicaid office will still need approval.
This is because Medicaid is provided state-by-state, so decisions on what will and won’t be covered vary greatly.
However, if your income isn’t as high, you can take advantage of Medicaid’s coverage for braces because the standards that apply to you will be relaxed.
Some states also have special provisions for children who come from low-income families.
Coverage is hard to come by, even if braces are medically necessary, even for children. Also, if you want Medicaid to pay for aesthetic braces, you will be disappointed.
When Does Medicaid Cover Children’s Braces
Federal laws necessitate that all states provide dental benefits to children enrolled in Medicaid via the CHIP (Child Health Insurance Program). Some of these benefits include:
1. Routine teeth check-ups.
2. Teeth restoration.
3. Teeth Cleaning.
4. Relief from tooth pain and infection.
Medicaid only covers orthodontic treatment for persons 21 years and under when these services are deemed necessary by a physician.
However, medical conditions that qualify people for Medicaid coverage for orthodontic procedures vary state by state.
Medicaid usually pays for kids’ braces when required to correct a disease, injury, or handicapping malocclusion.
Dental problems that interfere with normal mouth functions, such as chewing, swallowing, and other routine activities, may require fixing 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
Although Medicaid, for the most part, only pays for children’s orthodontic procedures, in recent times, it has expanded its coverage to include indigent or low-income adults, pregnant women, or disabled persons.
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 instance, Medicaid can pay for braces for adults with dislodged teeth or broken jaws due to an accident.
Adults with jaw and neck ailments also have a valid reason to lay claim to dental coverage by Medicaid.
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 can be approved without treatment if you’re experiencing pain, are ill, or have an infection.
Also, if the condition impacts the normal functioning of your body or your ability to go about your routines, then braces can also be approved by Medicaid.
What Doesn’t Medicaid Cover
Again, braces are approved for medical reasons only. Some of the procedures concerning orthodontics that Medicaid won’t pay for include:
1. Treatment to correct crowded teeth.
2. Braces are meant for aesthetic purposes.
3. If the patient has shown a lack of enthusiasm to maintain oral health and hygiene standards.
Medicaid won’t also pay for premium orthodontic care options such as Invisalign for both kids and adults because Medicaid is a mass program that pays for the least expensive treatment option.
How Can You Determine If You Qualify for Braces with Medicaid
In 2019, the AAO (American Association of Orthodontists) sought to clarify what a medically necessary orthodontic procedure is.
However, individual states still have a lot of say in what their Medicaid plans will cover and won’t cover
A free consultation with a Medicaid-approved orthodontist can help you better understand if you should get braces and whether your Medicaid plan will pay for all the expenses or a fraction of them.
If Medicaid decides to pay for the cost of your braces partially, there is no need to panic that dental insurance isn’t as expensive as Medical insurance, and you can get one to pay for as much as $1,500, about 25% of the cost.
But considering that the out-of-pocket costs for braces range from around $5,000 to $7,000, 3rd third-party dental insurance plan saves you a lot of money.
There are other options you should consider to manage dental expenses if Medicaid doesn’t pay, and they include:
1. Getting your dental services from university dental school clinics
2. No-interest financing
3. Cash discounts
4. Tax-exempt saving accounts
Also, non-profit programs such as Smiles for a Lifetime and Smiles Change Lives can offer you cut-price braces if you are a low-income individual who needs braces and can’t afford the entire cost of orthodontic treatment.
To sum it up, each US State establishes laws about which dental services are covered in braces and what makes you eligible for coverage.
So, you need to contact your local office for a final answer on whether Medicaid will pay for your braces.
US Map for Dental Grants (by State)