Last Updated on February 27, 2022 by Anne-Sophie Reinhardt
Does Medicaid Pay For Braces? Yes, Medicaid will cover braces if medically necessary by an approved doctor. Medicaid considers your age, state, and the reason you want to straighten teeth.
Even if your orthodontist recommends Medicaid for braces, you still need approval from your local Medicaid office. This is because Medicaid is provided state-by-state, so decisions about what will and won’t be covered can vary quite a bit.
If your income is lower, Medicaid will cover braces for you. There are special provisions in some states for children from low-income families.
Even if braces are required for medical reasons, coverage is tricky. You will also be disappointed if you apply for Medicaid to cover aesthetic braces.
What Are Braces?
Dental braces are wire-based devices to correct crooked or crooked jaws. In short, they move or straighten your teeth to improve their appearance and feel.
Braces can improve your gum health and long-term oral health. They also make chewing easier by spreading the pressure evenly across your teeth. Braces are most common among childhood, but braces can also correct misaligned teeth.
Braces apply pressure to the teeth, and gradually move them in the desired direction. The force causes the jaw bones to shift, allowing your teeth to move. Braces can help you achieve the perfect smile.
When Does Medicaid Cover Childrens Braces?
Federal law requires that every state provides dental benefits for children enrolled in Medicaid through the CHIP (child insurance program). These benefits include:
- Routine dental check-ups.
- Restorative dentistry.
- Teeth cleaning.
- Treatment for tooth pain and infection
Medicaid does not cover orthodontic treatment for people under 21 years of age unless a doctor deems it necessary. The state-specific criteria for Medicaid coverage of orthodontic treatment vary.
Medicaid typically covers braces for children who need them to treat a disability, an injury, or a disease.
You may need braces to correct dental problems that affect normal oral functions, such as chewing and swallowing and other routine activities.
These problems could include:
- Jaw problems.
- Cleft lip or palate
- Overjet protrusions.
- Congenital defects.
- Crossbites, underbites and overbites that are severe
- Pre-existing genetic conditions can lead to missing or additional teeth.
Move your teeth slowly in the desired direction. The force will cause the jaw bones to shift in order to allow your teeth to move. Braces can help you achieve the perfect smile.
When Does Medicaid Cover Adult Braces?
While Medicaid pays for orthodontics for children, the majority of Medicaid’s coverage is for adults. However, Medicaid has recently expanded its coverage to include low-income or indigent adults, pregnant women and disabled people. Braces are not eligible for medicaid.
When determining whether Medicaid will cover braces for adults, medical necessity is crucial. Medicaid may pay for braces for adults who have broken or dislodged their teeth as a result from an accident.
They will cover dental care for adults with neck and jaw problems.
Medicaid will also cover the cost of teeth repositioning to correct the following conditions.
- TMD (Temporomandibular Joint Disorders) or TMJ
- Sleep Apnea
- Handicapping Malocclusions
Ensure you include information about any medical conditions that could affect your ability to get Medicaid to pay for braces. However, if you are experiencing pain or ill, you may get approval for braces.
Medicaid can approve braces if your condition affects your normal functioning or your ability to carry out your daily routines.
What Doesn’t Medicaid Cover?
Braces can only be approved for medical reasons. The following are some of the orthodontic procedures that Medicaid will not pay for:
- The treatment of crowded teeth.
- Braces for aesthetic purposes
- If the patient does not want to maintain good oral hygiene and maintain good oral health,
Medicaid will not pay for Invisalign premium treatment options for adults and kids, as Medicaid is a mass program. However, it’s okay if you are not qualified, you can consider three alternatives for Medicaid.
How Can You Determine If You Qualify for Braces with Medicaid?
The AAO (American Association of Orthodontists), sought to clarify the definition of a medically required orthodontic procedure in 2019. Individual states have the right to decide what their Medicaid plans cover or not.
Free consultations with an approved Medicaid dentist can help you decide if braces are right for you and whether or not your Medicaid plan will cover all or just a portion of the costs. You don’t have to be alarmed if Medicaid pays a portion of the braces cost. Dental insurance is not as costly as medical insurance and can pay as much as 1500 USD (or about 25%).
A 3rd-party dental insurance plan can really help you save money, especially when you consider that braces’ out-of-pocket cost ranges from approximately 5000 USD to 7000 USD. You have other options to help you manage your dental expenses if Medicaid does not pay.
- University dental clinics can provide your dental services
- No-interest financing
- Cash discounts
- Savings accounts exempt from tax
If you don’t have the funds to pay for all of your orthodontic treatment, there are non-profit programs like Smiles for a Lifetime or Smiles Change Lives that can offer braces at a reduced price.
Each US state has laws regarding which services cover braces and what you can get coverage for. So, to find out if Medicaid will cover braces, you should contact your local office.