Wondering if Medicaid covers braces or aligners? You're not alone, orthodontic care can be pricey.
The good news: Medicaid may help, but coverage varies by state. This guide breaks down what treatments might be covered, who qualifies, and how to find out if you're eligible for help with orthodontic costs.
Medicaid may cover orthodontics, but it depends on your state and specific dental needs. Check with your provider to see if you're eligible for coverage, especially for children with medical conditions.
Medicaid is a state and federally funded program that provides health insurance to individuals and families with low incomes.
While Medicaid benefits vary by state, the program generally includes coverage for a range of medical services, including dental care.
However, orthodontic services are often a special case, with coverage primarily available for specific medical conditions or when the treatment is considered necessary to correct functional problems with the teeth or jaw.
In most cases, Medicaid will cover orthodontics for children under 21, as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit.
However, Medicaid’s coverage for orthodontics in adults can be limited or unavailable, depending on the state and the specific circumstances of the individual.
Medicaid typically covers orthodontic treatment for children if the treatment is considered medically necessary.
However, whether orthodontic treatment is deemed medically necessary depends on the severity of the dental or jaw issues and the potential for functional improvement.
If a child has a severe misalignment or bite problem that affects their ability to chew, speak, or breathe properly, Medicaid may cover orthodontic treatment. This can include conditions like:
In these cases, Medicaid may approve coverage for braces or other orthodontic appliances to correct the issue and improve functionality.
In contrast, orthodontic treatments that are purely cosmetic, such as braces for minor teeth misalignment without any functional issues, are typically not covered by Medicaid.
If the primary reason for treatment is aesthetics rather than medical necessity, the patient may need to explore other options for financing the treatment.
Eligibility for Medicaid orthodontics is determined by a few different factors, including income level, age, and the severity of the dental issue.
Here’s how you can determine if you qualify for Medicaid orthodontics:
To qualify for Medicaid, you must meet income and household size requirements, which vary by state.
Each state has its own set of income guidelines for Medicaid eligibility, and these are typically based on the Federal Poverty Level (FPL).
In most states, children under the age of 21 are eligible for orthodontic coverage if the treatment is deemed medically necessary.
However, adults may have more limited access to Medicaid-covered orthodontic services, depending on the state and the type of coverage available.
If you think your child might qualify for orthodontic coverage through Medicaid, here are the steps you should take:
The first step is to schedule an appointment with a dentist or orthodontist who accepts Medicaid.
The dentist will examine the child’s teeth and determine if there is a medical necessity for orthodontic treatment.
If necessary, the dentist will refer the child to an orthodontist for further evaluation.
In some cases, Medicaid may require additional documentation to prove the medical necessity of the treatment.
This may include X-rays, dental records, and a letter from the dentist or orthodontist explaining the need for treatment.
Once the necessary documentation is gathered, it can be submitted to your state’s Medicaid office.
The office will review the request and determine whether the treatment is covered under Medicaid. Be prepared for possible delays or requests for additional information.
After submitting the request, stay in touch with Medicaid to check on the status of the approval. If the request is denied, you may have the option to appeal the decision.
In most states, Medicaid does not cover orthodontic treatment for adults unless the treatment is deemed medically necessary due to a disability or specific condition. Coverage for adults varies by state.
To determine if your child qualifies, consult with a dentist or orthodontist who accepts Medicaid. They will evaluate the need for orthodontic treatment and provide the necessary documentation for Medicaid.
While Medicaid may cover the full cost of treatment for children, there may still be co-pays or deductibles. It's important to check with your local Medicaid office to understand what is covered and if there are any additional costs.
Medicaid does provide coverage for orthodontic treatment, but the eligibility criteria and coverage details can vary significantly depending on the state.
In most cases, children with medical conditions requiring orthodontic intervention can receive coverage, but the situation for adults is more limited.
To ensure that your child or you qualify for coverage, it’s essential to consult with a qualified dentist or orthodontist and understand your state’s Medicaid policies.
By following the proper steps and gathering the necessary documentation, you can make sure that your orthodontic treatment is covered under Medicaid, helping to reduce out-of-pocket costs.
Class One Orthodontics is where smiles are masterfully crafted. As Worcester and Newton's premier orthodontic experts, we pride ourselves on providing unparalleled care with a personal touch. Equipped with cutting-edge technology and a dedication to our community, we're not just creating beautiful smiles – we're shaping the future of oral health with a warmth and expertise that's unmatched.
