Does Medicaid cover braces? Braces coverage for children and adults.

August 12, 2023

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Medicaid which is a joint federal and state aid program, is a way to with the cost of dental braces in certain situations. Each state has different requirements in relation to the eligibility of its Medicaid insurance for orthodontic treatment including braces. In each instance there is a need for a dentist or a medical professional needs to identify a health issue that braces can help to resolve. Find out what conditions could cause you or your child to be eligible for free or discounted braces.

The most important takeaways

Medicaid the biggest health insurance service across the U.S., may help to pay for braces if braces are medically needed.
Every states’ Medicaid program has its own guidelines for medically needed orthodontic treatment, which can include braces.
Some braces-related services might require out-of-pocket expenses that vary between states and plans.
It is easier for children to be eligible for braces under Medicaid than adults.

What can you tell when you’ll need braces?

Braces are dental tools that are designed to straighten teeth that are crooked and close the gaps between teeth that are not spaced properly or to align your jaw. They have brackets and wires that are pressed against teeth to aid in helping teeth to become more aligned.

A significant misalignment of teeth – referred to as malocclusion, also known as a “bad bite” can result in problems with chewing and swallowing. It could cause further dental health problems, including tooth decay, loss or gum diseases or jaw-related issues. It’s much easier to address this problem in the early years however, at the very least, 25% of people wearing braces are adult.

The signs that you may need braces are:

Jaw pain or clicking when first awake or when you chew
Teeth aren’t aligned properly while your mouth is still
The teeth that are visible to the naked eye may be crowded or even crooked.
The difficulty of flossing and brushing

Overbite or underbite
Speech difficulties
Breathing through the mouth
Cleft palate
It is difficult to chew food.

Does Medicaid provide braces for adults?

Medicaid could cover orthodontic braces that are for adult patients but it is very unusual. You’ll need proof that your malocclusion affecting your overall health not only that of your mouth. With this information, Medicaid may not agree to pay for orthodontic treatment for you.

A majority of states provide the minimum amount of emergency dental care in their Medicaid programs. They might include braces when medically required. However, each state has its own definition of what qualifies as “medically required.”

A. The American Association of Orthodontists defines the medically essential orthodontics as “services to identify, prevent and treat, minimize or eliminate malocclusions (including craniofacial anomalies and pathological or traumatic anatomical deviations) that result in discomfort or physical deformity, major problems, or worsens the condition or leads to more injury or discomfort.”

Medicaid does not pay for braces solely for aesthetic reasons. For example, the program won’t cover braces solely to fix aesthetic issues caused by gaps between teeth, crowded teeth overbites or underbites.

Does Medicaid pay for braces for children?

Yes states that offer Medicaid coverage for children are required to provide dental care including braces in the case of Medicaid beneficiaries who are under 21. This obligation is contained as part of the Early and Regular Screening diagnostic and treatment (EPSDT) Benefit.

According to InsureKidsnow.gov Some states will cover braces for children with prior approval. Patients must have a impaired orthodontic condition. Braces should be able to address:

Treatment for malocclusion
The misalignment or improper position of teeth that have an adverse impact

Children who participate in the Children’s Health Insurance Program (CHIP) program might be covered under an EPSDT benefits. However it is the Centers for Medicare & Medicaid Services has declared: “States are not required to provide the EPSDT-level of service to offer all medically required services in the CHIP programs.”

How much will braces cost using Medicaid?

How much would braces cost when you are on Medicaid is contingent upon what your orthodontist charges as well as the costs your state’s program would cover,and what costs would be your to pay. In the event of your state’s Medicaid program, you could be responsible for costs out of pocket like the cost of enrollment as well as deductibles, premiums or copayments.

In the CHIP scheme for kids, parents will have to pay up to 5 percent of their family’s income to cover all dental and medical treatments.

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Are you able to get braces for free using Medicaid?

Medicaid could cover dental braces in the event of medical necessity. Dental care covered by Medicaid isn’t available in all states, though. States may decide to offer orthodontic services or any other dental services for their older Medicaid beneficiaries.

This table lists the amount of Medicaid dental coverage that each state currently provides.

No Medicaid Dental Coverage	Alabama, Delaware, Tennessee
Emergency Medicaid Dental Coverage	Arizona, Florida, Georgia, Hawaii, Idaho, Maine, Maryland, Mississippi, Nevada, New Hampshire, Oklahoma, Texas, Utah as well as West Virginia.
Limited Medicaid Dental Coverage	Arkansas, Colorado, Illinois, Indiana, Kansas, Kentucky, Louisiana, Michigan, Minnesota, Montana, Nebraska, Pennsylvania, South Carolina, South Dakota, Vermont, Virginia, and Wyoming.
Comprehensive Medicaid Dental Coverage	Alaska, California, Connecticut, Iowa, Massachusetts, Montana, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oregon, Rhode Island, Washington and Wisconsin.

How do you determine whether you’re eligible for braces coverage

Review your Medicaid plan’s documents to find out the requirements for braces eligibility coverage. You can also ask for the information from your state or local Medicaid office.

The steps to getting braces covered under Medicaid

Before you are able to get braces that are covered by Medicaid an orthodontist licensed by Medicaid will need to verify the condition of your teeth warrants the treatment. Adults will need to prove that dental braces are the most affordable and effective option to correct any dental health issue that is not related to it. Some dentists offer free consultation.

To begin finding out Medicaid braces coverage where you reside you must follow these steps:

Make sure to check the state’s Medicaid program offers an option for dental care that comes with braces.
Ask your health care provider if dental braces may correct a serious health problem.
Locate and schedule treatment with an orthodontist that is a member of Medicaid.

FAQ

Are orthodontist services available via Medicaid?

Absolutely, Medicaid provides orthodontic care but it’s primarily focused on providing for the needs of people who are younger than 21. The program will not reimburse for treatments for aesthetic reasons.

Does state insurance cover braces?

Every state decides whether and how they cover braces and other dental treatments for its Medicaid clients. The service must be considered to be necessary for health reasons, not for cosmetic reasons.