Most states limit Medicaid coverage to medically necessary services, including orthodontics like braces.
Taking care of your teeth is an important aspect of your overall healthcare routine. For children, and sometimes adults, that may include braces or other orthodontics.
Medicaid limits coverage for most services to what is considered medically necessary. That means the program isn’t likely to cover braces for purely cosmetic reasons, i.e., to improve your appearance. There are cases, though, when Medicaid covers braces.
When does Medicaid cover braces?
In every state, federal law requires Medicaid to provide some level of dental benefits for enrolled children. At a minimum, every state Medicaid program must cover routine cleanings and exams, infection care, pain relief, and teeth restoration.
Typically, orthodontic treatment is limited to medically necessary procedures, but every state is different. Medicaid usually pays for children's braces when it is required to treat a disease, injury, or severe malocclusion (when the teeth are misaligned). Normal oral function (eating, swallowing, talking) can be disrupted by the following dental issues:
● Cleft lip or palate
● Congenital deformities
● Extra or missing teeth caused by pre-existing hereditary conditions
● Extreme crossbite, overbite, or underbite
● Impacted teeth
● Jaw issues
● Overjet teeth (teeth protrude outward and sit over bottom teeth)
All of the above may qualify your child for braces covered by Medicaid.
Most states' Medicaid programs offer dental coverage for people ages 21 and younger, with very few patients older than 21 receiving coverage or reimbursement for dental care. However, just as with children, if it is considered medically necessary you may receive coverage.
Emergency dental care may also be covered. The following conditions might qualify an adult for braces covered by Medicaid:
● Broken jaw or dislodged teeth
● Misalignment that severely interferes with function (handicapping malocclusion)
● Sleep apnea
● Temporomandibular Joint Disorders (also known as TMD or TMJ)
Again, every state has differences in what its Medicaid program covers, so it is best to check with your specific state to see what is covered. Whether for children or adults, braces for a condition considered to be cosmetic are rarely (if ever) covered by Medicaid.
How much do braces cost?
Braces don't exactly come with a set cost; it depends largely on how severe the misalignment of teeth is and what underlying conditions may need to be treated. The type of braces also impact cost, with traditional metal braces averaging around $2,500 to $7,500.
Other options however, such as ceramic or lingual (behind the teeth) braces, can run as high as $10,000 or more. Adult braces generally cost more than braces for children.
Does Medicare cover braces?
Original Medicare (Part A and Part B) does not cover any dental care, including braces. However, if you are an adult who needs braces or other dental care, a Medicare Advantage plan (Part C) may provide coverage.
Advantage plans are required by law to include the same level of coverage as Original Medicare, but most plans come with a host of additional benefits. One of the most common additional coverage options for Part C plans is dental care.
Just remember that not every Medicare Advantage plan comes with dental; you need to make sure it is offered by the specific plan you choose. In addition, the level of dental coverage will vary, from the types of services to what you’d pay out-of-pocket, so compare details carefully.
It can help to talk to a knowledgeable, licensed Medicare agent. They’ll answer your questions and help you pick the right Medicare plan for your unique needs and budget. Call us toll-free at 888-992-0738 to talk to a licensed ClearMatch Medicare agent.
You can also do a bit more research with our Find a Plan tool. Just enter your zip code to compare Medicare plans in your area.
Alternatives for free or inexpensive braces
If you cannot get braces through Medicaid, there are still other options for free or inexpensive dental care. For children, it is much easier to find affordable dental care and Medicaid will cover anything medically necessary. But if it does not, you still have other methods.
Purchasing separate dental insurance is another option. Compare plans carefully, though, paying close attention to the requirements for orthodontics coverage. For example, you may have to wait a certain amount of time before the plan will cover braces.
There are also non-profit organizations that specifically provide braces and other dental care for children from low-income families, children in foster care, and children in unstable environments. Programs such as Smile For a Lifetime and Smiles Change Lives offer affordable braces, with both groups charging less than $1,000 for the application fee and braces themselves.
An orthodontic college is also a great place to look for inexpensive orthodontic work, be it braces or any other type of dental care. Rates are typically much cheaper for children and adults.
The Boston University School of Dental Medicine, for example, has much more affordable fees than most dentist offices, coming in at $145 per month for kids and $160 per month for adults. They also offer a discount for families that have multiple members being treated at once and offer different payment options. You can find other orthodontic schools that may be closer to you with similar programs here.
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