Does Medicaid cover braces in the US? A complete guide

Braces can be expensive, giving rise to the question of does Medicaid cover braces. Medicaid is a government-funded program providing health-care coverage to families and individuals under specific eligibility criteria. Medicaid can cover your braces expenses if it is considered to be necessary treatment. This blog will help you understand what orthodontic treatments are being covered by Medicaid, how much it will cost, and what the eligibility criteria are in the US to have medicaid facilities.

What is Medicaid orthodontic coverage?

Medicaid is a health insurance program providing medical facilities to low-income families. Medicaid coverage varies depending on your state in which you are living. Medicaid often includes orthodontic treatment for children, but usually limited to medically necessary cases.

Who qualifies? Understanding Medicaid braces eligibility

If you're considering Medicaid orthodontic treatment, understanding whether you qualify is the first step. Medicaid doesn't cover braces for cosmetic purposes; coverage is reserved for cases deemed medically necessary. Below are some key eligibility criteria for Medicaid orthodontic coverage.

Medicaid dental coverage for children

Medicaid mandates dental coverage for individuals under 21 through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit. This includes orthodontic services when deemed medically necessary.

Medicaid dental coverage for adults

Medicaid dental coverage for adults is optional and varies by state. Most states do not cover orthodontic treatment for adults unless it's critical due to a specific medical need.

Medically necessary orthodontic treatment

Common conditions that may qualify as medically necessary include the following. However, do keep in mind that a Medicaid-approved orthodontist will make the final call about your case.

Requirement of orthodontic referrals or assessments

A Medicaid-approved dentist or orthodontist must conduct an assessment to see if you are eligible or not.

Necessary documents

Make sure to have the following documents ready before applying for Medicaid.

Once you have the documents that suggest an immediate treatment of your dental problem, then you just need your national identity, proof of residence, and proof of your income.

How to apply for Medicaid orthodontic coverage?

Here is how to apply for Medicaid.

• It is important to qualify the eligibility criteria before applying for Medicaid. Consult a dentist or an orthodontist to obtain a medical certificate that mentions this treatment is medically necessary.

• Some of the documents, like a national identity, your residence and income proof, and your social security number, are essential for Medicaid Orthodontic Coverage.

• Collect the documents that show the urgency and necessity of your dental treatment. These documents include a medical certificate, orthodontic X-rays, general health records, or scans of the dental issue.

• Wait for their assessment to be done. Once it's completed, you will receive a notification of what Medicaid can cover in your case.

Note: Check your state-specific coverage before applying for Medicaid.

Alternatives if you're not eligible for Medicaid orthodontic treatment

Wondering how to reduce braces costs if you didn't qualify for Medicaid? There are some affordable teeth aligning treatments that can fix your smile within your budget, including clear aligners. Aligners can help fix various dental problems, including crossbite, overbite, deepbite, teeth crowding, teeth spacing, midline, and edge-to-edge issues. Clear Braces can help you straighten your teeth from the comfort of your home more affordably and conveniently. They are a great alternative to braces for mild to moderate cases.

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Medicaid orthodontic coverage can significantly reduce the cost for those who qualify. It is recommended to have a detailed orthodontic examination and have the required documents before you apply. Orthodontic treatment necessity and urgency are really important to qualify for the eligibility criteria of Medicaid.
Insurance can also be useful as it can cover up to 50% cost of your orthodontic treatment under specific criteria. For mild to moderate cases, clear aligners are an effective option. For complex dental problems, braces can be beneficial. Remember, Medicaid often includes orthodontic treatment, but usually limited to medically necessary cases.

FAQs

What is the cheapest you can get braces? +

Braces cost vary depending on which type of braces is recommended by your orthodontist that suits your case. Generally, for traditional braces, it costs between $3,000 to $7,000.

How much do Americans pay for braces? +

Americans are paying approximately $3000 - $7000 for metal braces, $4000 - $8000 for ceramic braces, $3500 - $8500 for self-ligating braces, $8000 - $10000 for lingual braces, and $3000 to $8000 for clear aligners.

Does health insurance cover braces USA? +

Yes, if you have dental insurance, braces can be covered by it. Most insurance plans cover 20% to 50% in each case.

Why are braces so expensive in the US? +

Braces are expensive because of the high cost of orthodontists' salaries, the labor-intensive nature of treatment, and the cost of materials and supplies.

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