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Does Medicaid Cover Braces?

First of all, what is Medicaid?

Medicaid is a program supported by state and federal governments that carries affordable health coverage to qualified grown-ups, children, pregnant women, elderly adults and individuals with disabilities. This assistance program aims to provide healthcare benefits for low-economic families and people who will be unable to bear the cost of healthcare coverage otherwise.

Will Medicaid cover the cost of braces?

For children under 21, Medicaid will cover the expenses of braces in the event that the need for braces is medically necessary. Once every year, your child can be assessed to determine whether braces are medically necessary. That means if you’re denied one year, you can schedule another evaluation during the following year. Normally, they will permit three evaluation attempts.

The Evaluation Process

You would begin by scheduling a complimentary consultation with our office, and telling our team that you are in the process of receiving Medicaid coverage. When you arrive at your first appointment, we will take diagnostic photographs and X-rays required by Medicaid for them to make an assessment. We’ll create a report detailing our findings and send this information to Medicaid.

Medicaid will assess your case and provide a verdict within about four to six weeks. They will inform both our office and your family whether you’ve received Medicaid coverage. On the off chance that they deny, and we noted in our report that the case was extremely severe, we may decide to appeal. If the appeal is denied, your family has the further option to appeal.

If you’re approved for coverage, we can celebrate and begin treatment! As long as you have Medicaid coverage by the time you agree to start treatment, Medicaid will typically cover the expense of treatment in-full.

Although, it’s important to note that every case is different. Insurance coverage isn’t black-and-white, and everything is subjected to the insurance provider’s review.

Past Cases Deemed Medically Necessary

As you will still need the official opinion of a dentist or orthodontist to determine the medical or cosmetic need for braces, here are some examples of past conditions that Medicaid deemed medically necessary:

  • Cleft palate
  • Difficulty opening the mouth, usually caused by structural jaw issues
  • Problems eating or chewing normally
  • Experiencing speech impediments from tooth and jaw problems
  • Severe underbites, crossbites and overbites
  • Teeth that are positioned horizontally rather than vertically (also known as overjet)
  • Impacted teeth with an eruption
  • Teeth that are missing due to pre-existing hereditary conditions (such as hypodontia)

In short, yes Medicaid will cover braces as long as you or your child meets a number of requirements and it’s determined that treatment is medically necessary for your quality of life.

Please don’t hesitate to reach out to us with any questions about your insurance coverage, or ideas about how we can make your entire orthodontic experience a pleasant one!

At Cooper Orthodontics, Dr. Andrew Cooper and Dr. Justin Cooper and our incredible team are here for you and your family! Let us help you transform your smile into its healthiest, most radiant form. Book your free exam today or complete our online smile assessment from the comfort of your home.

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