Are Braces Covered By Medicaid?
This information is current as of July 3, 2022.
Being born with perfectly straight teeth isn’t common, thus the overwhelming demand for teeth correction treatments like braces. For those who qualify for Medicaid, it may get you thinking about whether Medicaid can cover the cost of your braces.
If you cannot function properly without the help of braces, Medicaid will likely be able to cover the cost of your braces. However, it depends on several factors, including your age and home state. Children are more likely able to get Medicaid support for braces than adults.
While we know that it’s possible for Medicaid to cover the cost of braces, there are still numerous factors in deciding whether someone qualifies to receive Medicaid coverage for dental care. To help you gain a better understanding of getting braces through Medicaid, let’s cover Medicaid dental coverage in detail.
Introduction to Braces
Braces are devices that help straighten your teeth, and while you may know about them in general, you need to understand several aspects of braces, including why they can be expensive. You can expect to pay between $3,000 to $10,000 for braces if you pay out of pocket.
Type of Braces
Braces use specific types of materials, some being more expensive than others. For example, the most common braces are metal, costing around $3,000 to $7,500. Another type is ceramic, costing between $2,000 and $8,500. You can also choose to get Invisalign braces that are clear and easy to remove, costing $3,000 to $7,000.
The last type of braces you can get are lingual braces, which are a lot more expensive, ranging from $5,000 to $13,000. They are almost invisible and attach to the backside of your teeth rather than the front.
Braces are costly, even with the help of your insurance company. However, for children in the Medicaid program, there’s no need to worry as Medicaid should cover medically necessary orthodontic services.
Receiving braces as an adult can result in more costs, and it will require much longer for the braces to fix your teeth. Since you already form the shape of your bite during your teenage years, if you need braces as an adult, you’re likely to need them for a more extended period, almost 20 months.
Are Braces Covered By Medicaid? (In Detail)
Dental health is an essential element of your overall wellbeing. For children who are part of the program, Medicaid covers dental services such as the restoration of your teeth, dental health maintenance, and relief of any pain or infection in the teeth.
However, for adults, dental coverage under Medicaid depends on the state since federal law does not require dental benefits for Medicaid participants. To help you better understand whether you qualify as an adult, let’s look into a few individual states and what dental services they can cover for adults (21+).
Medicaid will cover around $500 annually for most dental care in adults, including a single visit, cleaning, one set of x-rays, and fluoride treatment. Depending on whether your dentist agrees you need treatment, Medicaid will cover fillings and tooth removal or pulling. Pending prior authorization, Medicaid may also cover dentures and surgical tooth pulling.
It’s important to note that dentures and tooth pulling fees are not against your $500 annual cap. However, you will only be able to get a single set in your lifetime. For $500, there aren’t any quality braces available so you may not be able to receive braces through Medicaid unless it’s a medical necessity.
In the case of an emergency or a life-threatening condition, Medicaid participants in Georgia can receive emergency dental treatment. However, this is on a case-by-case basis. You may not be able to receive the treatment if Medicaid decides it isn’t an emergency or life-threatening.
Braces are not usually considered emergency treatments, nor are there common life-threatening conditions that require you to get braces. You may not be able to receive braces under Medicaid. However, in the case of an emergency, then you could potentially qualify.
For those who live in Arizona, ALTCS and Tribal ALTCS members have a limit of $2,000 per person annually for any type of dental treatment. However, the $2,000 goes into different categories, and the first $1,000 is for any kind of diagnostic or preventative dental care. The other $1,000 is for any emergency dental care and extractions.
Due to the $2,000 maximum limit for dental coverage, it is doubtful that Medicaid would cover the cost of braces, usually $3,000 or more. Nonetheless, you may qualify for Medicaid coverage if it’s a necessary treatment.
In Pennsylvania, Medicaid coverage depends on numerous factors such as your age, eligibility category, and needs. Adults in Pennsylvania who enroll for Medical Assistance are eligible for surgical procedures and any emergency dental treatment for pain.
In addition, some adults are eligible to receive other forms of dental treatment. Regarding braces, adults are not likely to quality under Medicaid unless it is an essential treatment. However, it is on a case-by-case basis. If you’re unsure, speak to a representative, and they can give you more guidance.
South Dakota does provide limited dental coverage for those who participate in Medicaid. Adults have a limit of $1,000 per year for any dental treatment. However, medically necessary treatments, including emergencies and dentures, do not count towards the $1,000 limit.
Since South Dakota has a $1,000 limit, it’s doubtful that adults can qualify for braces under Medicaid. However, if braces are “medically necessary,” then you may qualify for help from Medicaid.
States That Provide No Dental Coverage for Adults
Despite many states covering some dental treatments for adults, some states cover no treatments whatsoever. If you live anywhere in the state of Tennessee, Delaware, or Alabama, then Medicaid does not cover any form of dental treatment for adults.
For any of the above states, you cannot receive braces with the help of Medicaid since the program doesn’t even cover emergency treatment.
Overall, Medicaid is a fantastic program that can cover a lot of dental procedures for children. However, it’s different for adults. If you qualify for Medicaid and think you need braces to function properly, speak to a representative to check whether braces are covered under Medicaid.
Frequently Asked Questions
Does Medicaid Cover Invisalign?
Invisalign braces are clear braces that can fit on top of your teeth. When you receive Invisalign braces, you get a custom pair from the dentist using a mold for your bite. Medicaid does not typically cover Invisalign treatment since it is partly cosmetic. However, your home state can make exceptions if Invisalign is medically necessary.
What Dental Service Does Medicaid Not Cover?
Depending on the state, Medicaid may not cover any type of dental treatment or only cover emergency dental treatment. For example, in Alabama, Medicaid does not cover dental care. However, Alaska, Florida, and Maine cover emergency dental services.
Does Medicaid Cover Braces for an Overbite?
Medicaid covers the cost of fixing an overbite for children. It also covers cases when a child has an underbite, crossbite, or severe crowding. In fact, the law requires Medicaid to cover the cost of braces for an overbite in children. For adults, it depends on your situation.
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