Does Medicaid Cover Braces?
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Table of Contents
- Key Facts
- Medicaid Plans
- Braces Coverage
- Orthodontic Insurance
- Paying for Orthodontic Care
- Other Options
- Medicaid for Braces FAQs
The answer is that it depends. Medicaid is a health-care program run by the federal government, but coverage varies from state to state.
Under federal guidelines, all states must provide dental coverage to children under Medicaid and the Children’s Health Insurance Program (CHIP). This means states must pay for children’s dental braces and orthodontics if the treatment is deemed medically necessary.
Adult orthodontic coverage is not mandated by federal guidelines. In some states, Medicaid will pay for adult orthodontic care if it is deemed medically necessary. Other states provide no orthodontic care coverage for adults through Medicaid.
There are additional areas of uncertainty as well. Different states may determine what is categorized as “medically necessary” differently. Age limits may also vary. Some states consider anyone under 18 years old a child, while others consider children to be under the age of 21.
Key Facts about Medicaid & Braces
- Medicaid is a federally-run health-care program, but coverage (including dental coverage) varies by state.
- The Children’s Health Insurance Program (CHIP) requires that all children covered by Medicaid receive dental coverage and care for any dental issues that are deemed a medical necessity. This may include braces.
- Adult dental care coverage through Medicaid is not mandated by federal guidelines. Some states provide no dental coverage or emergency coverage. Others provide comprehensive adult dental care, which may include braces if they are deemed medically necessary.
- For those who are seeking orthodontic services that aren’t covered by their Medicaid, low-cost options may include dental schools, low-income braces programs, grants, community organizations, and payment plans.
Medicaid Health Plans
As of June 2020, 68 million people in the United States receive health-care coverage through Medicaid. Medicaid provides affordable health coverage to qualifying low-income adults, children, elderly individuals, people with disabilities, and pregnant women.
For adults, dental care coverage varies by state. States can choose whether they provide dental benefits or not.
Children covered by Medicaid automatically receive dental benefits.
These basic dental services must be provided to children covered by Medicaid:
- Dental health maintenance
- Pain relief services
- Treatment of infections
- Teeth restoration services
Medicaid Coverage for Braces
Medicaid coverage for braces and orthodontic treatment is based on state funding, and coverage options vary from state to state. There is no standard for Medicaid treatment and braces coverage, however. To be considered for braces, the treatment must be considered medically necessary.
Medicaid coverage for braces is very different between children and adults because of the Children’s Health Insurance Program (CHIP).
When does Medicaid Cover Braces for Children?
CHIP guidelines require that children covered by Medicaid receive the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Through this screening, any problems needing treatment that are deemed medical necessities must be identified. The child must then be referred to a qualifying dentist or specialist for treatment.
Malocclusion (teeth misalignment) should qualify as a medical necessity and be covered under Medicaid if it’s an orthodontic issue requiring treatment. If the dentist or orthodontist that the child is referred to prescribes braces treatment for the misalignment, there should be coverage under Medicaid.
As an alternative to Medicaid, some states provide braces for low-income children. To find out if you live in one of these states, contact your Medicaid caseworker or state health department.
When does Medicaid Cover Braces for Adults?
Compared to children, adults may have a harder time getting coverage for braces treatment with Medicaid.
According to Medicaid.gov, less than half of states currently provide comprehensive dental care to adults. Most states provide some level of coverage for emergency dental services, but there are no minimum requirements or orthodontic coverage.
States that offer orthodontic services for adults through Medicaid will usually only do so when it is considered a medical necessity.
Each state may define what they consider a medical necessity differently. Some may include the following dental issues:
- Malocclusion due to trauma or injury
- Craniofacial abnormalities or deformities
- Misaligned teeth in conjunction with another medical condition or syndrome
- Malocclusion deemed to be severely handicapping and impacting physical and/or emotional well-being
- Congenital conditions, such as cleft palate or missing teeth
- Overjet and reverse overjet of specific measurements
- Crossbite in the back of the mouth that keeps teeth from matching up
It can be difficult to know what is going to be considered medically necessary and therefore what will be covered through Medicaid. Generally speaking, dental conditions causing extreme difficulties with everyday life, such as problems eating or talking, are most likely to be considered medically necessary.
Braces for aesthetic purposes are unlikely to be considered necessary.
If the cost of braces is not covered by the Medicaid plan in your state, you could purchase a supplemental orthodontic insurance plan. Even major medical insurance plans rarely include orthodontic coverage for adults and only some offer coverage for children under 18.
Supplemental orthodontic insurance for braces covers the cost of braces for reasons beyond just medical necessity, such as the following reasons:
- To straighten teeth
- To close spaces between teeth
- To correct bite irregularities
- To properly align lips and teeth
Orthodontic insurance plans can help to greatly reduce the overall cost of braces, though they will not likely cover the full cost. These plans are meant to supplement the costs of devices, like braces, that are used to fix abnormalities in the teeth or jaw. Orthodontic insurance plans are offered by most major insurance companies.
How to Pay for Braces or Other Types of Orthodontic Care
Braces can come with a price tag of up to $8,000 or more. Few families have the financial means to pay that much out of pocket.
Fortunately, there are ways to make the cost of braces more affordable. Consider these ways to get braces at a lower price tag:
Apply For Free Braces
Apply For A Medicaid Or CHIP Grant
Visit A School Dentistry Program
Ask About A Payment Plan
Medicaid insurance offers affordable health coverage for millions of Americans. Unfortunately, braces are not typically covered by Medicaid. If you or your child needs braces, you may need to get creative about how you pay for them.
Before you pay thousands of dollars out of pocket for braces, explore some of the available options to reduce the costs. If those options don’t work out, you can always purchase a supplemental orthodontic plan.
You can also look into other forms of orthodontic treatment that are more affordable, such as doctor-monitored, at-home aligners. You may be able to get the straight smile you want with a shorter treatment timeline and lower overall cost than braces. While some cases of misalignment may be too severe to correct with clear teeth aligners, this form of tooth straightening works well for most people with mild to moderate cases of misalignment.
Medicaid for Braces Frequently Asked Questions
Does Medicaid cover braces for an overbite?
When are braces considered medically necessary?
Dental braces are considered medically necessary when they treat a condition or prevent a condition, injury, or symptoms. The condition treated by orthodontic braces must affect oral health or interfere with chewing or speech.
Examples of instances deemed medically necessary include using braces to reposition teeth to restore optimal chewing function, making bite adjustments to treat temporomandibular joint disorders, or preventing sleep apnea due to teeth restricting airflow.
Comparison of Orthodontic Medicaid Funding in the United States 2006 to 2015. (August 2017). Frontiers in Public Health.
Dental Care. Medicaid.gov.
Organizations That Help Low-Income Children to Get Braces. (July 2017). Pocket Sense.
Supplemental Orthodontic Insurance for Braces: A Must-Have. (June 2020). Health Markets.
Coverage of Medicaid Dental Benefits for Adults (June 2015). Medicaid and CHIP Payment and Access Commission.
Does Medicaid Cover Dental Care? (May 2012). U.S Department of Health and Human Services.
Medicaid and Medicare Enrollees Need Dental, Vision, and Hearing Benefits (December 2020). Center on Budget and Policy Priorities.
Does Medicaid Cover Braces for Adults & Kids in Your State? (April 2021). Growing Family Benefits.