Does Alabama Medicaid Cover Braces

Eight Insurers Offer Stand

In 2022, there are eight insurers that offer stand-alone individual/family dental coverage through the health insurance marketplace, with coverage available for both adult and pediatric dental services. These are dental plans that are not included with a medical plan and must be purchased separately:

• Truassure Insurance Company

These plans can be purchased through HealthCare.gov during open enrollment or during a special enrollment period triggered by a qualifying life event. Exchange-certified stand-alone dental plans are compliant with the ACAs rules for pediatric dental coverage.

Are Braces Covered By Medicaid

This information is current as of July 3, 2022.

Being born with perfectly straight teeth isnt 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.

Are braces covered by Medicaid?

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 its 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, lets cover Medicaid dental coverage in detail.

State Oral Health Action Plans

To support the Oral health Initiative, CMS invited state Medicaid agencies to develop State Oral Health Action Plans as a roadmap to achieving in their goals.

CMS has received SOHAPs from the following 25 states: Alabama, Alaska, Arizona, California, Connecticut, District of Columbia, Delaware, Florida, Maine, , Massachusetts, Michigan, Missouri, Nebraska, New Hampshire, New Jersey, North Dakota, Oklahoma, Pennsylvania, Tennessee, Utah, Vermont, Virginia, Washington and Wyoming. CMS encourages the remaining 29 states to develop and submit their SOHAPs, and CMS stands ready to provide technical assistance to any state that requests it.

SOHAPs may be submitted using either a CMS-developed Oral Health Action Plan Template or a user-friendly template developed by the Medicaid-CHIP State Dental Association. Completed SOHAPs may be submitted to Andrew Snyder, Health Insurance Specialist via email to with a copy to your CMS Regional Office contact. Any questions about the SOHAPs may also be directed to Mr. Snyder.

Also Check: Dentist In Woodbridge Va That Accept Medicaid

All Kids Insurance For Children

Access to healthcare is vital. Children need to be healthy to reach their full potential. To stay healthy, children need to have regular checkups, vision and dental care, and get medical attention if they get sick or injured.

ALL Kids is a low-cost, comprehensive healthcare coverage program for eligible children under age 19. Benefits include regular checkups and immunizations, sick child doctor visits, prescriptions, vision and dental care, hospitalization, mental health and substance abuse services, and much more.

ALL Kids uses Blue Cross Blue Shield of Alabama to provide medical, and mental health and substance abuse services through their preferred provider network . Find a provider now.

What Do You Want To Do?

Typical Cost Of Braces

If your child needs braces, you should will have to cough out some $3,000$10,000. Quite naturally, its impossible to pin a particular figure as the price of braces. The price could fluctuate as a result of many factors such as the presence or absence of insurance coverage the amount of time the braces is to be worn the existence of broken or loose wires, cracked brackets and other complications the type of braces chosen and the severity of the dental conditions like an overcrowded teeth or a bad bite.While people with Medicaid pay lower for braces, with privately-insured patients paying around $3,500 because of their partial coverage for orthodontic treatment, those without Medicaid or those whose Medicaid cannot cover cosmetic dentistry, can expect to pay close to $6,000 for childrens braces.

Don’t Miss: Is An Iud Covered By Medicaid

Other Ways To Finance Your Braces

Some of the most popular ways to finance braces not covered by Medicaid include:

• Dental insurance: Some insurance plans with orthodontic coverage may offer 30 to 50% off braces
• Payment plan: You may be able to work out a payment plan with your dentist so that you can split your payments up over time
• Savings plan: A savings plan can give you a set discount on dental treatments
• Orthodontic school: Licensed dentists going through orthodontic school need to complete their training on real-world patients and may do so for a discount
• Dental loans: If you’re sure you can pay it back, a dental loan can give you the money for your treatment upfront
• Local health center: Your local health center can inform you if there are any charitable care options in your area

Dental Benefits For Children In Medicaid

Medicaid covers dental services for all child enrollees as part of a comprehensive set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment benefit. Though oral screening may be part of a physical exam, it does not substitute for a dental examination performed by a dentist. A referral to a dentist is required for every child in accordance with the periodicity schedule set by a state.

Dental services for children must minimally include:

• Relief of pain and infections
• Restoration of teeth
• Maintenance of dental health

The EPSDT benefit requires that all services must be provided if determined medically necessary. States determine medical necessity. If a condition requiring treatment is discovered during a screening, the state must provide the necessary services to treat that condition, whether or not such services are included in a state’s Medicaid plan.

Each state is required to develop a dental periodicity schedule in consultation with recognized dental organizations involved in child health care. Dental services may not be limited to emergency services for children entitled to EPSDT.

You May Like: Medicaid Where’s My Ride

Save Even More With Recommended Resources And Amazon Deals

Are you looking to save on additional items? You may want to check out our Recommended Resources page. For example, you can learn how to and use your EBT card.

Ally is responsible for researching, copywriting, and editing content at StandUp Wireless. She has extensive experience contributing to advertising and marketing campaigns for Tech Data, Bright House Networks, TV, telecom, internet, home security, cybersecurity, and retail. As a freelance author, Ally has penned six celebrity biographies for young readers.

Did you know?

Who Can Get Orthodontic Treatment With All Kids

If your child is covered under All Kids dental insurance, he or she may qualify for assistance in receiving orthodontic treatment! First, your child must be pre-approved for braces before being able to begin treatment. The orthodontic consultation to determine your childs eligibilityas well as the X-ray images, photographs, models of their teeth, etc.is complimentary under the All Kids program.

After this initial consultation, All Kids will be able to determine if your child is eligible for treatment. Certain criteria make make your child ineligible: for example, if your family is covered with Medical Card insurance, you will need to check with your provider to see if your child qualifies. Also, your child must be under the age of 20 and have moderate to severe orthodontic issues. The process of determining their eligibility usually takes 3-4 weeks, and you will be contacted directly by the All Kids administrators after your consultation.

Recommended Reading: Does Idaho Medicaid Cover Vision

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.

This can 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 less likely to be considered.

Some states do 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.

What Is The Best Dental Insurance For Seniors On Medicare

Determining which dental insurance plan is best for you requires a consideration of your specific needs and preferences. It all boils down to what aspects of dental coverage are most important to you, be it the cost, network size or benefits that address specific dental issues that concern you most. Start by narrowing your plan options based on your geography and budget. Next, you can compare various plans customer satisfaction ratings, coverage limits and more. Its also worth researching the top dental insurance providers before enrolling in coverage.

Don’t Miss: What Is The Best Medicaid Insurance

Other Options To Pay For Braces

So, if Medicaid wont pay for your braces, what other options do you have for payment? First, you should know that Medicare is not usually an option eithereven for those with disabilities. Original Medicare does not provide any dental benefits, and that also applies to orthodontic care. Remember that there are bigdifferences between Medicare and Medicaid. Medicare is available for seniors and people with disabilities, while Medicaid provides health coverage for low-income families.

One option that many people use to help pay for braces is a payment plan. You can ask your orthodontist about any payment plans they may offer to help you spread out the cost of your braces. Many offices will offer a free consultation where they can discuss your treatment options as well as the types of payment plans they offer.

Another option for getting affordable braces is to visit a dental school near you. Students in dental school often need to perform certain procedures, and many dental schools allow people to utilize these services at little or no cost. This could be a great way to get braces at an affordable rate.

What Is Medicaid And What Does It Cover

Medicaid is a government-funded program that ensures affordable health care is made available to families and individuals. This includes eligible adults, children, pregnant women, elderly adults, and people with disabilities. This program offers healthcare benefits to low-income families and individuals who may need assistance with affording healthcare coverage.

Children who are covered by Medicaid are entitled to Early and Periodic Screening, Diagnostic, and Treatment services when they go to the dentist. Meaning children with Medicaid must receive dental care that provides the following:

• Regular dental care maintenance, including teeth cleanings and checkups
• Tooth restorative care
• Pain and infection management or treatment

Find out if your family qualifies for Medicaid or CHIP here. You can find out if coverage includes the cost of braces. Many times, Medicaid covers dental care and orthodontic services, like braces, when they are deemed medically necessary for your child.

Medicaid will typically cover children 21 and under with orthodontic needs, that are deemed medically necessary. Scheduling a no-cost consultation can help you find out if this is an option for your family and if Medicaid can help with the cost of braces.

Kool Smiles partners can schedule a no-cost orthodontic consultation to help you figure out if your childs braces are considered medically necessary and if Medicaid can cover some of the cost.

You May Like: Vision Care That Accepts Medicaid

When Medicaid Covers Braces For Children

Medicaid covers braces for children more frequently than for adults. The Early Periodic Screening, Diagnosis, and Treatment program requires states to pay for orthodontic services necessary to prevent disease, promote oral health, and restore oral structures to health and function.

In other words, each state can come up with a unique standard as this definition leaves plenty of room for interpretation.

About All Kids Health Care Coverage:

• As soon as your child is enrolled in ALL Kids, you will then choose a doctor and dentist.
• When your child needs medical and dental care, you must use a Blue Cross and Blue Shield of Alabama Preferred Provider Organization provider.
• The PPO network is a group of doctors, dentists, pharmacies, hospitals and outpatient facilities enrolled as BCBSAL providers to offer services to ALL Kids enrollees at special, prearranged rates. There is no deductible when you use a PPO provider. Some services may require a small copay.
• A copay is a small fee you may have to pay up front when your child sees the providers. Depending on which coverage bracket your child qualifies for, some services may require a copay. Your copays are determined by the ALL Kids fee group your child is in. There are no copays for preventive services like regular check-ups, immunizations, dental cleanings and vision exams.
• You can choose any doctor who is enrolled as a BCBSAL PPO provider. To find a preferred provider in Alabama, you can look in your ALL Kids Preferred Provider Directory, call the Blue Cross and Blue Shield of Alabama dedicated customer service number, , or visit Blue Cross and Blue Shield of Alabama.

Read Also: How To Recertify For Medicaid

Average Cost Of Braces With Insurance

Most dental insurance plans dont cover braces or other orthodontics for adults. Some providers offer an add-on orthodontic insurance plan that may offer coverage. If your insurance does fully or partially cover the price, they will likely only cover you if your braces are deemed medically necessary.

Most dental insurance providers will at least partially cover braces for children under 18 if braces are deemed to be medically necessary.

Your insurance provider is most likely to cover the cost of traditional metal braces. If you choose to get a more expensive type of braces, many providers like Delta Dental have you pay the difference.

For example, if your insurance provider covers 50 percent of the cost of basic braces but doesnt cover other types of braces, heres how much you might end up paying.

Medicaid/chip Dental Coverage In Alabama

For adults enrolled in Medicaid in Alabama, there is no dental coverage provided for any level of care. For fully eligible children , Medicaid in Alabama does provide routine preventive and restorative services.

For children in Alabama, there is ALL Kids , a program which provides coverage to children and pregnant women with income above the eligibility limits for Medicaid. ALL Kids enrollees are able to receive up to $1,500 in covered dental benefits per year.

You May Like: Is Unitedhealthcare Community Plan The Same As Medicaid

Does Ky Medicaid Pay For Dentures

Currently, Kentuckys Medicaid enrollees have automatic access to dental insurance.

But the new plan requires patients to earn what the state calls My Rewards account dollars to pay for dental services, like a dental cleaning or filling.

Or, they have the option of sending patients away until they can pay.

Also Check: Does Medicaid Cover Mental Health Treatment

What Type Of Dentures Are The Best

Contents

In terms of stability, snap-on dentures are best. These dentures securely sit in place with the help of anchors on existing teeth or dental implants. To see also : Can I remove my own tooth?. These dentures are suitable for a patient without teeth, but who has enough bone tissue to support the implant.

Which dentures look the most natural? Plastic teeth will always have that artificial look, and even some of the ceramic teeth can often have a very flat look. The prostheses created by Eldridge Dental and Glidewell laboratories have a textured surface that helps them become prostheses of the most natural appearance in all light conditions.

You May Like: Doctors That Accept Medicaid In Chicago

Recommended Reading: Can College Students Qualify For Medicaid

Dental Benefits For Children In Chip

States that provide CHIP coverage to children through a Medicaid expansion program are required to provide the EPSDT benefit. Dental coverage in separate CHIP programs is required to include coverage for dental services “necessary to prevent disease and promote oral health, restore oral structures to health and function, and treat emergency conditions.”

States with a program may choose from two options for providing dental coverage: a package of dental benefits that meets the CHIP requirements, or a benchmark dental benefit package. The benchmark dental package must be substantially equal to the the most popular federal employee dental plan for dependents, the most popular plan selected for dependents in the state’s employee dental plan, or dental coverage offered through the most popular commercial insurer in the state.

States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on InsureKidsNow.gov.

Renal Dialysis For Kidney Failure

For those with kidney failure, AL Medicaid will cover 156 yearly outpatient dialysis treatments per year, which amounts to three per week. Keep in mind that if you are diagnosed with kidney failure , you will also qualify for Medicare! That means that you can get double the benefits with a D-SNP, or Dual Special Needs Plan.

Don’t Miss: How Much Does Medicaid Pay For Family Caregivers

What Is Periodontal Disease

Periodontitis, also known as periodontal disease, is characterized by inflammation of gum and bone tissue. If untreated, the disease can lead to tooth loss and chronic inflammatory diseases like diabetes and cardiovascular disease, for example. Scheduling regular dental exams and having your teeth professionally cleaned is a great way to avoid developing periodontal disease. Regular teeth cleaning also provides the following benefits.

• Brighter smile Having your teeth professionally cleaned by a hygienist or dentist is a great way to get rid of food, drink, or tobacco stains that may be keeping your teeth from being as white as they could
• Bad breath Professional cleanings can remove the bacteria and tartar that contributes to bad breath.
• Improved overall dental health Whether you realize it or not, dental health is inextricably tied to bodily health, which means that a clean mouth can help keep you healthy.

Home / FAQs / Medicare Coverage / What Dental Services are Covered by Medicare

If youre a Medicare beneficiary, you might wonder if dental services are covered. Unfortunately, Original Medicare doesnt cover routine dental. But, you can buy a dental plan alongside Medicare to pay for cleanings, exams, and dental care. Another option is an Advantage plan with dental benefits. Were here to help you make the right decision for your dental care needs and explain when Medicare covers dental services.