How To Get Medicaid To Cover Braces

How To Find Low

So, what do you do if you don’t qualify for Medicaid, or your Medicare doesn’t cover your dental, but you can’t afford a private plan or to pay out-of-pocket for dental care?

People who don’t qualify for Medicaid normally don’t qualify for one of the following reasons:

• Income is considered too high
• Their state didn’t expand Medicaid under the ACA
• They aren’t legal citizens of the United States

If you find yourself in one of these categories, there are still ways to access low-income dental care, and find a dentist that provides low-income care.

Braces With Hoosier Medicaid Plan

In the state of Indiana, each Medicaid program has different criteria for determining if a person or family qualifies for coverage. Eligibility for Medicaid is based on various factors including income, assets, family size, medical need, or a combination of these factors.

If you want to get Braces with Hoosier Medicaid Plan, first you need to know what Hoosier Healthwise is. Basically, it is a health care program for children up to age 19, pregnant women, and low-income parents/caretakers residents of the state of Indiana. Under Hoosier Healthwise Health care is provided at little or no cost to Indiana families enrolled in the program. The Plan is sponsored by the state of Indiana and administered by the Indiana Family and Social Services Administration . Hoosier Healthwise covers a variety of health needs such as prescription, doctor visits, mental health care, dental care, medicine, Therapies, Family planning services, Nurse practitioner services, Nurse midwife services, Lab and X-ray services, Chiropractors, hospitalizations, and surgeries at little or no cost to the member or the members family.

The Childrens Health Insurance Program is a part of the Hoosier Healthwise program. It is for children up to age 19 whose families have slightly higher incomes. In the Childrens Health Insurance Program, members have to pay a low monthly premium for coverage as well as copays for certain services.

When Does Medicaid Cover Childrens Braces

Federal laws necessitate that all states provide dental benefits to children enrolled in Medicaid via the CHIP . Some of these benefits include:

1. Routine teeth check-ups.

3. Teeth Cleaning.

4. Relief from tooth pain and infection.

Medicaid only covers orthodontic treatment for persons 21 years and under when these services are deemed necessary by a physician.

However, medical conditions that qualify people for Medicaid coverage for orthodontic procedures vary state by state.

Medicaid usually pays for kids braces when required to correct a disease, injury, or handicapping malocclusion.

Dental problems that interfere with normal mouth functions such as chewing and swallowing and other routine activities may require braces to be fixed.

Such problems may include:

2. Cleft palate or lip.

3. Overjet protrusions.

5. Severe crossbites, underbites, and overbites.

6. Missing or extra teeth due to pre-existing genetic conditions

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Durable Medical Equipment Prosthetics Orthotics & Supplies Competitive Bidding Program

If you live in or visit a competitive bidding area and need an off-the-shelf back or knee brace thats included in the DMEPOS Competitive Bidding Program, you generally must use specific suppliers called contract suppliers, if you want Medicare to help pay for the item. Contract suppliers must provide the item to you and accept assignment as a term of their Medicare contract.

Visit Medicares supplier directory to see if you live in or are visiting a competitive bidding area, or to find suppliers who accept assignment.

Does Medicaid Cover Braces How To Qualify For Free Orthodontic Care

• Posted on 17/08/2022

Some Medicaid beneficiaries may have difficulty getting orthodontic treatments like braces, which can cost a lot if paid out of pocket.

This is because eligibility depends on your age, state of residence, and whether the procedure is medically necessary.

Here we explain how to confirm your eligibility for Medicaid braces coverage, what is considered medically necessary, and how to qualify for free orthodontic care.

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Braces And Orthodontic Care

Since Medicaid covers procedures that are medically necessary, orthodontic treatment is could be covered for children. If your child has an underbite, overbite, crossbite or severe crowding it might be time to consider braces for kids with Medicaid.

Orthodontic Evaluation

When a dentist that accepts Medicaid conducts an orthodontic evaluation on your child, they will determine a recommended treatment plan. As part of this, they assess whether Medicaid is likely to cover the orthodontic treatment or not. Medicaid knows that braces can be an important treatment to ensure lifelong oral health for kids. As a dentist that accepts Medicaid, we will manage the full Medicaid approval process which includes submitting the appropriate documents and patient records. Then, Medicaid examiners will look at what we submitted and determine if your childs recommended orthodontic treatment will be covered. Medicaid will notify you and our office if the treatment is approved or declined.

The American Association of Orthodontists recommend children receive their first orthodontic screening by the time they turn 7. At this age, major jaw and tooth alignment problems will be visible. As with any health intervention, the earlier a problem is identified, the easier it is to create a treatment plan and schedule. Some issues that are treated by braces include:

• Overcrowding of teeth
• Overbite and underbite

Benefits of Braces

Kinds of Orthodontic Treatment Available for Kids with Medicaid

Does Medicaid May Cover Braces For Adults

There are no federal mandates requiring state Medicaid programs to provide dental coverage to adults ages 21 and over. Whether or not Medicaid offers dental coverage, including braces, is entirely up to each state.

In most states, Medicaid at least covers emergency dental care for adults, but coverage of routine dental care for adults isnt as common. Even more rare is coverage of braces and other orthodontic services. Braces may be covered when needed to treat a broken jaw or other injury or an illness that affects the jaw. But Medicaids coverage of braces in adults is much more restrictive than for those under 21.

You can review a breakdown of Medicaid dental coverage for adults in every state.

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Does Medicaid Cover Braces

Medicaid provides health care benefits for many low-income families and individuals. Medicaid is a program that is funded jointly by the federal government and each individual state. With many children and adults today needing braces for dental correction, you might be wondering whether or not Medicaid covers braces. The answer depends on a few different factors. The place you live can have an effect on coverage as well as your specific diagnosis. If you need braces, then keep reading! We will give you all the details on whether they will be covered by Medicaid, as well as some other options for paying for them.

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.

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Medicaid Dental Coverage By State

As you can see from this table that shows Medicaid dental coverage by state, different benefits are given to those in the Medicaid base population and Medicaid expansion population.

People who fall into the Medicaid base population are those who were receiving Medicaid before the Medicaid Expansion Program under the Affordable Care Act.

People who fall into the Medicaid expansion population are those who began receiving Medicaid benefits after the ACA gave states the option to expand funding for Medicaid.

Services Covered With Hoosier Medicaid Plan

Hoosier Healthwise covers two benefit packages

Hoosier Healthwise Package A This is a full-service coverage plan for children and pregnant women. Members of Hoosier Healthwise Package A do not have any cost-sharing obligations.

Hoosier Healthwise PackageC This is a full-service coverage plan for children enrolled in the Childrens Health Insurance Program . Members of Hoosier Healthwise have to pay a small monthly premium payment and co-pay for some services based on family income.

A patient can have either Anthem BC/BS or MDWISE which is administered by Dentaquest. These two are the only plans that have Orthodontic services.

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Children’s Oral Health Initiative

The Centers for Medicare & Medicaid Services is committed to improving access to dental and oral health services for children enrolled in Medicaid and CHIP. We have been making considerable progress in our efforts to ensure that low-income children have access to oral health care. From 2007 to 2011, almost half of all states achieved at least a ten percentage point increase in the proportion of children enrolled in Medicaid and CHIP that received a preventive dental service during the reporting year. Yet, tooth decay remains one of the most common chronic childhood diseases.

To support continued progress, in 2010 CMS launched the Children’s Oral Health Initiative and set goals for improvement by FFY 2015. To achieve those goals, we have adopted a national oral health strategy through which we are working diligently with states and federal partners, as well as the dental provider community, children’s advocates and other stakeholders to improve children’s access to dental care.

To support state Medicaid and CHIP programs in achieving their improvement goals, we developed Keep Kids Smiling: Promoting Oral Health Through the Medicaid Benefit for Children and Adolescents. It provides an overview of the children’s dental benefit in Medicaid, support for evidence-based policies at the state level, and details of successful strategies with state examples.

Free Braces When Pregnant

It is perfectly safe to get braces while pregnant. There are certain things to consider if you plan on getting braces treatment while you are expecting a baby: gum inflammation, headaches, and increased plaque growth are common side effects of both braces treatment and pregnancy. Talk to your orthodontist about when to begin braces treatment if you are also pregnant or planning on becoming pregnant.

If you qualify for Medicaid or another state-sponsored insurance plan, you may be able to get your braces covered as an adult. In the UK, the NHS specifically covers braces treatment for pregnant women, but in the U.S. your pregnancy does not impact whether or not your subsidized insurance will help pay for braces.

If you have Medicaid or a state-sponsored insurance plan, schedule a consultation to find out if your condition may qualify for braces coverage.

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How Much Does Medicaid Cover Braces

Kids braces usually cost around $3,000 to $7,000, but this price range may vary as there are different types of braces. Medicaid dental coverage often pays a portion of the full cost of orthodontic treatment.

However, if your childs treatment isnt classed as medically necessary for orthodontic coverage, you may buy a supplemental orthodontic insurance plan with affordable monthly payments.

To save money, you could also opt for the least expensive orthodontic treatment option, metal braces.

Why Kids Need Braces

Kids can need braces for any number of reasons, including crooked, overlapping, or overcrowded teeth, or a bad bite . Malocclusion is when theres a difference in the sizes of the top and bottom jaws. When the upper jaw is bigger than the lower jaw, its called an overbite. When the lower jaw is bigger, its called an underbite.

Sometimes tooth and jaw problems can be caused by losing baby teeth too soon, accidents, or habits like thumb sucking. But often theyre inherited, so if you or someone in your family needed braces, its likely that your kids will, too.

Often, your childs dentist will be the first to notice problems during a regular visit and recommend that you see an orthodontist . The orthodontist can decide whether your child does indeed need braces and which devices would be best.

Theres no set age for a childs first orthodontist visit some kids go when theyre 6, some kids go when theyre 10, and some go while theyre teens. Even adults can need orthodontic treatment. Many orthodontists say kids should see an orthodontist once their permanent teeth start coming in, around age 7. At this age, issues such as uneven bite and overcrowding will become apparent.

Starting the process early doesnt mean a child will get braces right away. It just means the orthodontist will be able to find problems and decide the best time to start treatment.

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Does Medicaid Cover Invisalign

No, unfortunately, Medicaid does not cover Invisalign. Medicaid coverage is limited to metal braces only. Metal braces are typically the cheapest option when it comes to orthodontic care. Most health insurance plans or dental insurance plans provide lower benefits for Invisalign and other cosmetically appealing options.

Metal dental braces might not be the most aesthetically appealing option for some people, but those are the only braces that will usually be covered by Medicaid. Some private or group healthcare coverage might still provide benefits for Invisalign or clear braces. However, Medicaid will typically not provide any coverage for those devices. So, if you opt for something other than metal braces, you might be stuck paying the entire cost on your own.

How To Get Free Braces With Medicaid

In a very small number of cases, adults may get free braces from Medicaid. First, you have to qualify for Medicaid. If you do, then you have to be able to prove that your malocclusion is negatively affecting not just your mouth, but your overall health.

If you can prove this, then braces could be covered under the health insurance component of Medicaid not under dental.

Examples of health problems that could be fixed with orthodontic treatment include:

• Repositioning teeth after a non-biting accident
• Treatment for sleep apnea
• Treating temporomandibular joint disorders

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How Can I Get Braces With Medicaid

First, it is important to understand that Medicaid will only cover orthodontic braces for children under 21. There are some new dental benefits of Medicaid braces for adults but this does not extend to braces or orthodontics. So if you are an adult with Medicaid and want braces, while our Medicaid orthodontist can definitely support you, it is important to understand that Medicaid insurance may not help you with the costs associated with braces. However, this is why we have a large variety of payment options

Moreover, if your orthodontic needs are declared medically necessary, we will help you find out if your Medicaid insurance will cover the costs for braces. Even though your childs braces may not be completely free, but Medicaid orthodontic coverage can help pay for most of the costs. Additionally, It is important to note that Medicaid will not cover adult braces for free.

The First Orthodontist Visit

At the first visit, the orthodontist will thoroughly examine your childs teeth, mouth, and jaw. He or she may ask your child to bite the teeth together and may also ask questions about whether your child has problems chewing or swallowing, or has ever had clicking or popping of the jaw.

The orthodontist may take X-rays of the mouth and teeth to see how the teeth are positioned and whether any permanent teeth still need to come in. He or she also may make a mold of your childs teeth by pressing a tray of gooey material into the top and bottom teeth. When the mold is removed and the material hardens, the result is a replica of your childs teeth that will allow the orthodontist to decide which treatment options are best.

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How Much Do Braces Cost With Insurance

Braces with insurance cost on average $3,407 out-of-pocket according to this report from CostHelper. However, this price can varyyou may pay less if you only need slight adjustments. Or, you may need to pay more if you need a lot of work done.

While upwards of $3,000 may sound like a lot, it’s still quite a bit less than what you could pay, considering orthodontic treatment can cost as much as $13,000 for the most expensive types.

Fortunately, there are ways that you can bring the price of braces with insurance down even further, which we’ll go over in a bit.

Criterias For Braces With Hoosier Medicaid Plan

Members meet the criteria for medical necessity for orthodontic care when it is part of a case involving treatment of craniofacial anomalies, malocclusion caused as the result of trauma, or a severe malocclusion or craniofacial disharmony that includes but not limited to:

• Overjet equal to or greater than 9 mm
• Reverse overjet equal to or greater than 3.5 mm
• posterior crossbite with no functional occlusal contact
• Lateral or anterior open bite with either palatal trauma or mandibular anterior gingival trauma
• One or more impacted teeth with an eruption that is impeded
• Defects of cleft lip and palate or other craniofacial anomalies or trauma
• Congenitally missing teeth of at least one tooth per quadrant

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