Quite often people wonder whether or not Medicaid will cover the cost of braces for children or adults. For several years this was the case, but after spending over 700 million just for braces alone in Texas from 2008 to 2011, this all changed.
For the last couple of years, Orthodontics (braces) are no longer covered by the CHIP/Children’s Medicaid program or Medicaid for Texas, including McAllen, Edinburg and the Rio Grande Valley. The only exception to this is if there is a severe alignment problem where health is threatened, such as a cleft palate which requires surgery and braces as part of the treatment.
For children enrolled in Medicaid, the dental coverage ranges from relief from pain and infection to regular checkups. States must provide orthodontic services to children “to the extent necessary to prevent disease and promote oral health, and restore oral structures to health and function.”
Here’s a quote from the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) manual:
“Orthodontic services for cosmetic purposes are not covered.”
If Medicaid is not an option – What to do?
Without help from Medicaid, we understand that you need excellent options and here at A Perfect Smile Orthodontics, we offer in-house, very low interest financing that means braces can cost as little as $99 a month.
We also offer a no-cost consultation here at A Perfect Smile Orthodontics where Dr. Taylor will check out you or your child’s teeth and determine if you will benefit from braces or other orthodontic treatment..
Many PPO insurance plans offer some orthodontic benefits. The amount covered by insurance varies depending on the insurance plan. If your insurance plan does not cover the full amount for affordable braces, we offer no-interest financing and low monthly payments to make the balance affordable. To find out if you or your children can benefit from affordable dental braces just call us and schedule a FREE CONSULTATION and we will work with you to find solutions that work for you.
Hello I am 21 and have horizon nj health family care/Medicaid I have been recommended by my doctor to get a orthodontist consultations and braces. Today I called my insurance and they said they only cover until 20 years of age. I have seen on their website as well as here that it is 21 so there I am already confused. I am wondering if there is any other option for braces at my age in NJ. I made a consultation appointment but now feel need to cancel it because I’m not sure if that appointment is covered. Do you have any advice or know if I can get braces any other way?
I had called the orthodontist and I am 18 they told me I couldn’t because I’m turning 19 and I have Medicaid.
In Texas, Medicaid does not cover braces unless it is deemed a medical necessity, which is very rare. So it doesn’t really make a difference what age you are. As an option, we do offer a free consultation and interest-free financing with a low downpayment and monthly payments.
Is an open bite and jaw popping a medical necessity
You have to go in and get a free consultation. It really needs an exam to be sure. The orthodontist that sees you will be able to tell.
I am 14 with an overbite and crossbite it really makes my mouth,jaw,and head hurt will medicaid cover my braces
You would have to get a consultation from an orthodontist to find out. Locate an orthodontist near you who offers a free consultation. They will be able to determine your situation.
I’m 14 and I have a overbite and my jaw always hurts and pops, I also really need braces will my medicaid insurance pay for them?
Hi Sarah, The only way to tell is to find an orthodontist near you that offers a free consultation and go in and let them take a look. Medicaid is only covering instances where the braces are considered vital for your health and only a doctor examination can tell that.
I’m 61 I need major braces work 2years ago jaw was started wired shut for 4 months now 13 teeth are missing …214-564-9963 ROBERTO CAVASOS jr ..460-21-0920 medicade
Hi Roberto, I am really sorry to hear about what happened. Please call us and schedule a Free Consultation, so Dr. Taylor can see what can be done.
I’m in Ohio I’m 25 I was told that I need braces and it basically medically necessary but I have caresource and they said if you’re over the age of 21 they will not cover braces but I called Medicaid and they said if I have a pre-authorization form sent in that shows proof it is medically necessary no matter what my age is I should be able to get it I don’t understand why medicaid states they will and care source states they won’t
I am 40, have over crowding and need a jaw expander due to a small mouth. I also have spacing and a tooth on the bottom that’s pushed forward. My spacing is not bad and it’s on the bottom as well.I was told I need braces for my overbite. I have NJ Health Insurace with full dental coverage. What’s the cut off for braces? And Jaw expander? Fustrated
I understand your frustration. Sadly medicaid does not cover braces for anything except a medical necessity. Our understanding is that if you can chew and eat, then Medicaid considers straightening your teeth to be “cosmetic”. You would have to go to a local orthodontics. Try to find someone who offers free examinations. They would have to actually look at your teeth and made the adjudication.
I’m 13 years old and have medicaid. My family has low income due to only have a mom. I have crowded and lifted top canine teeth. What’s the cheapest we can get braces?
Dear Caroline, every area has its own best choices. But first talk with your mom and see if she can afford a payment plan. Then what you need to look for is something similar to what we offer, which is a no interest payment plan. Not a lot of orthodontists offer them, but if you can find one then this would be your best option.
Look up Donated Orthodontic Services of NJ. I paid a 200.00 processing fee, they found a orthodontist in my area to donate their services and my daughter got her braces free of charge.
I turned 18 in june i have an overbite & gaps in my teeth j have driscoll health plan will it cover braces
Hello! We cant answer that without more of your information. Give us a call and we will look it up for you and tell you.
I’m 21, unemployed and soon to be a mother with Medicare. My Medicare covers dental, would it also cover for my braces?
Unfortunately not. Medicare only considers braces to be cosmetic. There are instances where braces are needed for medical reasons and medicare will cover those. But for comfortable teeth, good looking teeth, Medicare will not cover. Because of this we do offer payment plans with low monthly payments.
Hi I’m 14 and I have a overbite with crowded bottom teeth, and I often bite my cheeks alot due to my teeth sticking out so far, willy Medicaid cover this for free, or is there some payment required
I am really sorry but its unlikely that Medicaid will cover it. Look in your area for an orthodontist that offers a free consultation and payment plans and then talk to your parents about it.
So my son who is 10 now has SSI Medicaid. He is experiencing a lot of problems with his mouth. He still have 4 youth teeth that has to be surgically removed because they are blocking his canine from coming through. However his canine are at a point they are trying pierce through his two top adult teeth. One of his youth teeth at the bottom has been shifted over by some of his adult teeth so that has to be surgically removed as well. The orthodontist want to put spacers and arms on his teeth to pull down his canine. My question is do I file a claim with Medicaid or does this fall under medically need act?
Dear RonAe,
We cant tell if this is a medical necessity without seeing your son. Find a local orthodontist that offers free consultations. Get copies of his regular dental records and take those. I would also recommend finding a board certified orthodontist if you can. This sounds like a complex question and its best answered after an in-person exam.
My daughter is 17yrs and has an overbite. She is has Medicaid. I don’t know if Medicaid will pay for a jaw reconstruction in the state of GA.
You have to find an orthodontist near you that offers a free consultation. They will be able to give you a better idea. The general concept is that Medicaid will only pay if its a medical necessity – in other words if a doctor requires it to be done for the patients health.
hey i am 14 and i have gaps between my teeth so i wanted to get braces, will NJ insurance cover the cost?
I am sorry we are in Texas and are not familiar with NJ. Here in Texas Medicaid does not cover, and that is probably true in NJ as well. But check locally.
I am 24 years of age and recently went to the denist due to very uncomfortable crowding. I have a tooth pushed on the roof of my mouth and teeth growing under my bottom molars due to my mouth being too small for all my teeth. My jaw aches and throbs and I’m constantly getting severe headaches that make me sick. My denist wants me to see a orthodontist for braces but I’m not sure Medicaid will pay for braces at my age. I have got to get some relief. U cannot live with these headaches anymore .
Medicaid only covers braces that are considered a medical necessity. You may qualify but only an orthodontist will be able to tell. Get a consultation and see what they say. We offer a free consultation with Xrays if you are in our area. If not, there is likely someone near you that can do that consult for you.
I’m 14 years old and have Medicaid when I lived in California a year ago medical covered my braces for free because it was a medical emergency and for financial issues we moved to Florida and have Medicaid do you think Medicaid will cover my braces for free? In California I only had them on for 3-4 months only. My mom is a single parent and is expecting a baby in August estimated yearly income is less than $25,000 probably $20,000 will my insurance cover the braces?