Medicaid covers some healthcare costs, but those in need of braces may be frustrated to find out orthodontia is not always covered under Medicaid.
If someone pays out of pocket for braces, the cost could be thousands.
There are some circumstances that allow for Medicaid coverage and braces though.
When will Medicaid cover braces?
- location of residence
- medical necessity
If it is determined that braces are medically necessary, Medicaid will cover them.
What does medical necessity mean in terms of braces and Medicaid?
If the reason for wanting braces is for cosmetic reasons, then they won’t be covered by this healthcare.
Medical necessity includes
- cleft palate
- cross bites
A medical necessity is defined as, “a deformity that affects their oral health and or interferes with chewing or speech,” according to AS.
Children are able to get braces with more ease through the CHIP program.
Most cases of children receiving braces are not for medical reasons.
Medicaid, which CHIP goes through, will cover x-rays, imaging, office visits, the appliance, and follow-up care and retainers.
The cost can range from $3,000 to $7,300 for braces, with the potential for a reimbursement of up to $1,800 to $2,400.
Things like Invisalign won’t be reimbursed.
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