Does Medicaid Cover Orthodontics?

Orthodontics is a branch of dentistry that mainly deals with various types of teeth or bite misalignment. Many people think that an orthodontic treatment is only needed for cosmetic improvements. However, often, an orthodontic treatment is necessary to improve the oral or general health of a patient. So, in this case, does Medicaid cover orthodontics? Please read our article to learn about what types of orthodontic issues might be covered by Medicaid.

 

Does Medicaid Cover Orthodontics?

In some cases, Medicaid can cover orthodontic treatments. However, typically, the coverage will only apply if this type of treatment is strictly necessary from the medical point of view. If you are planning to undergo an orthodontic treatment for aesthetic purposes only, Medicaid is unlikely to cover it. Also, the coverage can sometimes have an age limit, meaning that only children under a certain age can receive financial aid, while adults might have to pay the full price out of pocket, even if the issues are severe. 

Rules and limitations for Medicaid coverage of orthodontic treatment may vary from state to state. Medicaid coverage for orthodontic treatments is typically decided on a case-by-case basis. Some of the factors that can be considered when determining if a patient can be approved for a Medicaid orthodontic treatment coverage include:

• A patient under 21 years of age and is eligible for pediatric dental services.
• Orthodontic issues have a significant negative impact on the oral and general health of a patient or cause functional problems.
• A patient requires emergency orthodontic care, for example, to relieve acute pain and stop tissue bleeding or infections that pose a threat to the overall health of a patient. 
• A patient is eligible for dental insurance coverage based on the level of income, the size of the family, or special healthcare considerations.

Orthodontic treatments approved for Medicaid coverage typically include basic options such as traditional metal braces. Medicaid is unlikely to approve any extra and cosmetic features such as colored braces, porcelain braces, Invisalign, etc.

 

Types of Orthodontic Issues That Medicaid Might Cover

Types of orthodontic issues that Medicaid might cover include:

• Teeth crowding that causes such issues as gum disease, tooth decay, or other chronic conditions, especially if they result in other general health problems. For example, if chronic gum disease is correlated with diabetes, heart, lung, or joint issues.
• Crossbite, underbite, or open bite that causes functional problems, TMJ disorder, chronic pain, etc.
• Cleft lip and palate—improper development of the lips or mouth.
• Craniofacial abnormalities—various defects that affect the development of the head and facial bones.
• Severe overjets (more than 9 mm)—a condition when the front teeth stick out at an angle.
• Severe traumatic deviation— bone or tissue loss due to various trauma.
• Life-threatening sleep apnea caused by orthodontic issues.

 

How to Apply for Medicaid Orthodontic Coverage

Understanding the ins and outs of medical insurance can be tricky and frustrating. Below, we list the main steps you can take to make the process more straightforward and less complicated.

• Go through a list of Medicaid eligibility requirements in the state where you live and make sure that you fit those requirements.
• Consult your dentist and other doctors, if applicable, to determine if an orthodontic treatment can be considered strictly medically necessary in your case.
• Gather all the documents necessary for applying for Medicaid coverage. Such documents typically include identification documents, proof of residency, proof of income, and social security numbers. 
• Collect the documents that prove the medical necessity of your orthodontic treatment, such as a document from your orthodontist and other medical specialists, photographs, x-rays, or scans of the dental issue, dental and general health records, etc. 
• Fill in and submit the Medicaid application along with the documents that prove the medical necessity of the treatment. In most cases, three main ways of applying are available: in person at a Medicaid office, by mail, or online.
• Wait for your Medicaid coverage to be approved. After the necessary assessment of your case is complete, you will receive a notification with the details of the services that Medicaid can cover. 

After you receive the confirmation of Medicaid coverage, you can schedule an appointment with an orthodontist approved by Medicaid.

 

Make an Appointment at Glendora Family Dentistry

Make an appointment with a reliable dentist at our office. We will conduct the necessary examination to determine if orthodontic treatment can be considered a medical necessity in your case and provide you with the documents proving the condition. Our specialists look forward to your visit.