June 9th, 2016
Does Medicaid Cover Braces?
As a Medicaid Orthodontist we get a lot of questions all the time about Medicaid coverage and how it works for getting braces. Many folks don't realize that we are, to the best of our knowledge, the leading Medicaid Orthodontist in Colorado. As such, we thought we'd provide a little insight. It is indeed a bit complicated!
First and foremost, it is important to understand that Medicaid will only cover orthodontic braces for children under 21. While there are now some dental benefits for adults with Medicaid, this does not extend to braces or orthodontics. So if you are an adult with Medicaid and want braces, while we can definitely assist you, realize that your Medicaid insurance will not help with the costs.
For children under 21, however, Medicaid will pay for the costs of braces in full if they determine that the need for braces is medically necessary. You can have your child be evaluated for this medical necessity once per year. So if they get reviewed for braces and are denied, you can try again-- but you must wait one year in between evaluations. Typically they will allow three attempts. If they are denied before they have all their adult teeth, it may be a good idea, depending on your finances, to wait a year and try again. If they are denied after they have all their teeth, we typically can not apply again and it would likely be time to discuss private financing. (We offer a discount to these cases along with interest-free financing).
The process for the evaluation goes something like this. You would schedule an appointment with our office and make sure to tell the staff you have Medicaid coverage. It will be critical that you are still covered on the day of this initial appointment. At this first appointment, we will take the photos and X-rays needed by Medicaid for them to make an evaluation along with filling out a report for them detailing our findings. We send this into Medicaid. They evaluate the case and typically will provide their determination within four to six weeks. They will notify both our office and your family by mail. If they deny, and we noted in our report that the case was extremely severe, we may choose to appeal. If the appeal is denied, your family has the further right to appeal. If approved, you would call our offices and make an appointment. As long as you have Medicaid coverage on the day of the appointment, Medicaid will then cover the cost of treatment in full.
So when should you bring your kids? The American Association of Orthodontics says see your orthodontist for your first visit by age 7. There is a lot we can do at that early age-- see another blog post for more details on this.