Does Medicaid cover braces?

Sometimes—but Medicaid usually only covers braces if they are medically necessary, and coverage depends on your age and your state.

Propel is the #1-rated EBT balance checking app

Download

When does Medicaid cover braces?#when-does-medicaid-cover-braces

In most states Medicaid can cover braces for children and young adults under age 21 through something called Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). Under EPSDT, Medicaid must cover healthcare services that are “medically necessary,” including dental care and orthodontic care like braces.

Adults 21 and over usually cannot get braces under Medicaid. Federal law does not require states to provide dental services to adults with Medicaid.

However, Medicaid is a state-run program, so some states may choose to provide dental care, including braces, to adults.

What makes braces medically necessary?#what-makes-braces-medically-necessary

In most cases, Medicaid is more likely to cover braces if there is a documented medical reason for treatment.

“Medically necessary” generally means the braces are needed to treat a condition that affects your health, function, or development, not just to fix how they look.

Common reasons a dentist or orthodontist may decide braces are medically necessary include:

• Severe misalignment that affects chewing, speaking, or breathing
• Jaw problems that cause pain, difficulty eating, or uneven wear on teeth
• Cleft palate or other craniofacial conditions
• Teeth that are impacted, missing, or severely overcrowded
• Dental issues caused by injury, disease, or developmental conditions

These types of issues can affect nutrition, speech, and overall development, in addition to dental health, which is why Medicaid may cover treatment in these cases.

To prove medical necessity most states require:

• An evaluation
• A severity score or screening tool
• Other documented proof that braces are medically necessary

Each state sets its own rules for covering braces, so the approval process can vary depending on where you live.

How to find out if your state covers braces#how-to-find-out-if-your-state-covers-braces

If you want to know if you are eligible to get braces with Medicaid in your state:

• Call your state’s Medicaid office
• Call the member services number on your Medicaid card
• Ask your dentist or orthodontist if they accept Medicaid and can submit a request
• Check your state’s Medicaid website for dental benefits and orthodontic criteria

If you or your family aren’t already enrolled in Medicaid , here’s how you can apply in 3 steps.

What are other ways to get low-cost braces?#what-are-other-ways-to-get-low-cost-braces

If your Medicaid plan doesn’t cover braces, you may still be able to get braces at a reduced cost.

Here are some options:

• Dental schools: Dental schools sometimes offer low-cost orthodontic care provided by supervised students
• Nonprofit or community programs: Some local organizations provide free or reduced-cost dental care and grants for children and families; visit 211.org or call 211 to find local organizations
• Payment plans: Many orthodontists offer monthly payment plans to spread out costs over time