Medicaid also takes into account your age, your state of residence resides in, as well as the reason you’d like to straighten your teeth. Even if an orthodontic specialist recommends Medicaid braces you’ll still require approval from the nearby Medicaid office. This is because Medicaid is offered on a state-by-state basis. Consequently, the choices on what will and won’t be covered by Medicaid can vary greatly.
In addition, if you hope to apply for Medicaid to cover aesthetic braces, you’ll be dissatisfied.
When Does Medicaid Cover Children’s Orthodontics?
Federal law requires that every state provide dental benefits for children with Medicaid braces through Medicaid. This is known as CHIP (child insurance for health). These benefits include:
1. Routine dental exams.
2. Dental restoration.
3. Teeth Cleaning.
4. The relief from pain in the teeth and infections.
Medicaid does not cover orthodontic services for people aged 21 years or less when the services are considered necessary by a doctor.
However, the medical conditions that allow people to be eligible for Medicaid insurance for orthodontic procedures differ from state to state.
Medicaid typically covers kids’ braces if needed to treat a condition or injury or correct handicapping malocclusion.
Dental problems that affect normal oral functions, like eating and swallowing as well as other activities that are routinely performed, may need braces to be adjusted.
The problems that can arise could be:
1. Jaw problems.
2. Lip or Cleft palate.
3. Overjet protrusions.
4. Congenital disabilities.
5. severe Crossbites, underbites, and overbites.
6. Extra teeth or missing teeth due to pre-existing genetic disorders
Does Medicaid Pay for Invisalign?
In most cases, Medicaid does not cover Invisalign treatment. While Medicaid may cover orthodontic care—such as traditional metal braces—for children and teens under 21 when it’s deemed medically necessary, it typically does not cover cosmetic or premium options like Invisalign.
Invisalign is considered an elective treatment, meaning it’s not usually eligible for Medicaid reimbursement, even if the patient qualifies for braces. However, each case is unique, and coverage can vary slightly by state or managed care plan.
At Top Nova Orthodontics in Sterling / Potomac Falls, VA, we work closely with families to help them understand their insurance options and offer flexible financing for those interested in Invisalign. If you’re curious whether your child qualifies for Medicaid-covered orthodontics—or want to explore affordable Invisalign alternatives—we’re here to help!
📞 Contact us today to schedule a free consultation and learn more about treatment options with or without Medicaid coverage.
When Does Medicaid Cover Adult Braces?
While Medicaid generally, for the portion, is a program that covers orthodontic treatments for children, In recent years, Medicaid has increased its scope of coverage to include low-income or disadvantaged pregnant women, adults, or disabled people. However, most adults are not eligible for Medicaid in the instance of braces.
Medical necessity is crucial in determining if Medicaid will cover braces for adults. For example, Medicaid can pay for braces for adult patients with fractured jaws or dislodged teeth due to an accident. Adults with issues with their neck and jaw have an excuse to lay claim to dental coverage through Medicaid. Medicaid will also cover tooth repositioning treatments to address the following problems:
1. TMD is also called TMJ (Temporomandibular joint disorder).
2. Sleep Apnea.
3. Handicapping Malocclusions.
When you present your application for Medicaid to cover your braces, ensure that you provide accurate information on a medical issue affected by jaw or mouth problems.
What Doesn’t Medicaid Cover?
The braces can be used solely for reasons of medical necessity. Some of the procedures about orthodontics that Medicaid will not cover include:
1. Treatment for the dental crowd.
2. Braces are designed to enhance the appearance of your figure.
3. If the patient is not motivated to maintain their oral health and hygiene requirements.
Medicaid will not also cover the most expensive orthodontic treatment options like Invisalign for children and adults because Medicaid is a massive program that provides the least costly treatment options.
Final Thought
Medicaid may not cover braces for everyone, but that doesn’t mean you can’t get them. Top Nova Orthodontics is here to help you navigate the process and find out if you qualify for this important dental treatment. Contact us today to schedule a consultation – we look forward to hearing from you!
