How To Get Free Braces With Medicaid – orthodontic treatments like braces help to improve one’s quality of life by correcting tooth and jaw alignment issues. Dental braces help to make oral hygiene easier and more effective. However, these benefits come with a significant cost. As per the American Dental Association, the average cost of braces for children ranges between $4685 to $6500, and this cost is marginally more for adults.
According to reports from Humana, roughly 4 million people in America wear braces, and around 45% of these individuals are adults. Braces are used by many people for different reasons to boost appearance and health. However, they can cost thousands of dollars. Unfortunately, not many can afford braces places to make sure of good dental health. If you’re wondering ‘How to get free braces with Medicaid’, the answer is a bit complex. Read on the below post where we will help you dive deep through the specifics of Medicaid coverage for braces in different states.
In this article, we will talk about:
- How does the Medicaid program cover braces?
- How to find out whether you qualify for Medicaid benefits for braces?
- What are the other ways to get free or low-cost orthodontic treatment such as braces?
Highlights of this Post
Key Takeaways
- Medicaid coverage for braces is generally provided for children and some adults under 21 if deemed medically necessary, with eligibility and extent of coverage varying by state.
- Orthodontic services for adults over 21 are rarely covered by Medicaid unless specific medical conditions warrant treatment, reflecting the limited orthodontic benefits for adults.
- Eligibility for Medicaid involves demonstrating income below a certain percentage of the federal poverty level, with necessary documentation varying across different states.
- Alternatives to Medicaid for orthodontic care include programs like CHIP, TRICARE, and non-profit organizations like Smile Change Lives, offering varying levels of assistance and eligibility criteria.
- Applying for Medicaid coverage of orthodontic services involves consulting with a Medicaid-accepting orthodontist for a necessary treatment assessment, confirming eligibility, and submitting detailed documentation including medical necessity proof.
How Much Are Braces In The US Without Insurance?
On an average securing braces without insurance will cost you somewhere between $3000 to $10,000 and is done for medical or cosmetic reasons. The key factors that contribute to the overall cost are the type of braces you get, your age, length of treatment and location.
If you don’t have insurance, it may be costly. However, there are multiple ways to reduce the cost and obtain braces for affordable rates such as applying for government assistance programs and nonprofit organizations.
Does Medicaid Cover Braces?
Medicaid is the joint federal and state program that makes sure households with limited income and resources can access the medical support and care that they need. While the federal government sets general rules, it leaves it up to the states to manage their own Medicaid Program.
The program provides coverage for braces for children and adults below 21 years of age only if they are deemed medically necessary by the doctor.
A few states provide braces coverage for low-income individuals who are over 21 years of age. It is important to note that to qualify for the Medicaid program, you need to show income below a specific percentage of the federal poverty level.
The income threshold may differ from one state to another so you must contact your local Medicaid office to know more. In many U.S. states, your age will be a big determinant of whether you can use the Medicaid program for braces and other dental treatments.
Head over to our next guide to learn how to get incontinence supplies covered by Medicaid.
Understanding Medicaid’ Coverage For Braces
Medicaid is a government assistance program that provides health insurance for eligible low-income households. The program includes compulsory dental benefits for children. This, however, doesn’t mean braces will be covered in every case.
Braces will be covered by the Medicaid program in your state if they are necessary for your medical condition. The Medicaid program is likely to cover braces in the following situations:
- Cleft lip and palate
- Extra or missing teeth
- Severe underbite, overbite and other malocclusions
- TMDs or temporomandibular joint disorders
- Other birth defects
- Jaw and mouth injuries that impact teeth alignment.
For eligible children enrolled in the Medicaid program, a variety of orthodontic services can be covered, including initial consultation and evaluation, traditional metal braces, follow-up appointments, adjustments and retainers after the braces are removed. Cosmic orthodontics or services that are considered non-essential are not covered by the Medicaid program.
Age-Related Medicaid Coverage For Braces
The Medicaid coverage for orthodontic services like braces is geared towards children and adults under the age of 21 years. This aspect of the Medicaid program offers primary focus on offering pediatric dental services as a part of the Early and Periodic Screening, Diagnostic and Treatment Benefit.
Dental treatments like braces are beneficial when the patient’s teeth and jaw are developing; hence encouragement is provided on early diagnosis and treatment. The program is unlikely to cover orthodontic treatment for individuals over 21 years.
Does Medicaid Offer Orthodontic Treatment For Adults?
The situation for individuals who are aged more than 18 or over 21 in a few states is different. Unlike children’s orthodontic treatment and braces, states do not have any obligation to cover adult orthodontic treatment as a part of their Medicaid Program.
A few states, however, can cover treatment for adults when it is deemed medically necessary, but unfortunately, the majority of the programs do not. There are no minimum requirements for the Medicaid Program in states when it comes to dental care, with a few states not even covering emergency dental treatment.
Read our next guide to know which Dentists take Medicare and Medicaid For Adults near me
Difference Between Medicaid And CHIP For Orthodontic Coverage
If you’re exploring options for your child’s orthodontic coverage, it is important to understand the basic difference between Medicaid and CHIP or Children’s Health Insurance Program. Even though the programs are similar, they have different criteria and benefits, including orthodontic services and braces.
Medicaid Coverage For Orthodontic Services
The Medicaid Program offers coverage for orthodontic services, including braces, on a case-by-case basis and is generally approved when deemed medically necessary. If the need for braces in children is severe enough to cause functional problems, then they will get orthodontic and braces coverage under the Medicaid program.
CHIP Coverage For Orthodontic Services
The Children’s Health Insurance Program, on the other hand, is designed to provide coverage for uninsured children in households with income that is too high to qualify for the Medicaid program but too low to afford private coverage.
This program will consider medical necessity and will provide lenient eligibility for orthodontic treatment compared to the Medicaid program. The orthodontic benefits may vary from one state to another, but generally, it covers a portion of the cost for braces even when the case isn’t as severe. A few covered orthodontic procedures under CHIP are as follows:
- Congenital hypodontia
- Impacted teeth
- Having jaw issues or structural jawline that causes difficulty or pain while closing or opening the mouth
- Severe overbite, underbite or crossbites
- Excessive overjet
- Incurring issues are pain while chewing or eating
- Cleft palate.
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What Is The Medicaid Coverage For Braces In Different States?
Every state has its own rules and regulations about the Medicaid programs. While the federal government establishes the Medicaid program and provides some of its funding, state governments have the authority to decide the eligibility, benefits and services covered under the Medicaid program.
Every state sets its own guidelines for qualifying orthodontic treatment coverage.
- For instance, the Medicaid program in Texas covers treatment for severe handicapping malocclusions.
- The Medicaid program in North Carolina covers treatment for functionally impairing manipulations.
As per Texas Orthodontics, the Medicaid program will not cover braces in most cases, and the Medicaid program in North Carolina can deny coverage even if the orthodontist considers the braces necessary. You need to contact local orthodontics that are accepting Medicaid to know whether you or your child can get coverage for braces.
Step-By-Step Guide To Apply For Medicaid Orthodontic Coverage
Obtaining orthodontic coverage for braces through the Medicaid program need not be an overwhelming process. By following the below-mentioned steps, you can easily apply for the Medicaid program and secure coverage that you or your child may need.
- Make an appointment with a licensed dentist or orthodontist who accepts Medicaid: The first and foremost step towards securing Medicaid-funded aligners emphasis or other dental treatment is to book an appointment for you or your child with a qualified and licensed orthodontist or dentist who accepts Medicaid. They will perform an orthodontic evaluation and determine whether the dental treatment is deemed medically necessary for you.
- Confirm your eligibility: It is important to meet the eligibility criteria for your state’s Medicaid program. This generally involves key factors like family size, income level, residency and special healthcare needs criteria.
- Gather relevant documents. To apply for the Medicaid program you need to provide proof of relevant documents such as proof of income in the form of pay stubs or tax returns, Social Security numbers for all applicants, Identification documents like birth certificates, passports or driver’s license and Proof of residency in the form of utility bills or lease agreements.
- Complete the application form: The next day requires you to fill out the application form of your individual state. The application can be submitted online, in person at your local Medicaid office or by mail.
- Provide supporting documents for orthodontic needs: A few states require additional documents for authorizing orthodontic services such as braces. This includes photographs of your dental issue, letters of medical necessity from a licensed orthodontist and X-rays or dental records.
- Wait for approval and schedule an appointment with an orthodontist: Once you submit your Medicaid application form the authorities will conduct a review process. If you’re approved, you will get information about the services that are covered, including specifications on orthodontic care.
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What Are The Other Ways To Get Free or Low-Cost Braces?
For those who are unable to qualify for Medicaid or CHIP programs can get coverage for braces or other orthodontic services from the following resources.
Government Grants for Free Braces
TRICARE
Tricare is a health insurance program funded by the federal government that helps active duty members to cover the cost of the braces. The program covers nearly 50% of the braces and is geared towards military families, veterans and their spouses including children under 21 years of age. Even though you may not get entirely free braces it will help you to offset some costs and reduce your burden.
Insurekidsnow.gov
Low-income households looking for affordable health insurance programs, including orthodontic services for their children, and teenagers can enroll in the Insurekidsnow.gov. You can find details on health insurance programs and dental providers within your state by visiting the official website. Families that are earning less than $60,000 can qualify for dental coverage from this resource.
Affordable Care Act
The Affordable Care Act allows people to pay for their braces. You can buy dental and medical insurance with their Affordable Care Act marketplace, which will provide you maximum coverage of $1000 to $1500 annually. This comprehensive healthcare program makes sure health and dental insurance are affordable to all.
Organizations That Help To Pay For Braces
DentalSave Dental Plans
Those who are not qualified for Medicaid or CHIP programs can easily get coverage from DentalSave Dental Plans. The plans are designed for low-income households who are looking for free or affordable orthodontic procedures. You can get a 25% discount on your braces by becoming a member of DentalSave Dental Plans.
Purple Heart
Purple Heart is a nonprofit organization that collaborates with local dental schools to help people get free braces. Children who are below 16 years of age and belong to parents who are Purple Heart recipients or members can get free dental treatment.
American Association Of Orthodontists
The American Association of Orthodontists administers many dental programs that help people get free or low-cost braces. The members and volunteers of the organization help less fortunate people maintain their overall dental health food store.
The organization has donated approximately 500 million to needy people in different forms, and nearly 914 patients in America received orthodontic services. Applicants need to be in age between 7 to 18 years to get donated orthodontic services or braces.
Smile Change Lives
Smile Change Lives provides orthodontic services to low-income people, and the applicants should be between 7 to 21 years old. You need to pay at least a $30 non-refundable application fee and other forms of payment.
Organizations ensure that maybe people can get the right orthodontic care, including braces. The mission of the charitable organization is to help children from low-income families access low-cost orthodontic treatment.
Smile For A Lifetime
Smile For A Lifetime is a charitable nonprofit organization that offers orthodontic care and braces to kids from low-income families including children who are in foster care or living in less stable living situations.
Young adults and children between 8 to 19 years can qualify for the program; however, they have to pay an application fee worth $20 and another fee worth $480. To learn more about how to get free braces and orthodontic care you can visit their official website.
Seton Hill University Orthodontic Clinic
You can get help from the Seton Hill University Orthodontic Clinic to get free braces or orthodontic services. The university offers financial assistance to those who are unable to afford their dental treatment due to financial barriers. They help with follow-up appointments, placement of retainers and routine adjustments.
Similarly, the Boston University School of Dental Machines also provides affordable orthodontic fees of $160 per month for adults, including a $10 discount for households with multiple members being treated.
Conclusion
Braces are complex medical procedures that are performed to beautify your smile and improve your oral health and teeth structure. Obtaining free braces for children is possible if your child is on Medicaid and requires braces for medical reasons. If you’re an adult, then getting free braces through the Medicaid program can be challenging depending on your state of residence and its Medicaid provision. Adults can get free braces depending on their state’s Medicaid policy only if their dental issues are causing health problems that can be fixed with braces. Additionally, you can get assistance with braces and orthodontic care from nonprofit organizations, dental charities, dental and orthodontic schools and community programs. We hope this guide has been helpful for you to get relevant insights about how to get free bases with Medicaid.
Head to our blogs at Get Government Grants to avail free resources and government programs for low-income families. Our guide has numerous supportive programs and names of organizations that help people in times of need.
Frequently Asked Questions
Can You Get Braces For Free With Medicaid?
Children below 21 years of age can get free braces with Medicaid if they are medically necessary. Adults with dental problems can get braces with Medicaid if they have a health problem that can be solved only through braces. However, it depends on their state’s Medicaid policy and rules. If you have Medicaid then you need to contact your insurance provider or healthcare provider.
Will Medicaid Cover All Of My Dental Treatment?
Even if your state’s Medicaid program covers braces, you still have to face some out-of-pocket expenses such as enrollment fees, deductibles, premiums and copayments. The cost that you have to pay from your pocket may vary depending on how your orthodontist is charging and what benefits are covered in your state’s Medicaid program.
How Do You Get Braces If You Don’t Have Money?
Those who are unable to afford the high cost of braces for themselves or their children can organize a payment plan, contact their insurance company, join a dental plan, apply for government programs like TRICARE, Medicaid, and CHIP, seek assistance from dental charities and nonprofit organizations like Smile Change Lives, American Association Of Orthodontists, Purple Heart to name a few.
How Much Are Braces In The US Without Insurance?
On average securing braces without insurance will cost you somewhere between $3000 to $10,000 and is done for medical or cosmetic reasons. The key factors that contribute to the overall cost are the type of braces you get, your age, length of treatment and location. If you don’t have insurance, it may be costly. However, there are multiple ways to reduce the cost and obtain braces for affordable rates.
