Can I Get Braces with Medicaid?

Yes, your child can get braces with Medicaid if they are deemed medically necessary. If you are wondering how much braces cost with Medicaid, it can help to find an orthodontist who will give you a no-cost consultation first. This is especially important if your child is covered by Medicaid, TRICARE or CHIP.

Read on to learn:

  • What Medicaid is and what it covers
  • How to determine if braces are medically necessary for your child
  • The average cost of braces
  • Common types of braces
  • Where to find no-cost braces consultations
  • Affordable payment options at Kool Smiles
  • Why you should choose our kid-friendly dentistry for orthodontic services

If you’re ready to schedule your no-cost consultation and see if you can get braces with Medicaid, give us a call today at 254-781-0553. We can answer all your questions to give you a clearer view of your options.

What Is Medicaid? What Does It Cover?

Medicaid is a program funded by state and federal governments that brings affordable health coverage to eligible adults, children, pregnant women, elderly adults and people with disabilities. This is an assistance program that seeks to offer healthcare benefits to low-income families and individuals who may not be able to afford healthcare coverage otherwise.

Children who are included in a Medicaid plan are entitled to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services whenever they visit a dentist. This means that kids must receive dental treatments that provide at the very least:

  • Dental health maintenance, including cleanings and checkups
  • Teeth restorations
  • Pain and infection relief

You can find out here if you qualify for Medicaid or CHIP and determine if your coverage includes the cost of braces. Medicaid typically covers dental services and orthodontic treatments, including braces, that are deemed medically necessary for your child.

Because Medicaid usually covers children 21 and under whose orthodontic needs are declared “medically necessary,” a consultation will help you find out if Medicaid can help cover the cost of braces.

Kool Smiles can provide a no-cost braces consultation to help you determine whether your child’s braces might be a medical necessity and whether Medicaid will cover a portion of the cost.

How Will I Know If Braces Are Medically Necessary?

While it is true that you’ll need the official opinion of a dentist or orthodontist to determine the medical or cosmetic need for braces, past cases have been deemed medically necessary because of:

Past cases deemed medically necessary:

  • Cleft palate
  • Difficulty opening the mouth, usually caused by structural jaw issues
  • Problems eating or chewing normally
  • Experiencing speech impediments from tooth and jaw problems
  • Severe underbites, crossbites and overbites
  • Teeth that are positioned horizontally rather than vertically (also known as overjet)
  • Impacted teeth with an eruption
  • Teeth that are missing due to pre-existing hereditary conditions (such as hypodontia)

This is not a complete list of conditions that qualify patients for medically necessary braces. Any dental issues that interfere with normal oral functioning and everyday activities can make braces a medically necessary dental treatment.

Only 5%–15% of patients with braces have a medical need for them. This means that it is more likely that your child’s orthodontic treatment will be categorized as a cosmetic dentistry procedure. In this case, Medicaid will not pay the bill, so it’s important to consider the cost of braces without insurance coverage.

Average Cost of Braces

If your child gets braces, you could be paying anywhere from $3,000–$10,000.

This number fluctuates depending on several factors, including:

  • Insurance coverage
  • Amount of time the braces need to be worn
  • Any broken or loose wires, cracked brackets or other complications
  • The type of braces you choose
  • Severity of dental conditions like overcrowded teeth or a bad bite

Patients who have private insurance typically have partial coverage for orthodontic treatment. On average they end up paying around $3,500. If you know that your Medicaid coverage will not pay for braces because they are considered to be cosmetic dentistry, you can expect to pay close to $5,000 or $6,000 for children’s braces.

Types of Braces

If braces are deemed medically necessary for your child, then it’s time to consider what type of braces is right for your kid’s smile.

Depending on your child’s needs, you might be looking at traditional metal wire braces, lingual braces or clear braces. Each type of braces has its own set of pros and cons, so it’s best to talk through the options at a consultation with an expert who can help diagnose your child’s needs.

Lingual braces, for example, are placed on the back of teeth instead of the front. This unique placement means that the braces are less noticeable, but it also can be uncomfortable while your child gets used to the braces crowding against their tongue. These can be a great option for children and teens who are conscious about the look of traditional braces, but they’re not right for everyone.

Ceramic and metal braces often cost less than lingual braces, and they are easier to clean since the brackets are attached to the front of teeth rather than the back. However, these are more easily visible. Ceramic braces are slightly less noticeable than metal options because the brackets are clear or tooth colored. However, ceramic braces stain or break more easily than traditional braces.

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Orthodontic Consultations | How to Get Braces

Kool Smiles is committed to providing affordable orthodontic care, so we will work with you to select the best type of braces and find the best payment solution, even if your dental procedure isn’t covered by Medicaid.

The no-cost braces consultations offered by Kool Smiles will help determine if your child’s teeth will benefit from braces or other orthodontic services. We can walk you through the process so that you and your child are comfortable and understand your payment options.

During the consultation, we can also provide information about other ways to pay for braces if Medicaid will not. We offer affordable pricing options for our patients, including payment terms that fit your budget.

Medicaid and Other Affordable Payment Options for Braces

Kool Smiles offers the following payment options:

  • Amerigroup Medicaid
  • Medicaid
  • Private dental insurance
  • CHIP
  • TRICARE
  • CareCredit (we can help you apply)
  • Cash
  • Credit

You can learn more about braces payment options by calling 254-781-0553 and talking to the professionals at Kool Smiles.

Why Kool Smiles?

At Kool Smiles, we believe great dental care should be affordable and accessible for every family. Here’s why you should come to us for your orthodontic services.

  • Affordability. Whether or not you have insurance, we work with your family to find a way for dental treatments to fit your budget.
  • Convenience. Our offices are often located in communities with the greatest need, making dental care more convenient for local families. The dental healthcare professionals at Kool Smiles understand that it isn’t always easy to schedule a dentist appointment for your child, so we offer extended evening and Saturday hours at most of our locations. This gives parents more time to get a no-cost braces consultation for their child without interrupting their busy work schedule.
  • Comfort. We aim to make visiting the dentist as comfortable as possible for newcomers and young children. Our family-friendly offices often include indoor play areas for children to enjoy as they wait. During your visit, we’ll thoroughly explain the steps we’ll take before, during and after each treatment. This means both you and your child always know exactly what to expect, with the added bonus of learning more about your family’s dental health.

If you’re looking for a great dentist or orthodontist near you that accepts Medicaid for braces, Kool Smiles is here for you. With over 120 locations across 15 states, chances are there’s a location near you.

Call Kool Smiles Today for a No-Cost Braces Consultation

Unsure if your plan covers certain dental services, like braces? We’ve got your answer. Kool Smiles has a mission to provide quality dental care to children all across the country and proudly accepts Medicaid at every location for general dentistry needs. If you’re worried about covering the cost of braces, even if they’re deemed medically necessary, we find a way to get your child the dental care they need at an affordable price.

To learn if you can get braces with Medicaid, call us today at 254-781-0553 to schedule your no-cost consultation at your local Kool Smiles.

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Sources:

Medicaid.gov: medicaid.gov/

Medicaid.gov: medicaid.gov/medicaid/benefits/epsdt/index.html

Medicaid.gov: medicaid.gov/medicaid/benefits/dental/index.html

Healthcare.gov: healthcare.gov/medicaid-chip/eligibility/

Growing Family Benefits: growingfamilybenefits.com/health-insurance-cover-orthodontic-braces/

American Association of Orthodontists: aaoinfo.org/news/2015/07/aao-leads-effort-establish-consistency-medically-necessary-orthodontic-care

CostHelper: health.costhelper.com/braces.html

ValuePenguin: valuepenguin.com/average-cost-braces

Live Strong: livestrong.com/article/193672-disadvantages-of-ceramic-braces/

CareCredit: carecredit.com/dentistry/

National Center for Biotechnology Information: ncbi.nlm.nih.gov/books/NBK225261/