Braces Coverage With Medicaid
- Medicaid may cover dental braces for children and adults depending on the rules in your state. Find out if you qualify for free orthodontic treatment.
If you qualify for Medicaid or the Children’s Health Insurance Program (CHIP), orthodontic treatment may be covered depending on where you live. Each state establishes their own rules about which dental benefits are offered and what makes a patient eligible to receive them.
When Does Medicaid Cover Braces for Children?
Federal law requires that all states provide certain dental benefits for children enrolled in Medicaid. These include, at a minimum, routine cleanings and checkups, teeth restoration and relief from pain and infection. Medicaid only covers orthodontic treatment for children and adolescents when it’s deemed medically necessary.
While the complete list of medical conditions that qualify patients for coverage varies by state, Medicaid often pays for children's braces when they are required to treat an injury, disease or handicapping malocclusion. Dental issues that interfere with normal oral functioning (talking, eating and swallowing) and everyday activities for children may include:
- Cleft lip or cleft palate
- Jaw problems
- Severe underbites, overbites and crossbites
- Overjet protrusions
- Impacted teeth
- Missing or extra teeth due to pre-existing hereditary conditions
- Congenital deformities
When Does Medicaid Cover Braces for Adults?
In most states, Medicaid provides dental coverage for children age 21 and younger. While some Medicaid programs have expanded to offer oral health benefits to adults, very few patients over 21 are reimbursed for braces or orthodontics.
As with children, medical necessity is the critical factor in determining whether Medicaid will pay for treatment. For example, Medicaid typically covers braces for adults with broken jaws or dislodged teeth resulting from an accident. Adults dealing with illnesses that affect the jaw and neck may also have valid claims. Teeth repositioning required to treat the following conditions may be covered:
- Temporomandibular Joint Disorders (TMJ or TMD)
- Sleep apnea
- Handicapping malocclusions
How to Determine Your Eligibility for Braces With Medicaid
In 2019, the American Association of Orthodontists sought to define what is considered medically necessary orthodontic care. However, individual states still have much flexibility in defining their own Medicaid coverages and plans. A free consultation with a local orthodontist can help you better understand if your braces are a medical necessity, and if your state Medicaid program will cover all or a portion of the cost.
In the event your orthodontic treatment is categorized as cosmetic, Medicaid does not cover braces. While the average cost for braces is $5,000-$6,000 out of pocket, there are other options for managing the expense, including:
- Dental insurance
- Tax-exempt savings accounts
- No-interest financing
- Cash discounts
- Services from a dental school clinic
Nonprofit programs such as Smiles Change Lives and Smiles for a Lifetime also provide free or discounted braces to low-income families who cannot afford the full cost of orthodontic treatment.