Medicaid does provide comprehensive dental coverage for their patients. Dental benefits include treatment for pain and infections, teeth restoration treatments, and regular check-ups and cleanings. For orthodontics however, very few patients requiring braces or other orthodontic services will qualify for coverage unless their condition is deemed medically necessary. At Love Orthodontics, we believe everyone should have the opportunity for a beautiful smile, so we do offer a discount for Medicaid patients. Additionally, we offer interest-free financing options with low monthly payments, which make coverage affordable! We have many options for braces so that we can meet your individual needs!
What is Medicaid?
Medicaid is a state and federally funded program that offers affordable health coverage to eligible adults, children, pregnant women, elderly adults, and people with disabilities. It’s an assistance program for healthcare to low-income families and individuals who may not be able to afford health care.
Does Medicaid Cover Braces?
Medicaid does provide comprehensive dental services in most states, but only about 5-10% of these patients are eligible to use their benefits for braces. Dental benefits include treatment for pain and infections, teeth restoration treatments, and regular check-ups and cleanings.
Unfortunately, in Missouri and most other states, braces are not covered by Medicaid unless they are found to be medically necessary. For children who need braces but do not have a strict medical reason why, there is no coverage.
There are only a few orthodontic services that are covered by Medicaid, which include cases of a cleft palate or severe anomalies of the face. If someone is believed to have a condition that needs orthodontic treatment, their dentist would usually refer the patient to a qualified orthodontist for examination to see if the treatment would possibly be approved by Medicaid.
Some pre-orthodontic care is usually covered, including extractions and restorations, and these services would be provided by a dentist.
However, just because a patient may have moderate or severe orthodontic issues, and/or has been advised by a dental professional that they need braces, this does not mean that the patient will qualify for coverage.
Per the the State Orthodontic Consultant (reference Section 13.44 of the Dental Provider Manual) in Missouri, to be eligible for orthodontic services, a patient must meet all of the following criteria. In addition to the standard requirements for Medicaid of being under 21 years of age, having good oral hygiene documented in the child’s treatment plan and all dental work completed, scenarios where orthodontic treatment would likely be covered by Medicaid include:
- Patient has cleft palate, severe traumatic deviations, or an impacted maxillary central incisor.
- Speech impediments from tooth and jaw issues.
- Patient has a deep overbite when the lower incisors are damaging the soft tissue of the palate.
- The orthodontic provider has provided written documentation which proves that orthodontic treatment is medically necessary.
- Has an over-jet (teeth that are positioned horizontally rather than vertically) greater than 9 mm, or reverse over-jet of greater than 3.5 mm.
Evidence shall also include detailed data regarding a medical condition which is directly affected by the condition of the mouth or jaw. Braces would be necessitated if without the treatment, the condition would result in in pain, infection, illness, or significant and immediate impact on the normal function of the body and the patient’s inability to functional normally.
Orthodontic Treatment Not Deemed Medically Necessary
- Braces are for aesthetic reasons only
- Treatment is to correct crowded teeth
- The patient has demonstrated a lack of motivation to maintain standards of oral hygiene and oral hygiene is deficient
Orthodontists Providing Medicaid Services MUST be Missouri Healthnet Providers. Love Orthodontics is not a Medicaid provider. Patients should be referred to approved providers via the Provider Enrollment Unit at email@example.com. The American Association of Orthodontists also provides a link if they believe their need for orthodontics is medically necessary.
Love Orthodontics Can Help!
We offer a special discount to those who have Medicaid but don’t qualify for Medicaid coverage.
With our in-house financing options you can start treatment and care immediately and pay over time.
As a service to our guests, we are pleased to offer in-house financing that is completely interest-free, with no downpayment and easy monthly payments. That’s ZERO DOWN and ZERO INTEREST.
We do also allow third party financing such as Care Credit, which offer a range of plans with monthly payments.
We accept all major credit cards and most dental insurance too!
Our goal is to work with each and every patient to make sure that braces are affordable, accessible to all and result in a healthy, aesthetic smile for life!
CALL NOW for a FREE CONSULTATION!
Here we will take the needed X-rays and Dr. G will perform a standard examination so as to adjudicate the best treatment options for you. You will then get a chance to discuss all treatment options and prices and get any questions answered, so that you know exactly what you need to do. Someone can work with you on any insurance plan you may have as well as financing options to work out the best plan of treatment for you.
We will provide you with all of the information necessary to assist you in making an informed decision regarding your family’s oral health needs.
All of this is complementary, done at no charge to you and free of any obligations. Just call us to make an appointment for your FREE CONSULTATION, or complete the form below and we will contact you!