Is Medicaid an option for braces here at Love Orthodontics?
Medicaid provides comprehensive dental coverage for its 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 offer a discount for Medicaid patients.
We also offer interest-free financing options with low monthly payments, which make coverage affordable! And we have many options for braces to meet your needs.
CALL NOW for a FREE CONSULTATION!
Call: 417.883.6898
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 healthcare.
Does Medicaid Cover Braces?
Medicaid provides 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, there is no coverage.
Only a few orthodontic services are covered by Medicaid, including 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 might be approved by Medicaid.
Some pre-orthodontic care is usually covered, including extractions and restorations. A dentist would provide these services.
However, just because a patient may have moderate or severe orthodontic issues — or a dental professional has advised that they need braces — this does not mean that the patient will qualify for coverage.
Other Requirements for Medicaid Coverage
Per 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 the following criteria.
The standard requirements for Medicaid are to be under 21 years of age, have good oral hygiene documented in the child’s treatment plan, and have all dental work completed.
Scenarios of Medicaid likely covering orthodontic treatment include:
- The patient has a cleft palate, severe traumatic deviations, or an impacted maxillary central incisor.
- Speech impediments from tooth and jaw issues.
- The patient has a deep overbite when the lower incisors damage the soft tissue of the palate.
- The orthodontic provider has provided written documentation that proves that orthodontic treatment is medically necessary.
- The patient has an over-jet (teeth positioned horizontally rather than vertically) greater than 9 mm, or a reverse over-jet of greater than 3.5 mm.
Evidence would also include detailed data about a medical condition directly affected by the condition of the mouth or jaw. Braces would be necessary if, without treatment, the condition would result in:
- pain,
- infection,
- illness, or
- significant and immediate impact on the normal function of the body and the patient’s inability to function 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.
You can find an approved provider via the Provider Enrollment Unit at mmac.providerenrollment@dss.mo.gov. The American Association of Orthodontists also provides a link if you believe your 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 you, we are pleased to offer in-house financing that is completely interest-free with easy monthly payments. That’s ZERO INTEREST.
We do also allow third-party financing, such as Care Credit, which offers a range of plans with monthly payments.
We accept all major credit cards and most dental insurance too!
Our goal is to work with you to make sure that your braces are affordable, accessible, and result in a healthy, aesthetic smile for life!
CALL NOW for a FREE CONSULTATION!
Call: 417.883.6898
During your free consultation, we will take the needed X-rays, and Dr. G will perform a standard examination to adjudicate the best treatment options for you.
You will then have time to discuss all treatment options and prices and get your questions answered. That way, you’ll 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 the information necessary to assist you in making an informed decision regarding your family’s oral health needs.
All of this is complimentary, 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!