Does Medicaid Covers Braces at Orthodontic Experts?
At Orthodontic Experts, we have a team of professional orthodontists that take Medicaid or Medical Card (i.e., Public Aid or All Kids). Naturally, we get a ton of questions about Medicaid coverage and how it works when getting orthodontic treatment (i.e., braces or clear aligners). Being an expert of orthodontics, we thought we’d provide some clear information and explain some details related to Medicaid braces. Continue reading to know the answer to the following most asked questions:
So What is Medicaid?
Medicaid is a form of a government-funded health care program. It is offered by state and federal governments. Medicaid brings affordable health coverage to eligible adults, children, pregnant women, elderly adults, and people with disabilities.
Does Medicaid Cover Braces for Adults and Kids?
For children who are enrolled in Medicaid, the dental coverage ranges from any infection and pain relief to regular checkups. States are required to provide orthodontic services to children “to the extent necessary to prevent disease and promote oral health,” and restore oral structures to health and functionality. Illinois has two Medicaid braces programs specifically for children & those plans are All Kids and Family Care program.
The All Kids insurance provides health care to children of low-income families, while Family Care provides coverage for children and their parents. Each of these programs includes dental care for kids and it might assist in paying for orthodontic treatments such as braces and Clear Aligners. This dental program is administered by DentaQuest of Illinois.
How Can I Get Braces with Medicaid?
First, it is important to understand that Medicaid will only cover orthodontic braces for children under 21. There are some new dental benefits of Medicaid braces for adults but this does not extend to braces or orthodontics. So if you are an adult with Medicaid and want braces, while our Medicaid orthodontist can definitely support you, it is important to understand that Medicaid insurance may not help you with the costs associated with braces. However, this is why we have a large variety of payment options (i.e., Care Credit, flexible payment plans, no down payments, etc.)
Moreover, if your orthodontic needs are declared “medically necessary,” we will help you find out if your Medicaid insurance will cover the costs for braces. Even though your child’s braces may not be completely free, but Medicaid orthodontic coverage can help pay for most of the costs. Additionally, It is important to note that Medicaid will not cover adult braces for free.
Are All Types Of Orthodontic Treatment Covered By Public Aid, Medicaid, Medical Card?
Only comprehensive (Phase II) orthodontic treatment with braces can be covered by All Kids insurance. Early or interceptive treatment such as upper jaw expansion, growth modification and multiple other fixed or removable orthodontic appliances are not covered by Public Aid.
Therefore, your child must have all permanent teeth to be considered for All kids orthodontic coverage. If your child requires early (interceptive) treatment or a fixed or removable orthodontic appliance other than braces, All Kids insurance will not cover the cost of treatment. If your child still require braces after interceptive treatment, the pre-approval can be submitted to the Medicaid administrator – DentaQuest – when all the primary (baby) teeth have been lost.
frequently asked questions
How to Know If Braces Are Medically Necessary
Braces are a medical necessity if there are any physical difficulties that can be cured by it. Cases of extreme underbite and overbite make it difficult to speak or chew easily and usually, it can be solved through braces.
Typical Cost of Braces
Braces typically cost between $1000 to $10,000 depending on the type of braces.
Kinds of Orthodontic Treatment Available for Kids with Medicaid
All kinds of orthodontic treatment are available for Kids under the age of 21.
If Medicaid is not an option – What to do?
If Medicaid is not an option you can apply for multiple programs that would sponsor your remaining options. These programs include ACA or any other health insurance program which can be reached through SEP (Special Enrollment Program).
Does Medicaid pay for braces?
Yes , it pays for braces for children under the age of 21.
NO-COST Consultation
During your no-cost consultation, our Medicaid orthodontist will evaluate your child and will let you know if your child qualifies to have the dental records (i.e., photographs, X-ray images, molds of teeth, etc.) submitted for pre-approval to the Public Aid office. If he or she does qualify, then we will take the necessary orthodontic records and will submit them to the Public Aid administrators – DentaQuest.
At the time of this no-cost consultation, all necessary photographs, X-rays, teeth molds, and measurements will be taken and our Medicaid orthodontist along with our orthodontic team will discuss your child’s treatment plan. After the consultation, we can proceed with your child’s orthodontic treatment.
Don’t Waste Any More Time Wondering where to Get Braces for Your Child
There is no charge for an orthodontic consultation at Orthodontic Experts. This is necessary for digital x-rays and any other dental record for the initial stages. Once an orthodontic case is submitted for pre-approval, it generally takes 3-4 weeks for the case to be evaluated by the All Kids [Public Aid, KidCare, and Medicaid] administrator. Our staff at Orthodontic Experts will contact you as soon as we receive the approval decision from All Kids.
If your child is selected for braces treatment, we will schedule you to come back to our orthodontic office to get started on your child’s orthodontic treatment.
Our orthodontists accept All Kids insurance and provide Public Aid (All Kids) orthodontic treatment to the residents of the following areas. For more detailed information about orthodontic coverage by All Kids, visit our Illinois Public Aid Braces website.
You can also visit one of our orthodontic offices for a complimentary consultation. We have offices in Algonquin, Arlington Heights, Aurora, Chicago- Avondale, Chicago- Bucktown, Burbank, DeKalb (Located in Sycamore), Glendale Heights, Harwood Heights, Hillside- Westchester, Homewood, Joliet, Chicago- Kedzie, Mundelein, Chicago- Pilsen, Orland Park, Rockford, Skokie, and Waukegan.
Call our office at 855-720-2470 for our Illinois offices to learn more about how Public Aid and Medicaid can help your child get straighter teeth!
