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How will I know if braces are medically necessary?

While it is true that you will need the official opinion of a dentist or orthodontist to determine the medically or cosmetic necessity of braces, please note that the following cases were deemed medically necessary:

  • Cleft palate.
  • Difficulty opening the mouth, usually caused by structural problems with the jaw.
  • Trouble eating or chewing normally.
  • Experiencing speech impediments from teeth and jaw problems.
  • Serious bites, crossbites and overbites.
  • Teeth that are positioned horizontally instead of vertically (also known as overjet).
  • Impacted teeth with an eruption.
  • Missing teeth due to pre-existing hereditary conditions (such as hypodontia).

Of course, this is not a complete list of conditions that qualify patients to receive medically necessary braces. Any dental problem that interferes with normal oral function and daily activities can make braces a medically necessary dental treatment.

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

Average cost of braces

If you finally decide to put the braces on your child, it is important that you know that the average cost is between 3,000 and 10,000 dollars.

This number can vary depending on several factors such as:

  • Insurance coverage.
  • The amount of time the brakes must be used.
  • Any broken or loose cables, cracked brackets, or other complications.
  • The type of orthodontics you choose.
  • The severity of dental conditions such as crowded teeth or a bad bite.

Patients who have private insurance often have partial coverage for orthodontic treatment. On average they end up paying around $3,500. If you already know your Medicaid coverage won’t pay for braces because they’re considered cosmetic dentistry, you’ll probably pay about $5,000 or $6,000 for your kids’ braces.

Brace types

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

Depending on your child’s needs, you may need to use traditional metal wire, lingual, or clear braces. Each type of orthodontics has its own advantages and disadvantages. Therefore, it’s best to discuss the options in consultation with an expert who can help diagnose your child’s needs.

Lingual braces

They are placed on the back of the teeth instead of the front ones. This unique placement means the braces are less noticeable, but it can also be uncomfortable as your child gets used to the braces bunching up against their tongue. These can be a good option for kids and teens who are self-conscious about the look of traditional braces, but they’re not right for everyone.

Ceramic and metal braces

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

Does Medicaid cover braces? Orthodontic consultations

A free orthodontic consultation is the best option to determine if your child’s case warrants treatment and if your child will benefit from braces or other orthodontic treatment.

Through the consultation you will also be able to obtain information on the forms of payment for the braces, in case Medicaid does not do so.

Below are the most common means of payment for this type of treatment:

  • Amerigroup Medicaid
  • Medicaid
  • private dental insurance
  • CHIP
  • CareCredit
  • Cash
  • Credit


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