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Navigating Orthodontic Treatment and Braces with Medicaid or CHIP Coverage

A beautiful smile not only enhances your appearance, but it can also play a crucial role in your overall well-being. The importance of orthodontics is much more than the aesthetics of having straight teeth. Because they are harder to clean, crowded and crooked teeth can lead to tooth decay, gum disease, or tooth loss. On top of hygiene challenges, a misaligned bite can wear down the enamel of the teeth and affect the ability to speak and chew. Adolescent orthodontic issues left untreated can also lead to extensive dental work and more significant costs of care later in life.

For individuals covered by Medicaid or Children’s Health Insurance Program (CHIP) plans, achieving a straight and healthy smile through orthodontic treatment is not only possible but also accessible. There are options and benefits available for those with Medicaid or CHIP coverage, making the journey to a healthy smile more attainable.

As government-sponsored health insurance programs, Medicaid and CHIP plans are designed to provide health coverage for eligible individuals and families, including dental and orthodontic care. While coverage may vary by state, both programs recognize the importance of orthodontic care in maintaining good oral health. Many states offer coverage for orthodontic treatment, including braces, for eligible beneficiaries, particularly children and adolescents. For those enrolled in Medicaid, it is specified that dental coverage is required, at minimum, to provide relief of pain and infections, restoration of teeth, maintenance of dental health, and medically necessary orthodontic services.

To confirm if braces are medically necessary for your child, you must consult an orthodontist or dentist. They will consider medical necessity based on the following conditions:

  • Cleft palate
  • Structural jaw issues that make it difficult to open the mouth
  • Issues with eating or chewing normally
  • Concerns with speech impediments from tooth or jaw problems
  • An underbite, crossbite or overbite
  • Overjet teeth – When teeth protrude outwardly and sit over the bottom teeth
  • Impacted teeth with an eruption
  • Missing teeth due to hereditary conditions (like hypodontia)


The Benefits of Orthodontic Treatment

Orthodontic treatment goes beyond cosmetic improvements; it is vital in promoting oral health. Medicaid and CHIP plans often prioritize early orthodontic intervention for children, recognizing the importance of addressing orthodontic issues during developmental stages. This can help prevent more severe problems in the future such as misaligned teeth which can lead to a range of issues, including difficulty chewing, increased risk of tooth decay and gum disease, and even speech problems. These are all important reasons why Medicaid or CHIP beneficiaries have access to orthodontic services that address these concerns and promote proper oral health from an early age.

Your choice of braces will depend on your child’s dental needs after consulting with an orthodontist. Generally, options for orthodontic treatment with Medicaid or CHIP include:

Traditional Braces: These come in the form of ceramic and metal braces and are attached to the front of teeth. They remain a reliable and effective option for correcting misaligned teeth. The brackets for ceramic braces are clear or tooth-colored, but can stain or break faster than traditional wire braces. Covered by Medicaid and CHIP in many states, traditional braces offer a cost-effective solution for achieving a straight smile.

Lingual Braces: Unlike traditional braces, they are placed on the back of teeth instead of the front. Putting the braces on the back makes them less noticeable and, therefore, a great option for those who are conscious about the look of them in their mouth. It can, however, be initially uncomfortable until your child gets used to the braces crowding against their tongue.

Clear Aligners: In some cases, Medicaid or CHIP may cover clear aligner treatments, such as Invisalign. Clear aligners provide a discreet and convenient alternative to traditional braces, especially for those who are self-conscious about wearing visible braces.


The Patient Journey for Orthodontic Treatment

To navigate the orthodontic process, patients will begin with a consultation and evaluation with their dental home’s orthodontist. During this visit, the orthodontist will assess the individual’s needs and determine the most suitable care plan, including if braces are medically necessary, as alternative treatment options may be available. Dental practice administrators will then work closely with the family to verify Medicaid or CHIP coverage for orthodontic treatment. Understanding the specific terms and conditions of coverage in your state will ensure a smooth process throughout the treatment.

While orthodontic treatment is typically included in Medicaid and CHIP plans, the cost of that care can fluctuate due to many factors. Pricing variability can include the amount of time the braces are worn, the existence of broken or loose wires, cracked brackets and other complications, the type of braces chosen, and the severity of the dental conditions like overcrowded teeth or a bad bite.

Patients who undergo orthodontic treatment, such as braces, should plan for regular follow-up appointments, which are crucial for monitoring progress and making any necessary adjustments. Medicaid and CHIP coverage typically include maintenance visits, ensuring continued treatment success. It is especially important for patients in orthodontic treatment to visit a dental professional for preventive oral healthcare like routine cleanings. While wearing braces, Benevis dentists recommend brushing teeth three times per day and flossing daily.

Since a lack of knowledge on dental hygiene can increase the risk of tooth decay in adulthood, adolescent education and communication on preventive dental health measures are imperative during orthodontic treatments at your dental home.


Schedule Your Consultation Today

A straight and healthy smile is within reach for children and adolescents covered by Medicaid or CHIP. With various orthodontic treatment options, these programs empower beneficiaries to enhance their oral health and overall well-being. By taking advantage of the coverage provided, individuals and families can embark on a journey to a confident and radiant smile, setting the stage for a brighter future.

To make an appointment or learn about orthodontic care options, check out the following resources:

  • For patients to confirm if they qualify for Medicaid or CHIP benefits, click here, or to find a list of dental Medicaid or CHIP plans in each state, click here.
  • For those interested in scheduling an orthodontic consultation, please find a Benevis location close to you and we’ll help provide affordable orthodontic care.
  • For patients, families, and caregivers to gain a better understanding of potential payment and financing options for orthodontic services, visit our Ortho Cost Calculator. The calculator delivers cost transparency and clearly articulates customized payment plan timelines.