Does Pregnancy Medicaid Cover Braces

How Can I Enroll In Apple Health

Does Medicaid Cover Braces For Children

You can enroll in Apple Health at any point during the year on the Washington Healthplan Finder. If you do not qualify for Apple Health, the Washington Healthplan Finder has many other insurance options for you to choose from.

About 7-10 days after applying for Apple Health coverage, a ProviderOne services card will be mailed to you. This is a plastic ID card that looks like other health insurance ID cards. Take this card with you to your doctor and dentist appointments. Providers use this card to make sure your service is covered.

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What Is Medicaid And What Does It Cover

Medicaid is a government-funded program that ensures affordable health care is made available to families and individuals. This includes eligible adults, children, pregnant women, elderly adults, and people with disabilities. This program offers healthcare benefits to low-income families and individuals who may need assistance with affording healthcare coverage.

Children who are covered by Medicaid are entitled to Early and Periodic Screening, Diagnostic, and Treatment services when they go to the dentist. Meaning children with Medicaid must receive dental care that provides the following:

  • Regular dental care maintenance, including teeth cleanings and checkups
  • Tooth restorative care
  • Pain and infection management or treatment

Find out if your family qualifies for Medicaid or CHIP here. You can find out if coverage includes the cost of braces. Many times, Medicaid covers dental care and orthodontic services, like braces, when they are deemed medically necessary for your child.

Medicaid will typically cover children 21 and under with orthodontic needs, that are deemed medically necessary. Scheduling a no-cost consultation can help you find out if this is an option for your family and if Medicaid can help with the cost of braces.

Kool Smiles partners can schedule a no-cost orthodontic consultation to help you figure out if your childs braces are considered medically necessary and if Medicaid can cover some of the cost.

Does Medicaid Cover Braces In Mcallen Texas

Quite often people wonder whether or not Medicaid will cover the cost of braces for children or adults. For several years this was the case, but after spending over 700 million just for braces alone in Texas from 2008 to 2011, this all changed.

For the last couple of years, Orthodontics are no longer covered by the CHIP/Childrens Medicaid program or Medicaid for Texas, including McAllen, Edinburg and the Rio Grande Valley. The only exception to this is if there is a severe alignment problem where health is threatened, such as a cleft palate which requires surgery and braces as part of the treatment.

For children enrolled in Medicaid, the dental coverage ranges from relief from pain and infection to regular checkups. States must provide orthodontic services to children to the extent necessary to prevent disease and promote oral health, and restore oral structures to health and function.

Heres a quote from the Early and Periodic Screening, Diagnostic and Treatment manual:

Orthodontic services for cosmetic purposes are not covered.

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What Does Medicaid Cover In Your State

To give you a better idea of how wide the range of services can be from state to state, heres a comparison of optional benefits for Medicaid coverage in four states:

Medicaid Coverage in Nevada

What does Medicaid cover in Nevada?

Nevada Medicaid provides quality health services to low-income Nevadans who qualify based on state and federal law. Nevada Medicaid does not reimburse an individual for medical services. Payments are sent directly to health care providers when they render services to Medicaid recipients.

Nevada Check Up is offered concurrently with Medicaid and is designed for children who do not qualify for Medicaid but who come from families with incomes that are at or below 200% of the Federal Poverty Level. Nevada Medicaid is the payer of last resort, meaning that if you have other health insurance that can pay a portion of your bills, then payment will be collected from them first. Benefits covered by Nevada Medicaid and Nevada Check Up include:

  • Ambulance/Transportation

Medicaid Coverage in Texas

What does Medicaid cover in Texas?

Texas Health and Human Services administers Medicaid and CHIP in the state. It administers four Medicaid programs: STAR, STAR+PLUS, STAR Health and traditional Medicaid. The type of Medicaid coverage a person gets depends on where the person lives and what kind of health issues the person has.

These benefits include:

Medicaid Coverage in New York

What does Medicaid cover in New York?

Pregnancy And Newborn Healthcare

Medicaid for Braces

Quality healthcare coverage from Home State Health helps moms and babies stay healthy during and after pregnancy. Our health plan:

  • Provides check-ups and other care for pregnant women
  • Covers the delivery of the baby

We also provide healthcare coverage for the entire frst year of the babys life, for both mother and child.

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Does Medicaid Cover Braces Overview

The answer is yes, well, sort of. Medicaid will pay for your braces but only if these devices are deemed a medical necessity by an approved physician. Medicaid also considers your age, the state you reside in, and why you want to straighten your teeth.

Even if an orthodontist recommends that Medicaid pay for your braces, you will still need approval from youre local Medicaid office.

This is because Medicaid is provided on a state-by-state basis, so decisions on what will and what wont be covered vary by quite a lot.

However, if your income isnt as high, you can take advantage of Medicaids coverage for braces because the standards that apply to you will be relaxed.

Some states also have special provisions for children who come from low-income families.

Coverage is hard to come by even if braces are medically necessary, even for children. Also, if youre looking to get Medicaid to pay for aesthetic braces you will be disappointed.

Will Medicaid Cover Braces For Adults

Medicaid is for the most part insurance for kids 21 and under. In recent years, it has expanded to cover low-income or indigent adults, the disabled and pregnant women. In the case of braces, however, its extremely uncommon that an adult will qualify.

In rare cases, Medicaid covers braces, such as when illnesses affect the jaw and neck and make repositioning the teeth necessary, like in cases of:

  • Temporomandibular joint disorders
  • Sleep apnea
  • Osteoporosis
  • Handicapping malocclusions

Again, the reason for braces must be medical. If Medicaid doesnt cover braces, private options like dental insurance, cash discounts and tax-exempt savings accounts can help.

If youre on Medicaid, chances are money is tight. The good news is that dental insurance isnt all that expensive. Unlike medical insurance, dental insurance is affordable. Considering that braces can cost anywhere from $3,000 to $7,000, if you have dental insurance your policy may cover as much as 25% of the cost, or in this case around $1,500. Its not free, but there are ways to save money.

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How To Apply For Medicaid

Because Medicaid is administered through the state and states determine eligibility, you will need to visit your states Medicaid office or website to apply. When applying you will need proof of income, residency, age, citizenship and/or immigration status for every member of your household.

Contact your state Medicaid office . Getting approved for Medicaid can take time, so start the application process as soon as there is a clear need. Most offices allow you to apply or at least start your request online. You may need to go into one of their offices for an interview as part of the application process. Have all your needed verification documents ready.

Medicaids Eligibility factors include income, residency, age, citizenship, immigration status, household composition, and pregnancy.

The exact verification documents you will need will vary based on what state you are in. However, be prepared to have any proof of income, proof of residency, your social security card, and immigration status confirmation documents on hand . Generally, household composition and pregnancy status do not require formal verification.

Does Medicaid Cover Braces For Adults & Kids In Your State

Common Orthodontic Question: Can Medicaid Cover Braces?

Does Medicaid cover braces? The answer is it depends on your age, the state where you live, and the reason you need to straighten your teeth.

This public benefit program provides essential but not comprehensive dental care in most states, and orthodontists work often falls into a gray area.

Adults hoping to have Medicaid pay for treatment will often strike out unless a covered accident or illness drives the need to reposition your teeth.

Meanwhile, low-income families with children can take advantage of orthodontic coverage more frequently because laxer standards often apply.

Each state establishes rules about which benefits to offer and what makes a patient eligible for reimbursement. Therefore, you ultimately need a local resource for the final answer.

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What Doesnt Medicaid Cover

Again braces are approved for medical reasons only. Some of the procedures with regard to orthodontics that Medicaid wont pay for include:

  • Treatment to correct crowded teeth.
  • Braces meant for aesthetic purposes.
  • If the patient has shown a lack of enthusiasm to maintain oral health and hygiene standards.
  • Medicaid wont also pay for premium orthodontic care options such as Invisalign for both kids and adults because Medicaid is a mass program that pays for the least expensive treatment option.

    Medicaid Dental Providers For Adults And Children

    According to the American Dental Association, 36% of lower-income Americans have lived through untreated cavities. Dentists that take Medicaid can be hard to find, in fact, only 38% of dentists in the US accept Medicaid.

    The low percentage of participation of Americans in Medicaid may be due to the facts that:

    • Many states make it very difficult for providers to become dentists that accept Medicaid
    • Those who can receive dental coverage from Medicaid in their state are unaware.

    If you need to find a dentist that takes Medicaid, Medicare or CHIP, you can go to Dentaquests Find a Dentist page and search by state.

    Another way to find a dentist that accepts Medicaid is simply by calling an office near you and asking.

    Also, youll most likely receive a booklet along with your Medicaid insurance information. Inside should be listed all of the Medicaid dental providers in your area.

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    What Do Moms Smiles Have To Do With Thriving Babies

    Sarah Vidrine

    Oral Health Policy Analyst

    Weve long understood the connection between a mothers health and her childs health. The science backs up what we can understand intuitively: a womans health during pregnancy has a huge impact on whether her baby will survive and thrive. More recently, researchers have helped us begin to understand that moms and babies health continue to be deeply intertwined throughout early childhood . While this may seem less intuitive, dental health is a key part of that picture.

    Oral health is key to overall health

    Oral health care and medical care have separate rules, separate educational institutions and trade associations, and separate care delivery systems. This historical separation between dentists and doctors does us all a disservice. The health of our mouths and teeth are integral to our overall health and well-being. Poor dental health is strongly associated with heart disease, diabetes, and other health problems.

    There is a severe shortage of dental care in particular in rural and low-wealth communities. This means that women and children of color in particular are more likely to suffer from a wide range of health outcomes that go way beyond tooth decay.

    Medicaid for Pregnant Women
    • Although most care is proven to be safe, some dentists are still reluctant to treat pregnant women, making it even harder to find care. And some women may be nervous about the impact of treatment on their pregnancy.

    What Is Medicaid For Pregnant Women

    Dental Insurance: Benefits, Costs, and Alternatives

    With Medicaid for pregnant women, you get full health care benefits during your pregnancy and for two months after your babys birth. Medicaid may also cover your medical bills for the three months before you enroll. You also get dental benefits during your pregnancy. Dental services are through the Smiles for Children program. For help finding a dentist or to learn more, call Smiles For Children at 1-888-912-3456. Also read the Guide to Dental Coverage.

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    Cms Learning Lab: Improving Oral Health Through Access

    The Center for Medicaid and CHIP Services at the Centers for Medicare & Medicaid Services is hosting a series of webinars to support States and their collaborative partners to improve access to dental services for children enrolled in Medicaid and CHIP. The webinar materials are available below. For more information about the CMS Oral Health Initiative and the CMS Learning Lab webinars, see the .

    Reducing Early Childhood Tooth Decay: Approaches in Medicaid May 27, 2015

    How To Know If Braces Are Medically Necessary

    You will need to have an orthodontist or dentist confirm if braces are medically necessary for your child. There are a number of considerations your dentist or orthodontist will need to review in order to deem braces as medically necessary. Some of which are:

    • Cleft palate
    • Structural jaw issues making it difficult to open your mouth
    • Issues with eating or chewing normally
    • Issues with speech impediments from tooth or jaw problems
    • Any extreme 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

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    Can I Get Braces With Medicaid

    The answer is yes! If braces are deemed medically necessary for your child, Medicaid can assist in getting them. Some orthodontists will offer a no-cost consultation to discuss your childs needs. This can be very convenient if youre looking into the cost of braces with Medicaid, CHIP, or TRICARE.

    Keep Reading to Get Answers to These Questions:

    • What is Medicaid and what does it cover?
    • How do I know if braces are medically necessary for my child?
    • What is the average cost of braces?
    • What are the most common kinds of braces?
    • Where can I find a no-cost consultation for braces?
    • Where can I find affordable payment options for braces?
    • Why should I choose a Kids-First dental office or orthodontics?

    Ready to schedule a no-cost consultation today? Find a Kool Smiles Kids Club partner dentist near you here. Or keep reading to learn more about braces and how you can find affordable treatment for your child.

    What If Treatment Is Not Medically Necessary

    Can I Use Medicaid to Pay For Invisalign?

    If your treatment is not deemed a medical necessity by Medicaid, you wont qualify for coverage. Braces for cosmetic reasons do not qualify. If you need braces but Medicaid wont pay for them, there are private options.

  • Dental insurance can be affordable and offers plans that cover braces. Insurance plans that include braces usually pay at a rate of 25% to 50%.
  • Going to an orthodontic school clinic for braces may sound harrowing at first, but in reality the students are already licensed dentists completing their orthodontic training. Getting your braces from an orthodontic school can save you a lot of money.
  • Working out a payment plan always makes good financial sense. Most dentists offer some type of payment plan to their customers. They are in the business of practicing good health, after all.
  • If youre short on cash but your credits okay, think about financing your braces. Many dentists do the financing themselves and require just 50% down.
  • Dental assistance programs help low-income families. Free clinics and charitable organizations often have programs. Never underestimate the power of good research.
  • Another thing to consider is whether or not you really even need braces. These days, alternatives like retainers, head gear, clear aligners and ceramic veneers can work well. At-home aligners are a cost-effective alternative to braces. Not only do you save on the materials, mail-order impression kits save you expensive office visits as well.

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    Services Unrelated To Pregnancy

    Medicaid sometimes expands coverage for services unrelated to pregnancy or treatments typically not addressed by healthcare plans.

    In these cases, the full-scope and CHIP pathways are more likely to provide these benefits. At the same time, the limited and emergency programs have restrictions with some notable exceptions.

  • Breast Pumps
  • What Does Medicaid Cover

    Medicaid is a social insurance program administered by state and federal governments designed to cover the basic healthcare needs of lower income families in America. This means that Medicaid helps people with low incomes cover their health care costs. But what does Medicaid cover for you? And are you eligible for Medicaid in your state?

    To qualify for Medicaid coverage, a person must make less than 133 percent of the federal poverty line, which is about $16,000 for an individual or about $32,000 for a family of four.

    In recent years, Medicaid enrollment has surged across the U.S. and now, along with the companion Childrens Health Insurance Program program, cover more than 74 million people.

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    Is It Ok To Have Dental Work While Pregnant

    Dental work while pregnant, such as cavity fillings and crowns, should be treated to reduce the chance of infection. If dental work is done during pregnancy, the second trimester is ideal. It is best to avoid this dental work while pregnant and avoid exposing the developing baby to any risks, even if they are minimal.

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    Pregnancy & Newborn Services

    Medicaid Orthodontics

    Start Smart for Your Baby is our special program for women who are pregnant and for those moms who just had a baby. We want to help you take care of yourself and your baby every step of the way. If you are pregnant, let us know. Call us at 1-800-704-1484 or submit a . After completing this form you will be enrolled in Start Smart. You will receive information in mail and over the phone. You can also get information in the .

    Tips for PregnancyIf you are pregnant or want to become pregnant, keep these things in mind:

    • Go before you show! Go to the doctor as soon as you think you are pregnant. It is important for you and your baby to see a doctor as early as possible. It will keep both of you healthy. It will also help your baby get off to a good start. It is even better to see a doctor before you are pregnant. This is so you can get your body ready for pregnancy.
    • Maintain healthy lifestyle habits. This includes exercising, eating balanced and healthy meals, and resting for 8-10 hours every night.
    • Do not use tobacco, alcohol or drugs now or while youre pregnant.

    Are You Pregnant? Tell Us Right Away!Call us at 1-800-704-1484 .

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