Does medical cover braces? This question is asked often by the parents of children who are in need of orthodontic treatment, but aren’t poor enough to qualify for free dental care through Medi-Cal. Unfortunately, the answer isn’t simple; it depends on a number of factors like your child’s age and type of braces you want to get, as well as where you live in California.
Yes, with certain limitations
If you have Medi-Cal dental coverage, you may be able to get your orthodontic treatment through Medi-Cal. With a few exceptions, does medical cover braces for adults over age 21 who have permanent teeth. Unfortunately, adults between 18 and 21 are not eligible. Depending on your circumstances, you may be able to start treatment at any time with a referral from your dentist or health care provider.
Orthodontic treatment for children under 21 is available only under certain conditions; if you fall into one of these categories—for example, if your child has a cleft palate—you will likely qualify for Medi-Cal services. Keep in mind that orthodontic services can include more than just braces; they can also include Invisalign® aligners, clear retainers and oral surgery (such as jaw realignment). Call us today to learn more about how we can help you access Medi-Cal dental benefits. Or, use our online estimator tool below!
No, it doesn’t cover all cases
Medi-Cal doesn’t cover all dental procedures. It does, however, cover some orthodontic treatment and maintenance. But even if your teeth need straightening, it won’t necessarily pay for braces to do it. There are two reasons for that: 1) Medi-Cal doesn’t want to replace private insurance; and 2) Medi-Cal can’t pay for treatments where there isn’t a clear medical necessity.
How much you’ll have to pay out of pocket
Medi-Cal dental coverage for adults is different from its coverage for children. Adults can have monthly premiums of $15, as long as they make less than 185 percent of California’s poverty level (around $22,000 per year). A sliding scale applies to those who earn between 185 and 300 percent of poverty level (between $33,000 and $47,000 a year). If you make more than 300 percent of poverty level ($48,800 or more), then you won’t be eligible for Medi-Cal at all. As far as out-of-pocket costs go, people with incomes below 150 percent of poverty level will pay no more than 10 percent of their income on co-pays and deductibles; those with incomes between 150 and 200 percent will pay up to 15 percent; those with incomes between 200 and 250 will pay up to 20 percent; and those with incomes above 250 will pay 25 percent.
How do I know if I need braces?
To know whether you need braces, your orthodontist can evaluate your smile by looking at what’s called a dental panoramic x-ray. This is a picture of all of your teeth from top to bottom, side to side, and front to back. You may also want to ask yourself these questions about your oral health: Do I have crooked or crowded teeth? Is my jaw out of proportion with my face and/or teeth? Do I bite down on both sides equally? If you answer yes to any of these questions, chances are good that you need orthodontic treatment, which could include braces. Only an experienced dentist or orthodontist can tell for sure. The American Association of Orthodontists recommends getting a professional opinion if you feel your teeth aren’t straight enough to look right in pictures or if they cause you pain when chewing certain foods.
Even if you don’t think you need braces, it never hurts to get a second opinion from another dentist or orthodontist. That way, you can make sure that your treatment plan will be as effective as possible. Remember: A lot of adults are choosing to wear clear aligners instead of traditional metal braces because they offer some benefits over traditional metal brackets and wires. Clear aligners do not require removal for eating and brushing like traditional metal braces do, so many people find them more convenient than traditional treatments. However, aligners are not always appropriate for everyone; talk to your doctor before deciding on a course of action.
What can I do about my bad teeth now?
If you’re looking for affordable dental care, Medi-Cal is a good place to start. But does medical cover braces for adults? Let’s find out. Here are some questions about adult dental coverage in Medi-Cal and their answers. The state of California does not include orthodontics as a covered benefit in its two main forms of insurance, Healthy Families and State Children’s Health Insurance Program (known as SCHIP). In other words, if you already have coverage through Healthy Families or SCHIP, orthodontic work probably won’t be covered (despite what ads from private insurers may say). However, most Californians who need orthodontia get how are braces put on.
What else does Medi-Cal cover?
Medi-Cal insurance covers thousands of dental procedures. Though Medi-Cal typically doesn’t cover orthodontic treatment, there are exceptions. In most cases, California dentists won’t start or continue with treatment if they know Medi-Cal isn’t going to cover it. Still, in some cases, If you have questions about whether or not you can get braces covered by Medi-cal, be sure to call your local dental office and ask them what their experience has been working with patients on Medi-cal in regards to orthodontic treatment.
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