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Does Medicare Cover Dental Services? (And Other Questions about Orthodontic Insurance)

Western dental braces have been in existence for quite a while now, since ancient mummies have been dug up that showed them with crude metal bands wrapped around their teeth. However, it was only in the 1960’s when the use of stainless steel became an accepted practice. Since then, there have been quite a few advances in orthodontics, but questions like “Does Medicare cover dental services?” still persist because there aren’t really all that much media coverage about the topic.

does medicare cover dental

Scarcity of Orthodontic Dental Insurance

The problem is that while braces have become common, it’s still not as common as it should be in the US. That’s because of the general lack of orthodontics insurance. More than 130 million people in the US don’t have any dental insurance at all. And every dental insurance plan is insurance that covers braces.

So what happens is that many people are faced with two unpalatable choices. Either they pay for the expense of braces and other expensive orthodontic services themselves, or they make di and suffer the consequences of not availing of orthodontia at all.

Medicare, Medicaid, and Dental Insurance that Covers Braces

If it’s just a matter of the health of your teeth, then Medicare will not cover it at all. Dentists say that routine checkups and regular cleanings are essential to dental health, and Medicare won’t pay for those. It’s the same thing for orthodontic services. They are also not covered, for the most part.

Of course, there are exceptions, but these pertain only to the state of your general health:

is dental insurance worth it
  • Dental splints and wiring are covered if you need them because of your jaw surgery.
  • You need to have surgery to a jaw or facial fracture.
  • A facial tumor has been removed and it involves jaw reconstruction.
  • You have a condition that affects your jaw and dental services are needed for radiation treatment.
  • You get an oral examination as part of the heart valve replacement or kidney transplant.

That’s it. While a few Medicare Advantage plans may cover routine dental services, they don’t cover orthodontics.

The same principle applies to Medicaid as well. While the rules may be different in each state, the fact of the matter is that for orthodontics to be covered they must be recognized as necessary. Still you should always ask; some, for example, accept a small number of children under Medicaid. And in some states like California, orthodontic treatments may be covered when conditions like cleft deformity is involved.

Getting Dental Insurance that Covers Orthodontics

When it comes to dental insurance orthodontics is often a special case that’s categorized as a cosmetic treatment. So if you want to specifically reduce orthodontic costs, you may want to look for secondary dental insurance that specifically covers braces for your kids.

Here are some steps you need to take:

1.Review your current health and dental insurance plans. Check and see if you have some sort of coverage for braces and other orthodontic treatments. If the coverage is insignificant or non-existent, then you may want to consider another dental insurance plan.

2.Ask your dentist for some recommendations. They may give you specific options if you need to know what insurance covers braces. They may point you to great orthodontists, and then you can ask them as to which insurance plan you should take.

3.Insurance or Discount. Usually, your choices are either a straight up insurance plan or a discount, although with orthodontics you may often have to still pay part of the costs. With discounts, you get a certain percentage off from your orthodontic expenses, but you will also need an orthodontist that accepts the discount plan.

4.Review each possible insurance plan. You generate a list of possible options, and then you make your choice. You will need to consider premiums, the deductibles, the co-pays, and the excluded services from the insurance plan.

Factors for Consideration

So before you get another dental insurance plan, here are some factors to consider if you are looking for the best dental insurance for braces:

  • Is your employer offering dental insurance?

This is often the most advantageous deal for you, as it may not cost as much.

  • Does the insurance plan cover braces?

What else is covered? Most insurance plans cover the basics, such as regular cleanings, fluoride treatments, and X-rays. But what you need is a plan that specifically mentions braces.

  • Can you choose your own dentists?

It’s crucial that you feel comfortable and relaxed when you visit your dentist, and that’s not always the case with the particular dentists your insurance plan restricts you to use. If you have already picked your own dentists or orthodontist, then it may be worth it to restrict your insurance search for those which accommodate your choices.

  • Do you have to go with the cheapest treatment?

Some insurance plans will cover only the cheapest treatment for a dental condition, even though this may not be the best treatment option for you. The best insurance plans will give you a choir in the treatment you get.

  • How much will it cost you?

Obviously, the only way insurance makes sense is if your premiums cost less than what you will pay for braces later on.

Conclusion

Is dental insurance worth it? This is a very common question, especially these days when people are trying to cut down on unnecessary expenses. But dental health is crucial. It affects not just your physical health but your psychological well being as well. Having straight, good-looking teeth can affect both your work and your social life, and those areas need all the help you can get.

If you liked our article, please share it and use the comment section below to tell us about your experiences or ask any questions. Thanks!

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{ 4 comments… add one }
  • Emani

    Hello, I just need help with obtaining the best dental plan for me. Are there any programs or dental plans that may offer disabled individuals special offers and plans?? My dentist is with Western Dental in San Francisco, but I was told by the orthodontist that they don’t have the equipment to help me with my dental work ( I was consulting about braces). Any suggestions will be appreciated. FYI, I’m also a full-time college student, if that helps at all!

    Thank You

    • Susan

      Hi Emani!

      Thanks for asking, I’m sure many people are in a similar situation.

      Most dental plans are designed for a general person. Few plans are specifically designed for disabled people, as you requested. Generally, dental plans do not distinguish between disabilities because so few are going to affect having dental work in the mouth.

      There are some programs through Medicare/Medicaid that may help, but you would need to call your local administrator to find out if they have coverage in the local area. Nearly all disabled people are able to obtain some form of aid from either of these programs.

      As a college student, there are plans available through nearly all colleges for medical and dental. We recommend contacting your on-campus medical clinic to find out what options they have.

      If either option is not available, we recommend calling a medical insurance broker. These people are in contact with several insurance companies and can do the research required to find out about the special questions you have. They are also the best people to help you negotiate a better price.

      We’re hesitant to give you specific information on individual plans. Last year alone, there were over 2,000 changes to insurance and medical requirements. What is correct today may not be correct tomorrow. At least, if you call a broker, they have information in writing directly from the insurance companies.

  • teaira

    hi my name is teaira me and sister are getting braces in march but we have medicare we live in elkhart indiana how much would be the avg cost for braces

    • Hello Teaira!

      Your question is a typical question, but difficult to answer.

      Every dentist and a person receiving them are different. Typical costs are approximately $4,000.

      There are several factors that go into this cost: how long will the braces be worn, what level of tooth misalignment is occurring, what level of braces is required, how many dental visits are required per month, what is your insurance, what are the dentists fees, how well will the person take care of the braces, what will the aftercare be, and the list goes on.
      Some people have gotten away with $1,300 for simple braces for 6 months, while others can face years and nearly $10,000 with all the extra requirements. Here is a post that breaks down braces costs in more details.

      You also need to know what your insurance will pay for and what they will not. Many dentists will help with the bills that are not covered. There are also dental schools that provide much lower cost services.

      I recommend talking with your dentist about what your options are. This should be a free appointment, especially if the dentist knows the braces will help.

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